I wrote a post, Chest Wall Contouring in Female-to-Male Transsexuals, in December as I prepared to do my first such surgery. I was up front with him about him being my first FTM though not my first mastectomy.
Well, I had to perform a second procedure to correct the first. Here is what I learned from this experience:
1. A minimal scar is not worth having extra skin remain.
I opted for the first surgery to use a peri-areolar incision/scar feeling it would allow enough skin excision and leave less of a scar. The scar was smaller, but even after months to allow full contraction of the remaining skin turns out not enough skin excision.
The extended concentric circular scar looks good with a nice chest contour.
2. The inframammary crease must be fully obliterated.
I knew this from my reading. I thought I had done so. I recommend freeing up the skin from the chest wall a good 2 inches below the marked crease to ensure it’s destruction.
3. Use drains.
No matter how well you think you have controlled the hemostasis.
I am happy with the results after the revision. The patient is too if his smile and statement are any indication -- “I can now look at my chest without revulsion.”