Journal
AESTHETIC SURGERY JOURNAL
Volume 39, Issue 2, Pages 150-163Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/asj/sjy098
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There is an increased demand for gender affirmation surgery. Chest contouring, or top surgery, is especially important in the female-to-male (FtM) transgender population. This Continuing Medical Education (CME) article critically appraises the available literature on top surgery to allow plastic surgeons to understand current practices and determine the best surgical technique using a decision algorithm and the patient's preoperative anatomy and characteristics. Because a single best surgical approach does not exist due to significant variance in preoperative patient anatomy, and in order to provide a useful framework for decision making, surgical approaches described are categorized as: approach 1remote incision procedures without skin excision; approach 2procedures with periareolar skin excision; and approach 3mastectomy procedures with skin excision other than periareolar skin excision. Decision algorithms that help determine the most suitable surgical technique for individual patients are reviewed. Data on complication rates and patient satisfaction will improve informed consent discussions and create realistic patient expectations.
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