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After Care of Female to Male Sex Reassignment Surgery (FTM SRS)
First Stage: Mastectomy
Mastectomy – A surgical procedure where the female breasts are removed and the chest is re-shaped into that of the male form and structure. Two different surgical techniques may be used depending on the size of the patient’s breast (amount of breast tissue) to be removed, which are as follows:
| 1.1 |
For small breasts a peri-areolar incision is preferred. The breast tissue is removed through either a cut inside the areola or around it. The skin around the breast will contract itself to have the flat chest. |
| 1.2 |
For bigger breasts or sagging breasts where the nipples are at a lower level than that in the males, the breast tissue and excess skin are removed, as well as the nipple with the areola, and re-located at a more appropriate position. As a final result the patient may have the T shaped scar on the chest. |
The incision wounds from either of these two techniques will heal and look good in time.
Information on the Post-operative Care (Mastectomy) of the Patient
| 1 |
After this surgical procedure (mastectomy), the excess blood and lymphatic fluid will be drained through a tube inserted into the breasts, to prevent clotting of excess blood that may accumulate inside the breast tissue, causing excessive swelling of the post-operative breasts. As soon as the amount of discharges from these drains is noted to be minimal, the surgeon removes these tubes. The sutures are usually removed before the patient is discharged. However, if the patient wants to be discharged earlier, and the wound around the nipple and areola are not completely healed, the sutures may be removed later than. |
| 2. |
After removing the sutures, the surgeon applies a thick bandage dressing over the surgical wound to promote fast healing and prevent wound from gaping. After discharge, if there is oozing of pus or blood from the surgical wounds, the patient should make an appointment with the doctor for re-evaluation and dressing of the wounds on both breasts. |
| 3. |
After the wound heals completely, usually in two weeks, the patient usually is allowed to take a bath. When taking a bath, the patient should not rub around the wound area as this may traumatize it or cause gaping of the wound. |
| 4. |
After mastectomy, the wound areas may be swollen because the breast wall is not completely adherent to the pectoral muscle (chest muscle). With the correct technique of applying the elastic bandage over the chest, swelling of the breasts may be prevented. |
| 5. |
Loss of sensation or numbness may be felt on the breast area which may persist for several months but which will gradually normalize. The patient must be warned when applying hot compress to both breasts as instructed during the later post-operative period to take extra precaution when doing so, as the transient numbness may prevent the patient from detecting if the compress is too hot thereby causing some burn injuries. |
| 6. |
Normally, the scar will swell for the first three months after surgery because of the relatively gradual healing time. However, if the patient notes some abnormal and prolonged swelling, it is recommended that they be covered with silicone gel sheet for about three months. If after three months have passed with the silicone gel sheet covering the sear and swelling is still is still notable, the patient is advised to schedule an appointment with the doctor for re-evaluation and possible treatment with Triamcinilone Acetonide injection, the drug of choice for this condition. |
| 7. |
Post-operatively, the original nipples may look bigger than those in the males. Because of this, corrective surgery may be done 6 months after the mastectomy, when all the surgical wounds have completely healed. Also, breasts that are not so well contoured may be corrected through liposuction and lipofilling.. |
Information on the Post-operative Wound Care of the Patient ( Inverted “T” Procedure and Reconstruction of Nipple-Areola)
| 1. |
After undergoing mastectomy, tubes will be inerted on each breast for 3 -5 days, to drain excess blood and lymphatic fluid, preventing blood clot formation and excessive swelling of the breasts upon which the draining tubes will be removed. Proper application of an elastic bandage around the patient’s chest will also help control excessive swelling of the breasts. The proper drainage of wound discharges and proper application of the elastic bandage will also help prevent re-construction and/or re-location of the nipple and areola. Stitch removal is usually scheduled about 7-10 days after the surgery. |
| 2. |
After the stitches have been removed, plaster is applied on the wound to promote healing and prevent wound dehiscence. Pulling of the wound when removing stitches is to be avoided. Two weeks after the stitches are removed, the wound will be completely healed and the plaster may be removed and the wound may be rinsed and cleaned. In cases of slow healing wounds, the patient must wait for another 1-2 weeks before the plaster may be removed. After the follow-up appointment, the doctor will decide when the plaster may be removed, depending on his evaluation of the status of the wound. |
| 3. |
Generally, the area of the wound around the re-constructed nipple and areola has a slower healing time with this technique compared to that using the other type of surgical technique. After the reconstruction surgery is done, the patient should avoid wetting and touching the area. Also, the reconstructed nipple and areola must be covered with plaster with the right tightness and firmness. There is no need to change or remove the plaster before coming for the follow-up appointment, unless the plaster becomes wet with bloody or lymphatic discharges, in which case the patient should seek an appointment with the doctor for re-evaluation and dressing of the wound. |
| 4. |
The reconstructed nipple and areola may appear to be dark in color for around a month. After complete wound healing has occurred, the epidermis is normally shed off and is replaced by the new pinkish epidermis. If the wound remains swollen and oozing even up to this time, the patient should seek appointment with the doctor for re-evaluation and further recommendations. |
| 5. |
Initially, the scar will usually look stiff and reddish, as part of the healing process. If the scar remains longer in this condition, it is possible that keloid formation may set in, the treatment of which would be long-term i.e. injecting solution to dissolve the keloid. Keloid formation may also be prevented by applying silicone gel on the wound. The recommendation is to use the silicone gel a month after the wound is completely healed. |
| 6. |
Normally, the sear will swell for the first three months after surgery because of the relatively gradual healing time. However, if the patient notes some abnormal and prolonged swelling, it is recommended that they be covered with silicone gel sheet for about three months. If after three months have passed with the silicone gel sheet covering the sear and swelling is still is still notable, the patient is advised to schedule an appointment with the doctor for re-evaluation and possible treatment with Triamcinilone Acetonide injection, the drug of choice for this condition. |
| 7. |
Corrective surgery for clients unsatisfied with their breasts or have other related complains, will be re-evaluated by the doctor 6-12 months after the surgery, when optimum healing has occurred and enough time for observation has been given for the client to decide if whether or not she is satisfied or otherwise. In the mean time the doctor provides the patient special instructions and will keep the communication lines open for whatever problems the patient may have during the 6-12 month observation time. |
If there are any other further concerns or questions please feel free to clear these up with our surgeon or nurse, in order to achieve optimal surgical outcome.
PLASTIC AND RECONSTRUCTIVE SURGERY DEPARTMENT
Yanhee International Hospital |
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