Important considerations for breast reduction surgery

Female-to-male chest reduction surgery, also known as mastectomy for gender-affirming chest reconstruction, is a cosmetic procedure similar to the inverted-T mastopexy technique. This surgery involves the removal of breast tissue, glands, and excess skin.

However, like any surgery, it carries potential risks, such as bleeding, seroma formation, infection, tissue necrosis, loss of sensation or prolonged numbness, and hypertrophic scarring. Below are insights from Dr. Ho Cao Vu regarding common complications associated with female-to-male chest reduction surgery.

Hematoma

Hematoma can occur shortly after breast reduction surgery, often due to inadequate hemostasis during the procedure. If the bleeding is minimal, the body can reabsorb the blood naturally. However, significant bleeding can lead to hematoma formation.

The breast consists of skin, fat, glandular tissue, and stromal tissue, Within the stroma lies a complex network of arteries, veins, and lymphatics. The main arterial supply includes the lateral thoracic artery and the anterior and posterior intercostal perforators. These branches form a vascular plexus within the anterior fatty layer, making breast reduction surgeries prone to greater bleeding compared to standard breast augmentation procedures.

Hematoma presents with swelling, pain, and bruising, which can compromise blood flow, increasing the risk of infection and prolonged inflammation. This can affect the skin flap's viability, delay healing, and potentially cause breast deformities.

Female-to-male chest reduction surgery carries risks that need to be considered carefully. Photo courtesy of Dung Ho

Infection

Infection is one of the early complications following female-to-male chest masculinization surgery. It typically presents as localized inflammation and is often manageable with oral antibiotics. However, if an infection persists despite medication, surgical drainage or debridement of the infected area may be required.

Most postoperative infections occur between the third and seventh day after surgery, although some may appear later. Symptoms of infection include loss of appetite, altered taste, fever, pain at the surgical site, erythema, or swelling.

According to Dr. Vu, if any of these symptoms occur, early evaluation by a surgeon is advised. If the infection cannot be controlled with antibiotics, surgical intervention may be necessary to clean the infected area, debride infected tissue, and drain accumulated fluid.

Nipple-areola necrosis

Nipple-areola necrosis is a potential complication resulting from compromised blood supply, often due to excessive tissue damage around the nipple-areola complex caused by surgical excision or cauterization.

Loss of sensation

Loss of sensation in the breast and nipples is a common complication in surgeries involving incisions around the nipple-areola complex.

For individuals with smaller breasts and minimal glandular tissue, opting for preservative surgical techniques and careful incision placement may help reduce the risk of sensory loss.

For those with significant glandular tissue or aging skin, the risk of complications is higher. Using electrocautery for tissue resection at high temperatures can cause thermal damage, leading to reduced sensitivity, numbness, or complete loss of sensation in the nipple.

Unfavorable scarring

The aesthetics of scars depend on the surgeon's technique and experience in assessing skin elasticity the risk of scar formation. A well-planned surgical approach, combined with proper scar management before, during, and after surgery, helps minimize the risk of hypertrophic or contracture scars. Scarring is inevitable in breast reduction surgery, and its severity depends on the surgical method and postoperative care.

A necessary part of breast reduction surgery is comprehensive preoperative testing to rule out conditions such as coagulation disorders and hypertension, as well as discontinuing anticoagulants and certain herbal medications. Though rare, anesthesia can carry risks, including airway obstruction, cardiac arrhythmias, allergic reactions, brain injury, stroke, and even death.

To minimize surgical risks, it is recommended to undergo breast reduction at licensed hospitals, preferably multispecialty hospitals, that are approved by the Ministry of Health, ensuring safety and prompt medical intervention if complications arise.

Scarring is inevitable in breast reduction surgery, and its severity depends on the surgical technique, method, and postoperative care. Photo courtesy Dung Ho

Advantages of using Ultrasonic Scalpel

Dr. Vu highlights the benefits of the next-generation Ultrasonic Surgical Scalpel, which features an integrated chip to control coagulation, sealing, and cutting functions. This technology enhances surgical safety, especially in breast reduction procedures that require the excision of large amounts of glandular tissue and skin.

The ultrasonic scalpel offers several postoperative advantages, including a 90% reduction in pain, same-day discharge, no need for additional analgesics, faster and softer scar maturation compared to electrocautery, and a reduction in early and late complications. It uses high-frequency ultrasound waves to precisely dissect tissue, minimizing damage to surrounding healthy tissue, which helps shorten recovery time and reduce pain, particularly in female-to-male chest masculinization surgeries and breast reshaping for sagging breasts.

The next-generation Ultrasonic Surgical Scalpel enhances surgical safety, particularly in breast reduction procedures that require the excision of large volumes of glandular tissue and excess skin. Photo courtesy Dung Ho

Surgical procedure

The procedure begins with assessing the current condition of the breasts, including glandular tissue, soft tissue, any abnormal masses skin structure, and ribcage anatomy. The surgeon will design the incision and develop a plan for safe tissue resection. The nipple-areola complex may need to be repositioned, especially in cases of breast ptosis or significant glandular descent. significant glandular descent beyond the inframammary fold, accompanied by excessive skin laxity. Care is taken to avoid excessive excision of glandular and soft tissue, which could compromise vascular perfusion, increasing the risk of wound necrosis, nipple-areola complex ischemia, and hypertrophic scarring.

During the next step, tissue dissection and release, while simultaneously achieving hemostasis and blood control through coagulation and sealing, effectively minimizing postoperative serous fluid accumulation with high surgical precision is performed using an ultrasonic scalpel. This advanced technique minimizes thermal injury, accelerates wound healing, and reduces complications like serous effusion and hypertrophic scarring tissue necrosis.

The final step involves suturing to promote rapid healing and ensure optimal aesthetic results.