Mastectomy/Breast masculinization

What is Mastectomy/Breast masculinization?

One of the most commonly requested female-to-male surgical correction is breast masculinization. The techniques developed for this purpose are much different than the ones used for breast reduction and under no circumstances should a breast reduction be performed instead of a breast masculinization. Although the breast may show some significant atrophy after hormonal treatment, surgical correction cannot be avoided, due to skin and nipple abundance. Depending on the size of the breasts and laxity of the skin, different techniques can be selected. As a general rule, the smaller the breast, the smaller the scars and more pleasing the result. As suggested from a big study from Dr. Stan Monstrey, an algorithm can be applied to select the right procedure for the right size of breast.
1. Small breasts: In cases of very small, pubertal breasts, they can be treated as a gynecomastia in men. The procedure is performed through a small semi-circular incision beneath the nipple, the gland is removed, and additional liposuction can be performed to further improve the appearance of the breasts.
2. Medium sized breasts: Similar to smaller breasts, the subcutaneous mastectomy is performed through a small incision below the nipple, however the areola of the nipple is reduced and excess skin around the nipple removed. Skin tightening can either be performed in a circular manner around the nipple, or by extending bilaterally to the nipple. Scars are minimal and are usually well-hidden underneath the hair from hormonal therapy.
3. Large breasts: In larger breasts, a different surgical technique is necessary, in order to address the excess skin. The mastectomy is performed though a horizontal, slightly tilted and curved incision, which is placed exactly at the lower pectoral muscle border. A crucial step during this procedure is the complete destruction of the strong connective tissue of the submammary fold. Handling of the nipple can differ. We prefer to maintain blood supply and innervation of the nipple as a flap, rather than reallocating the nipple as a graft. In our experience, nipple grafts tend to shrink, discolor and become irregular, while nipple flaps are more stable and offer the advantage of some sensation.


Breast masculinization is performed under general anesthesia and requires 1-2 days hospitalization. Vacuum drains are placed for 2-5 days and an elastic garment is used for 6 weeks. The final result is evaluated after 6 months and some additional scar treatment can be performed at that time, such as lasers, tattoos etc. This procedure is often combined with a hysterectomy, which is performed simultaneously from our partner obstetrician.