What are the different types of procedures for chest masculinization offered by Dr. Silverman?

• Keyhole: an incision is made along the bottom of the areola (from the 3 o’clock to 9 o’clock position if looking at a clock). The breast tissue is removed from this incision. Silverman will offer this procedure to patients with small breasts and small areolas.

• Peri areolar (concentric circle, purse-string): an incision is made around the border of the areola (if the size of the areola needs to be reduced then the incision is made within the areola) and a second larger circular incision is made. The intervening skin is removed and the breast tissue is removed. A "purse-string" technique is performed and the resulting incision is around the areola. Dr. Silverman will offer this procedure to patients with small breasts and good skin elasticity.

• Button-hole: the nipple-areola complex is maintained on a thin dermal pedicle. This preserves blood supply and some of the nerve fibers. Then two horizontal incisions are made and the breast tissue and redundant breast skin are removed. The two incisions are closed to each other and the resulting incision is above where the previous inframammary fold was located. Based on measurements a circular incision is then made at the location for the areola. The nipple-areola complex is then pulled thru this new location. Dr. Silverman will offer this procedure to patients with medium to large breasts.

• Double incision (free NAC graft): the nipple-areola complex is excised from the breast skin in what is called a free nipple-areola graft. Then two horizontal incisions are made and the breast tissue and redundant breast skin are removed. The two incisions are closed to each other and the resulting incision is above where the previous inframammary fold was located. Based on measurements a circular incision is then made at the location for the areola and the top layer of skin is excised. The free nipple-areola graft is then secured to this new location. Silverman will offer this procedure to patients with large ptotic breasts.

Why should I have a chest masculinization procedure?

Chest contouring is the most common gender-confirming surgical procedure individuals undergo. This will establish a more male-appearing chest and remove the stigmata of the female chest.

Will my insurance cover a chest masculinization procedure?

Typically, insurance companies will cover these procedures. Patients may need to meet certain requirements specific to their insurance company prior to authorization of the procedure.

What are my restrictions after the procedure?

Each patient will have a drain under the skin on each side of the chest. This will be in place for approximately 7-10 days. The patient will be wrapped with an Ace wrap after the surgery. Dr. Silverman recommends no heavy lifting for three weeks. Scar management will be discussed during post-operative appointments.

If you have any questions, don't hesitate to call New Beginnings Plastic & Reconstructive Surgery at (845-454-6392)