Background and objective.

Masculinizing chest surgery, or top surgery, is one of the main surgical treatments in the gender transition from female to male.

This review aims to describe the mastectomy techniques in transgender patients with mammary hypertrophy and assess the advantages and disadvantages of each one.

Methods.

A narrative review was conducted through a search on Pub-Med, Google Scholar, and SciELO using the keywords: gender identity, hypertrophy, mastectomy, transgender persons, in Spanish, English, and Portuguese. Only articles that included masculinization of the chest in patients with mammary hypertrophy were selected for analysis.

Results.

The primary technique mentioned was the double transverse incision with the use of nipple-areola-complex (NAC) graft, which allows a wide operative field, treatment of the submammary groove, precise repositioning of the NAC, and, in its variants, the treatment of lateral skin redundancy. Another option for skin resection is the Wise pattern, which results in an inverted T-shaped scar difficult to conceal. Treating the NAC through grafting it is preferred to achieve a flatter chest compared to treatment with a pedicled NAC. Patient satisfaction was not standardized, making it difficult to compare outcomes.

Conclusions.

Although we did not identify an ideal technique universally applicable, we were able to synthesize the advantages and disadvantages of each technique providing a guiding framework in decision-making.

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