Surgical Masculinization of the Breast: Clinical Classification and Surgical Procedures.
BACKGROUND
Aesthetic breast area improvements for gynecomastia and gender dysphoria patients who seek a more masculine appearance have increased recently. We present our clinical experience in breast masculinization and a classification for these patients.


METHODS
From July 2003 to May 2014, 68 patients seeking a more masculine thorax underwent surgery. They were divided into five groups depending on three factors: excess fatty tissue, breast tissue, and skin. A specific surgical treatment was assigned according to each group. The surgical treatments included thoracic liposuction, subcutaneous mastectomy, periareolar skin resection in one or two stages, and mastectomy with a nipple areola complex graft. The evaluation was performed 6 months after surgery to determine the degree of satisfaction and presence of complications.


RESULTS
Surgery was performed on a total of 68 patients, 45 male and 22 female, with ages ranging from 18 to 49 years, and an average age of 33 years. Liposuction alone was performed on five patients; subcutaneous mastectomy was performed on eight patients; subcutaneous mastectomy combined with liposuction was performed on 27 patients; periareolar skin resection was performed on 11 patients; and mastectomy with NAC free grafts was performed on 16 patients. The surgical procedure satisfied 94% of the patients, with very few complications.


CONCLUSIONS
All patients who wish to obtain a masculine breast shape should be treated with only one objective regardless patient's gender: to obtain a masculine thorax. We recommend a simple mammary gland classification for determining the best surgical treatment for these patients LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Division of Plastic Surgery, INNOVARE Cirugia Plástica Especializada. Jalisco Institute of Reconstructive Surgery "Dr. José Guerrerosantos", Zapopan, Jalisco, Mexico. drlazaro@drlazarocardenas.com.
Lazaro
http://orcid.org/0000-0002-4071-8389
L
Cardenas-Camarena
Division of Plastic Surgery, Jalisco Institute of Reconstructive Surgery "Dr. José Guerrerosantos", Guadalajara, Jalisco, Mexico.
Carlos
C
Dorado
Private Practice at INNOVARE, Cirugía Plástica Especializada, Zapopan, 45019, Jalisco, Mexico.
Maria Teresa
MT
Guerrero
Division of Plastic Surgery, Jalisco Institute of Reconstructive Surgery "Dr. José Guerrerosantos", Guadalajara, Jalisco, Mexico.
Rosa
R
Nava
D000293:Adolescent; D000328:Adult; D001828:Body Image; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D006177:Gynecomastia / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D015187:Lipectomy / Q000379:methods*; D008297:Male; D016462:Mammaplasty / Q000145:classification / Q000379:methods*; D057228:Masculinity; D015414:Mastectomy, Subcutaneous / Q000379:methods*; D008875:Middle Aged; D010781:Photography; D012189:Retrospective Studies; D018570:Risk Assessment; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult
Breast masculinization; Gynecomastia; Male breast surgical treatment