Mastectomy

Preparation during direct consultation and surgery.

During direct consultation with our surgeon – the surgeon will evaluate your general health status and any pre-existing health conditions or risk factors such as examine your breasts and take measurements of their size and shape, skin quality and placement of nipples and areolas, take photographs, discuss your options and recommend a course of treatment and discuss likely outcomes of top surgery and any risks or potential complications

Preparation for Mastectomy

• Inform us about any allergies, any serious medical condition(s), and all medications you are taking (both prescription and non-prescription). 
• No Aspirin 2 days before surgery.
• Stop vitamin E Oil 1 day before surgery.
• Stop smoking 2 days and a month after surgery.
• Tell doctor if you have any serious medical condition(s). 
• Stop meal and water starting from midnight before surgery.
• Plan to be in Thailand at least 7 days after surgery.
• Mastectomy/Top surgery doesn’t require psychiatrist or Testosterone approval letter.
• Age 18 years+.
• Not require testosterone / psychiatrist letter by Mastectomy
• An extra charge is 50% from cost of surgery fee, if HIV+
  

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Surgery Schedule (required 10 days after surgery in Thailand)

Day 0 - Arrival date (check in hotel)

Day 1 - Consultation and Prepare for Laboratory Testing

Day 2 to 3 - Surgery and one night in hospital private room after surgery

Day 3 - Discharge from Hospital
Day 3 to Day 7 - Stay in hotel for recovery period and follow up by doctor appointments

Day 7 - Stitches removal and final checkup (5 days, after surgery)
Day 9 or day 10 - Safe to fly

Things should bring from home.

• Button-up shirts in large sizes
• Slip-on shoes or slippers
• Phone charger, long phone charger
• Books, magazines
• Travel neck pillow

During direct consultation with our surgeon – the surgeon will evaluate your general health status and any pre-existing health conditions or risk factors such as examine your breasts and take measurements of their size and shape, skin quality and placement of nipples and areolas, take photographs, discuss your options and recommend a course of treatment and discuss likely outcomes of top surgery and any risks or potential complications. FtM mastectomy also includes preserving as much sensation as possible and trying to minimize scaring. 

Trans men with smaller breasts, a peri-areolar or “keyhole” procedure may be done where the mastectomy is performed through an incision made around the areola. This avoids the larger scars of a traditional mastectomy.

With moderate to large breast tissues are usually required double incision with nipple graft. Two tiny horizontal incisions are located under chest line. Reconstruction of nipple grafts including areolas allow resizing of the nipple and placement in a typically male position.

By opinion technique, there are three possible techniques that can be used in Mastectomy (Breast Removal). This is depend upon the size of breast, elasticity of skin and your preferences:

• Keyhole – Best for small breasts (A or small B cup) with good skin elasticity. Incision/scar – Along bottom border of areola. How’s done – Breast tissue is removed via a small incision across or under the areola. Nipples – Not resized or re-position.  But can be perform as nipple reduction surgery.
• Drawstring/ Pursestring – Moderate size breast (B or C cup), with good skin elasticity. Incision/scar – Circle around the edge of the areola. How it’s done – Breast tissue is removed via an incision around the edge of the areola.  A ring of skin is then removed in a wider circle around the areolar incision and the skin is pulled toward the centre of the opening and stitched to the edge of the areola. Nipples – Areola may be trimmed to reduce its size.  It may be possible to slightly reposition the nipple.  But preserve sensation.
• With free nipple graft (Double incision) – Large saggy breasts or inelastic skin. Incision/ scar – Horizontal or U-shaped cuts across each breast, usually just below the nipple.  The aim is to place the incision just under the line of the pectoral muscles so it is not highly visible. How it’s work – The skin is peeled back and the breast tissue and excess fatty tissue are removed.  The excess chest skin is then trimmed and the incisions closed. Nipples – Removed, trimmed to smaller size, and grafted onto the chest to approximate positioning of “male” nipple.

Summary

Step 1: General Anesthesia - Medications are administered for your comfort during the surgical procedure.

Step 2: Mastectomy to remove the breast tissue - A mastectomy will remove the breast tissue present on your chest. Sometimes, excess skin will need to be removed as well.

Step 3: Creating a masculine shape and any excess skin is removed, the remaining tissues must be repositioned to create a masculine contour to the chest.

Step 4: Repositioning the nipple and areola as sometimes the nipple and the areola need to be reduced and/or repositioned on the chest after the mastectomy is performed. The nipple and areola tend to be smaller and lie slightly more lateral and inferior on the male chest.

Postoperative Top Surgery Recovery

After Top surgery, there is some soreness and discomfort which is easily controlled by medication. Following top surgery, gauze or bandages will be applied to your incisions. An elastic bandage will minimize swelling and support the reconstructed chest. A small thin tube may be temporarily placed under the skin to drain any excess blood or fluid.

Dr.Preecha, Dr.Burin and Dr.Sutin will given specific instructions that may include: How to care following surgery, medications to apply or take orally to aid healing and reduce the risk of infection and when to follow up with your plastic surgeon.

There is some soreness and discomfort which is easily controlled by medication. Swelling and skin discoloration around the incisions generally will subside in a few days after surgery. This may be a temporary loss of sensation in the nipples and breast skin. This condition will improve with time. Sutures will be removed within seven days of surgery.

Scars remain highly visible for 8 month or up to a year following surgery, then fade.
Since no two breasts are the same size and shape before surgery, usually a slight variation will exist after surgery.

Everyone will recover from mastectomy surgery differently. But commonly are

• Discomfort and pain will be most prevalent in the 3  to  4 days following surgery. This is normal.
• Sleep on your back for at least the first week after surgery.
• Swelling and bruising will decrease in the first 2 – 3 weeks but may take longer for some people. This is normal.
• To help the healing process you need to rest, eat healthily, refrain from smoking and drinking, and listen to your body.
• To shower the lower part of your body, but only if you can avoid getting your bandages wet. Baby wipes and sponge baths are two of the easiest ways to clean the top of your body.
• Not to lift your hands above your head for at least 2 to 3 weeks after surgery.
• After 6 or 8 weeks, you can typically resume physical exercise such as sports, lifting, and running.

Nipple graft technique Top surgery Post - Initial Healing Phase during week one and two

• Dressings & Bandages
  Typically left in place for several days post-op.
• Follow your surgeon’s specific instructions about when and how to change them (if at all).

Drains

• Surgical drains may be placed to prevent fluid buildup.
• Most are removed within one day or depending on output volume.

Pain & Discomfort

• Common symptoms: Pain, swelling, tightness, numbness.
• You’ll likely be prescribed pain medication - take as directed.
• Swelling and tightness will gradually improve; numbness may last longer.
• Grafts may appear dark, scabbed, or even “dead” in early days. This is often normal.
• Do not pick at scabs or touch the area unnecessarily.
• Your surgeon may have placed bolsters (protective padding) over the grafts. These will be removed during a follow-up.
• Initial appearance does not always indicate failure such as color and healing often improve with time.

Weeks 2 - 6 (Healing & Monitoring):

• Activity Restrictions: No lifting, stretching, or strenuous activity.
• Graft Care: You may be instructed to keep the graft area clean and dry. Sometimes, a bolster dressing (protective sponge or mesh) is used over the graft for the first week to hold it in place.
• Follow-up Visits: Frequent check-ups to monitor the graft’s viability. 
• Your surgeon will schedule a post-op checkup, typically within 1 week.
• Stitches require to removal on day 7.

6+ Weeks (Ongoing Recovery):

• Appearance: The nipple graft color improves over weeks to months. It may flatten slightly compared to natural nipples.
• Sensation: Most patients lose full sensation in the nipple and breast skin. Some partial return may happen over months but is not guaranteed.
• Scarring: Scars mature over 6 - 12 months and can be minimized with proper wound care and scar treatments.

Once the grafted nipple heals and settles (usually 6 - 12 months), 3D areola tattooing can improve the appearance by adding color and dimension, especially if pigmentation is lost or if only a nipple mound was created without natural coloring.

Keyhole technique Top surgery Post - Op cares (1-2 weeks)

Dressings & Compression

• Dressings: Sterile dressings may be placed over incisions.
• Compression Binder: Typically worn 24 / 7 (except while showering) for the first 1 - 2 weeks. Reduces swelling, supports healing and helps contour the chest and follow your surgeon’s specific guidance on duration and fit.

Drains

• If used, they’re usually removed within a day.

Showering

• Usually allowed after 3 - 5 days, depending on your surgeon’s instructions.
• Avoid soaking in baths, pools, or hot tubs until fully healed.
• Pat incisions dry—do not rub.

Pain, Swelling & Sensations

• Pain: Mild to moderate, managed with prescribed or over-the-counter pain relievers.
• Swelling & Bruising: Common, especially during the first week.
• Numbness or Tingling: May occur around the incision area - often temporary.
• Itching: Can occur as incisions heal.

Activity & Movement

• Rest is critical during the first few days.
• Avoid lifting anything over 5 - 10 lbs for at least 2 weeks.
• No strenuous activity, upper body workouts or stretching arms above shoulder height.
• Short, gentle walks are encouraged to promote circulation.

Follow-Up Appointments

• Your surgeon will schedule a post-op checkup, typically within 1 week.
• Stitches require to removal on day 7.

Recovery Timeline Mastectomy

• The day after surgery before discharge hospital. PAI doctor team will visit you
• Removing Incisions will appointment within 7 days after surgery
• No heavy exercise 4 weeks after surgery

The decision on when to return to work and normal activities depends on how fast you heal and how you feel.

Surgery Schedule (required at least 10 days after surgery in Thailand)

 Day 1 - Consultation and Prepare for Laboratory Testing

Day 2 to Day 3 - Surgery and one night in hospital private room after surgery

Day 3 - Discharge from Hospital
Day 3 to Day 6 - Stay in hotel for recovery period and follow up on doctor appointment

Day 7 to Day 9 - Stitches removal and final checkup (Five to seven days after surgery date)
Day 10 - Safe to fly

For local’s patient - You may resume to work after ten days surgery but must avoid heavy lifting object over the head or fast movement during four weeks after surgery date. Stitches are remove five to seven days after surgery date.

For international patient - Please plan to be in Bangkok at least ten days all together. Stitches will remove five to seven days after surgery date. You may resume to work within a few days but must avoid heavy lifting object over the head or fast movement during four weeks after surgery date.

◊ Any bruising and swelling will usually dissipate within 3 to 6 months after mastectomy surgery.