Flying brevet: a technique for mastectomy in female-to-male gender reassignment

Abstract

Background: Several techniques are described for chest wall contouring in female-to-male (FTM) transgender patients, each with specific applications and limitations. Factors to consider are the aesthetic requirements of the male chest, elimination of anatomical female breast features, operative technique, scar minimisation and success of outcome. We describe the ‘flying brevet’ technique, named for the pattern of excised skin that resembles pilot’s wings. This procedure is tailored to FTM patients but can also be used for large gynaecomastia patients. We present a description of the technique with a retrospective review of outcomes and case series of patients who have undergone this procedure.
 Methodology: This is a retrospective review of a single surgeon experience with 113 consecutive patients who have undergone the flying brevet technique. The approach involves a semicircular areolar incision, with superior skin resection and glandular resection. A planned second stage procedure may be performed for larger breasts if required.
 Results: Seven per cent incidence of postoperative haematoma, one case of fat necrosis, one case of partial nipple-areolar-complex (NAC) necrosis and one case of full NAC necrosis in the series. There was one postoperative infection and six per cent incidence of hypertrophic scarring.
 Conclusions: The flying brevet provides a consistent method of mastectomy for FTM chest wall reconstruction. It permits large glandular and skin resection in ptotic breasts with preservation of NAC circulation. The flying brevet is an additional technique that can be added to the current options for mastectomy in FTM chest wall reconstruction.