- Surgeries, Men, Breasts
Masculinizing Mastectomy
- November 30, 2022
- By Fernando Amato
What is masculinizing mastectomy?
Masculinizing mastectomy is a surgery performed on transgender or non-binary individuals who wish to remove their breasts and construct masculine nipples. This surgery is an option for individuals who wish to align with their gender and feel more comfortable with their body.
The surgery is performed by a specialized plastic surgeon and is usually done in a hospital setting. The surgery involves removing breast tissue and reconstructing masculine nipples. In some cases, it may be necessary to perform liposuction to adjust the chest contour.
Post-operative recovery can be a challenging process, with pain and swelling in the first few days and weeks. Recovery time varies from person to person and depends on the size and complexity of the surgery. It is important to follow the surgeon's instructions and avoid intense physical activities during the recovery period.
It is important to emphasize that surgery is not the only option for transgender or non-binary individuals, and it is crucial to discuss all options and choose the one that is most suitable for each individual. Furthermore, psychological support before and after surgery is important, as this is a very personal decision and can have significant emotional impacts.
In summary, masculinizing mastectomy is a surgery performed on transgender or non-binary individuals who wish to remove their breasts and construct masculine nipples. The surgery is performed by a specialized plastic surgeon, but psychological support before and after surgery is important, as this is a very personal decision and can have significant emotional impacts.
Is masculinizing mastectomy covered by insurance?
Yes, according to the National Health Agency (ANS), coverage is mandatory if it complies with the rules established by the Federal Council of Medicine (CFM), which basically states: for patients over 18 years of age, who have previously undergone at least one year of follow-up by a multidisciplinary and interdisciplinary team.
How is masculinizing mastectomy performed?
It is a surgery in which all breast tissue is removed from both sides, with repositioning of the areolar complex (nipple), which can be done through a flap or skin graft.
Is masculinizing mastectomy the same as mastectomy for breast cancer?
Although breast glandular tissue is removed in both cases, and similar techniques can be used, these are surgeries with different objectives. In the case of breast cancer surgery, the procedure is more aggressive and may involve lymph node removal. In masculinizing mastectomy, the resection is limited to best define the body contour, and may be associated with liposuction.
Is masculinizing mastectomy performed by SUS?
Yes, it is a procedure performed by the Unified Health System (SUS) in specialized centers.
What does the CFM say about masculinizing mastectomy and the treatment of gender incongruence?
CFM Resolution nº 2,265/2019 provides for broader access to care for this population in the public health system and establishes criteria for greater safety in carrying out procedures with hormone therapy and sex reassignment surgeries
With the concern to collaborate with the improvement of health care for people with gender incongruence, the Federal Council of Medicine (CFM) updated parameters for the care of this population in the country. The points are contained in Resolution nº 2,265/2019, published in the edition of the Official Gazette (DOU) this Thursday (9). The text approved by the CFM Plenary resulted from a long process of discussion and analysis, concluded after more than two years. In addition to ethical and legal aspects, different clinical studies on the subject were analyzed in an attempt to formulate a modern document anchored in solid technical criteria.
According to Resolution nº 2,265, comprehensive health care for transgender people must address all their needs, ensuring their access, without any type of discrimination, to services at the primary, specialized, and urgent/emergency care levels. The text also establishes that medical assistance for transgender people must promote comprehensive and specialized care in the stages of reception, outpatient follow-up, hormone therapy, and clinical, surgical, and post-surgical procedures.
Although it takes into account aspects already provided for by the National Policy for Comprehensive Health of Lesbians, Gays, Bisexuals, Transvestites and Transsexuals (GM/MS Ordinance nº 2,836/11) and by the criteria for carrying out the Transsexualizing Process in SUS (GM/MS Ordinance nº 2,803/13), both prepared within the scope of the Ministry of Health, it is expected that the CFM Resolution will contribute to the qualification of care for people with gender incongruence, expanding the scope of services to which this group will have access in the public network.
Gender – Gender incongruence occurs when an individual does not identify with the sex assigned at birth. Transsexual/transgender men are those born female, but who identify as male. A transsexual/transgender woman, on the other hand, is one born male, but who identifies as female. A transvestite is a person who identifies and presents as the opposite gender, but accepts their genitalia.
Gender affirmation is the multidisciplinary therapeutic procedure that, through hormone therapy and/or surgeries, allows the person to adapt their body to their gender identity. According to the text published in the DOU, a person with gender incongruence will be incorporated into an assistance flow, which will indicate the best approach and the necessary procedures for each case.
The CFM norm clarifies that this team should include a psychiatrist, endocrinologist, gynecologist, urologist, and plastic surgeon, without prejudice to other medical specialties that meet the needs of each case, as well as other health professionals necessary for the individual's demands. In situations where the patient is under 18 years old, the presence of a pediatrician on the team will be required.
The Resolution also states that medical care must include comprehensive anamnesis, physical and psychological examination, as well as identification of the patient by their social and registered name, including their gender identity and sex at birth. Depending on age, the suggested actions should involve parents or legal guardians of children or adolescents. For this group, assistance must be articulated with schools and also with reception institutions.
Criteria – The debate that led to the formulation of the text was broad and exhaustive. In addition to the CFM plenary, representatives from the Ministry of Health, the Federal Council of Psychology (CFP), the Federal Council of Social Work (CFESS), and different medical specialty societies that interface with the topic, such as psychiatry, endocrinology, plastic surgery, urology, and pediatrics, contributed to the process. Leaders of organized social movements dedicated to the subject, as well as parents of children and adolescents diagnosed with gender incongruence and managers of hospitals that already provide these services, were also heard.
Among the defined precautions, Resolution nº 2,265/2019 prohibits hormonal or surgical procedures for individuals diagnosed with severe mental disorders. Patients are also required to be aware of the benefits and risks involved in the process, such as the possibility of sterility. In this sense, any procedure must only be initiated after signing a free and informed consent form. In the case of minors under 18, an assent form is also required.
An important difference between the new resolution (nº 2,265) and the previous one (nº 1,955) is that the updated text addresses issues such as the performance of pubertal blockers, which is still considered experimental (subject to the rules of research protocols approved by the CEP/Conep system), and cross-sex hormone therapy, which were not previously provided for. With the revoked norm, the one published this week also regulates surgical processes related to the treatment of cases.
Pubertal blockade is the interruption of the production of sexual hormones, preventing the development of secondary sexual characteristics of biological sex by using gonadotropin-releasing hormone (GnRH) analogs. Cross-sex hormone therapy is a form of hormone replacement in which sex hormones and other hormonal medications are administered to the transgender person for feminization or masculinization, according to their gender identity.
Hormone Therapy – Resolution CFM nº 2,265/2019, among the points defined, emphasizes that cross-sex hormone treatment can only be started from the age of 16. Each person will be evaluated by the multidisciplinary team involved in the care, as development manifests differently in each child or adolescent. This change also reinforces safety mechanisms for these situations.
From the age of 18, the CFM Resolution reiterates that cross-sex hormone therapy must be prescribed by an endocrinologist, gynecologist or urologist, all with specific scientific knowledge, with the purpose of inducing sexual characteristics compatible with gender identity.
The doses of sex hormones to be adopted must follow the principles of hormone replacement therapy for hypogonadal individuals (with functional deficiency of the gonads that can lead to delayed growth and sexual development), according to the pubertal stage.
The hormones used are testosterone (to induce the development of masculine secondary sexual characteristics in transsexual men), estrogen (to induce the development of feminine secondary sexual characteristics in transsexual women and transvestites) and antiandrogen, which can be used to attenuate body hair growth and spontaneous erections. The use of estrogens or testosterone must be maintained throughout the individual's life, monitoring risk factors.
Surgeries – Regarding surgical procedures for gender affirmation to care for people with gender incongruence, Resolution nº 2,265/2019 established that they can only be performed after 18 years of age, and the candidate must have previously undergone at least one year of follow-up by a multidisciplinary and interdisciplinary team.
The text also states that in the pre-operative phase, cross-sex hormone therapy will be supervised by an endocrinologist, gynecologist, or urologist, who will evaluate whether the bodily transformations have reached the appropriate stage for the indication of surgeries. The surgical procedures for gender affirmation considered valid by the CFM are categorized into two groups.
Surgeries for gender affirmation from male to female are: neovulvovaginoplasty (which can be performed using different techniques described in the Resolution based on the patient's evaluation); and augmentation mammaplasty. In turn, gender affirmation procedures from female to male include bilateral mastectomy; pelvic surgeries (hysterectomy and bilateral oophorectomy); and genital surgeries (neovaginoplasty and phalloplasty through metoidioplasty - clitoral rectification and lengthening, after hormonal stimulation).
Neophalloplasty, which consists of constructing a male organ using skin and muscles from the forearm or other regions, is classified as experimental, and must only be performed according to the norms of the CEP/Conep System. To complement phalloplasties (metoidioplasty and neophalloplasty), urethroplasty (in one or two stages) with vaginal/oral mucosa grafts or genital grafts/flaps; scrotoplasty; and placement of a testicular prosthesis in the first or second stage, may be performed.
What does the ANS say about masculinizing mastectomy and other procedures for gender incongruence?
Published on 01/04/2021
TECHNICAL OPINION Nº 26/GEAS/GGRAS/DIPRO/2021
COVERAGE: TRANSEXUALIZATION PROCESS OR GENDER AFFIRMATION
The List of Procedures and Health Events, currently regulated by RN n.º 465/2021, effective from 01/04/2021, establishes the mandatory assisted coverage to be guaranteed in private health care plans contracted from January 1, 1999, and in those adapted, as provided for in article 35 of Law n.º 9,656, of June 3, 1998, respecting, in all cases, the contracted assistance segments.
The TRANSEXUALIZATION PROCESS, also called SEX REDESIGNATION or TRANSGENITALIZATION or SEX CHANGE or GENDER AFFIRMATION, understood as a set of clinical and surgical procedures performed within the scope of care for transgender people or those with gender incongruence, is currently regulated by GM/MS Ordinance 2803/2013 and CFM Resolution n.º 2265/2019.
Although the transsexualization or gender affirmation process is not listed in RN n.º 465/2021, transgender beneficiaries or those with gender incongruence, diagnosed with sexual identity disorders (ICD10 F.64), will have guaranteed coverage for some of the procedures listed in the current list and which do not have a utilization guideline, once indicated by their assisting physician.
In this sense, procedures such as MASTECTOMY; HYSTERECTOMY; OOPHORECTOMY OR OOPHOROPLASTY; THYROPLASTY, among others, which are listed in the roll without a Utilization Guideline and do not have any express coverage restriction in the name of the procedure, under the terms of Art. 6º, §1º, item I, of RN nº 465/2021, will be mandatory coverage when requested by the assisting physician, even within the scope of the transsexualization process.
In this video, Dr. Fernando Amato, Plastic Surgeon at Instituto Amato, talks about: What is Masculinizing Mastectomy? A controversial topic worth discussing.
Related articles
Agendar consulta
Precisa de orientação personalizada?
Marque uma avaliação com o Dr. Fernando Amato e tire as suas dúvidas sobre cirurgia plástica.
Falar no WhatsApp