FTM CHEST SURGERY

女變男胸部整型手術

涂懿美 譯

The procedure used is based on the following:

手術施行須考量下列三點

·  Size and shape of breast 胸部的大小和形狀

·  Elasticity of skin 皮膚的彈性

·  Patient's needs and preferences 病人的需求和喜好

一般來說，如果病人的乳房較小，就可以在乳暈（乳頭顏色較深的部份）的下半部做切口，然後透過抽脂和切除來完成手術。較大的乳房如果皮層較厚、較有彈性、沒有損壞、沒有外擴的話，也可以使用這個技術完成切除。就皮膚顏色狀況較好的病人而言，切除後多餘的皮膚和乳暈部份都會有很大幅度的收縮；如果收縮得不夠，就需要移除少數的皮膚（大約切出鑰匙孔的形狀，或者沿著乳暈切除）。如果病人願意回來多做一道手續，我覺得這是一個合理的做法。至於那些乳房較大、乳房皮膚品質較差而且下垂的病人，我通常建議移除胸肌折縫中的多餘皮膚和乳房組織，然後再將乳頭移植回去。不過，這會在胸部留下較大的疤痕。

In general, patients who have smaller breasts can have the entire surgery performed through an incision in the lower half of areola (the pigmented portion of the nipple) using liposuction in combination with surgical removal. It is also possible to remove larger breasts using this technique, if the skin of the breast is thicker, more elastic, and not damaged or stretched out. In these patients with good skin tone, the excess skin and the areola will shrink a remarkable amount. If the skin does not shrink enough, it may be necessary to have a small amount of skin removed (in a keyhole pattern or in an incision around the areola). If the patient is willing to return for an additional procedure if necessary, I think this is a very reasonable approach. In those patients with a large amount of breast tissue with excessive skin of poor quality and droop, I usually recommend removing the excess skin and breast tissue in the crease of the pectoralis muscles and put the nipples back on as grafts. However, this surgery leaves larger scars on the chest.

有些小胸部的病人偏好只做抽脂，目的為了保持胸部的感覺，也為了降低成本。你當然可以先做抽脂，多餘的乳房組織可以等第二個手術時移除。兩階段手術應該不會改變最後的結果，但是確實會因為增加了手術的次數而影響到病人必須多請一次假。對大多數只做抽脂的病人，我可以用外科手術切除殘留的乳房組織以改善結果。不過，這也只是我個人的意見，有些人很滿意只做抽脂。

Some small breasted patients have a strong preference for liposuction alone in order to preserve sensation or to stretch out the costs. You can have the liposuction done first, and if necessary, the residual breast tissue can be removed in a second operation. Having this done in two stages probably doesn't alter the final result, but does increase the number of operations required and time off work. In a majority of patients who have liposuction alone, I think I could improve the result with surgical excision of the remainder of the breast tissue. Nevertheless, this is my opinion, and some people are quite content with just liposuction.

胸部手術通常不需要住院，但是依照不同的手術形態，術後的病人可能還需要在醫院附近待上三到六天，以防萬一，不過病人最好有朋友或家人就近照顧。

Chest surgery is routinely done as an outpatient. The patient will need to stay in the area from three to six days following the surgery depending on the type of procedure done. If a patient chooses to stay in a hotel they should have a friend or family member stay with them to help with their care.

top

Risks and complications

可能的風險和併發癥

上述步驟都有風險，也可能併發其他癥狀，以下就做個簡介。

Obviously, procedures such as this are not without risks or complications and I want to review these with you.

·  Bleeding 流血

任何手術都可能造成流血，但是在這個案例中不太可能需要輸血。不過，如果透過好幾個小切口來切除大部分乳房組織，失血的風險就比較大。雖然到目前為止還沒有聽說過做這個手術需要輸血的例子，但是為防萬一，還是建議病人事先存下一份自己的血液，以便需要輸血時可以確保是自己的血液。

Bleeding is a risk of any operation, but the need for transfusion is very unlikely. However, when using minimal incisions to surgically excise most of the breast tissue the risk of blood loss is greater. Although a transfusion has not been required to date using this combined approach, it is recommended that you consider donating a unit of your own blood in advance of surgery to assure that if a transfusion is necessary, the blood would be your own.

·  Infection 感染

Infections are rare complications. 不太可能發生感染併發癥。

·  Nipple numbness 乳頭無感覺

區域性的手術可能損壞乳頭的血液供應，使得乳頭壞死。如果移植乳頭，它們也可能無法存活。但是就我的經驗而言，這種情況很少很少發生。

The blood supply of the nipple might be damaged with the more limited surgery, and the nipple could die. If the nipples are used as grafts, then it is possible that they might not survive. These complications are exceedingly rare in my experience.

·  Scarring 結疤

乳暈的疤通常癒合狀況很好，胸肌下的疤就需要較長的時間才會消失，這些疤痕也可能變寬。不過，疤痕若是突起或是過寬就可能需要進一步處理：這可能是因為一些多餘的組織沒有移除乾淨，以致於看來好像輪廓畸形。這些就需要第二個階段的手術移除。

The scars of the areola usually heal very well. The scars below the pectoral muscles will take longer to fade out and will widen as mentioned above; however, a raised or excessively wide scar is possible and might need further treatment. It is possible that there may be residual tissue left,which appears as a contour deformity. This would need to be removed at a second stage.

·  Other risk 其他風險

乳房組織移除後，皮膚有凹下的風險，也可能有其他併發癥。如果在皮膚內留下一些乳房組織，就可以降低或避免這類併發癥發生。不過，由於還保留一些乳房組織，所以還是有產生癌癥的可能，因此，病人最好要保持警醒，繼續做例行性的乳癌自我檢查。

Depression of the skin where the breast tissue was removed is a risk and possible complication. The possibility of this complication can be reduced or avoided by leaving some breast tissue on the skin. Since not all the breast tissue is removed, you are still at risk for developing breast cancer, and therefore, you should still be vigilant in routine self-exam and screening for breast cancer.

top

Top Surgery上半身手術病人經驗

by Jamie Walker

（以下的資訊來自我的閱讀和親身經驗，也來自我和為我手術的外科醫生以及其他有過相關手術經驗的醫生的對談。我不是外科手術專家，每個人的經驗都可能不同，那跟醫生使用的技術和個別的案例有關。）

(This information is gleaned from my reading and personal experience, conversation with my surgeon, and with others who have had surgery. I am not an expert on surgery. Your experience may differ, depending on the technique of your surgeon and on your individual case.)

女變男變性手術的上半身手術叫做「男性胸部重建」，這和乳房切除術不同的地方在於，其中所作的切割和重建都是為了塑造一個男性輪廓的胸部。要是單純的乳房切除，那可能只是使胸部前方凹陷，沒了乳頭，以及留下明顯的疤痕。你最好確定你的外科醫生了解你不是要做乳房切除，而是做男性胸部重建。

Top Surgery for female-to-male transsexuals is called "male chest reconstruction." It differs from a mastectomy in that the incisions and reconstruction are done with the intended result of a contoured, male-looking chest. A mastectomy by itself would result in a concave chest front, no nipples, and more obtrusive scars. Make sure that your surgeon understands the technique not just of mastectomy itself, but of male chest reconstruction.

本手術需要全身麻醉，因為整個手術要三個半到四小時的時間。左右乳房各做出切線，一併移除多餘的皮膚和乳腺，脂肪也去除，只剩下維持一般胸部外觀所需的量。乳頭和乳暈摘除後，準備做皮上移植，縮小到男性的大小，再分別縫合回去。皮膚須要經過塑形縫合，配合男性胸部的輪廓。

The operation is usually done under general anasthesia, because it takes so long - 3-1/2 to 4 hours. An incision is made under each breast, excess skin and the mammary glands are removed. Fat is removed also, leaving the right amounts in the right places to have a normal looking chest. The nipples and aereolas are removed and prepared as separate split skin grafts, reduced to male size, then sutured back on individually. The skin is contoured and sutured together.

在兩個乳房的主要切口下各開一個小口放排水管，放置幾天到一星期。縫線大約一星期後拆除。接下來要穿綁胸帶一兩個星期，以避免皮下累積體液。麻藥和手術都需要三、四個星期來復原，你會很容易疲倦，因此需要保留體力，努力復原。

Drains are put in, in a small incision under the main incision, one on either side of the chest, and left in for several days to a week. Sutures are removed in about a week. A binder is worn for a week or two to keep fluid from forming under the skin. It takes 3-4 weeks to recover from the anasthetic as well as the surgery itself -- expect to tire easily, and save your energy for healing!

手術的疤痕大約六星期後最難看，然而這些新長出的血管和組織卻可以幫助癒合，癒合的過程會感覺癢。

The scars look their worst at about 6 weeks due to growth of blood vessels and scar tissue which enable healing. They may also be itchy, again due to healing.

術後六星期到六個月，疤痕慢慢平坦，顏色變淡。六個月後，外科醫生就可以做進一步的修整：因為每個個體對於外科手術的反應很難預測，有時會產生「狗耳」（手術切口多出來的皮膚）、乳頭太小、多餘脂肪等等現象。

From six weeks to six months the scars gradually flatten and pale. At six months the surgeon can do any further modifications needed. Sometimes there are "dog ears" (excess skin at end of incision), too small nipples, excess fat, etc., due to the inability to predict how an individual's body will respond to surgery.

疤痕變小大約要一年或更久，因年齡、健康和個人情況而定。抽煙一定會阻礙癒合；維生素、草藥、健康的生活則對治療有幫助。

It takes at least a year, and maybe more, to a minimal scar. This all depends on age, health, and individual variations. Smoking definitely impedes healing. Vitamins, herbs, and clean living may help healing.

top | 回前頁