Chest Contouring Surgery - Manchester University NHS Foundation Trust

We are one of the biggest units in the UK receiving approximately 300 referrals every year. We hold the NHS contract for individuals from Scotland but almost 50% of our workload involves individuals from England and Wales. We aim to provide excellent care to trans individuals in a professional and timely manner.

All consultants are members of the WPATH and are undergoing continuous training in trans healthcare beyond their scope of work to ensure efficiency and inclusivity. We are offering the entire range of surgical techniques available and continue to improve our skills by liaising with other units nationally and internationally. We have been recognized as a training centre for trans top surgery by GDNRSS and we regularly attend and present our work in international conferences. We have been invited to participate with a book chapter regarding our expertise in a leading surgery companion (awaited in late 2021).

Peri-areolar

You must have a small chest size to be considered for this technique and it is rarely performed. It involves having a scar underneath or to the side of the areola (the dark circular area around the nipple). The areola remains the same size after surgery.

Concentric circum-areolar and PDS stitch

This is best for patients with a small chest who have little or no chest skin droop. A small amount of skin is removed to try and shrink the chest skin and a scar is placed all around the circular areola. The areola can be made significantly smaller if desired. A permanent Gortex stitch is placed around the newly sized areola to try and stop it from stretching again post-operatively. The Gortex stitch can remain inside your body forever without causing any side-effects. The advantages of this technique are that it can be performed through a small scar and has the potential for the scar to remain just around the edge of the areola. The disadvantages are that it can be difficult to reach the very edges of the chest tissue and to disrupt the junction between the chest tissue and the chest wall. This can mean that there could be “ghosting” of the chest disc – the visual illusion that there is still a circular chest shape on the chest wall. In addition, it can be hard to re-position the nipple if it needs moving to a wider position on the chest.

Dermal flap double incision

This technique is good for patients with a medium-sized chest who specifically want to try to keep the sensitivity of their nipples. It is an alternative to nipple grafting. The scars are placed at the bottom of the chest area and around the circular edge of the areola. This results in a “double incision” scar. It is worth noting that dermal flap and nipple grafting both use the “double incision” type of scar but are different surgical techniques.

The dermal flap is the skin from the bottom area of the chest, which has its top layer removed, so that the nipple can be placed inside the chest area and re-positioned in a more male-like position, still connected to its blood supply. The advantages are that nipple sensation can be preserved in up to 70% of patients. Disadvantages can be that the buried skin can lead to slight bulging and an increased risk of infection and bleeding. The scars are larger than with the three techniques above.

Free nipple graft double incision

This is the most straightforward of all the techniques and can be carried out on any chest size. It is often chosen when nipple sensation is not important. Sometimes it can be the only possible technique to obtain a flat chest. This is particularly true if a large volume of chest tissue and skin needs to be removed. The advantages are that it is a quicker operation, requiring a shorter anaesthetic time, and the complication rate tends to be lower. It often results in a flat chest area. However, the nipple sensation will be lost as can the brown/pink colour of the nipple and areola. In about 2% of cases the nipple/areola can fail to obtain the blood supply from the surrounding skin and be partially or completely lost. In these rare cases the resulting scar is often enough to resemble a nipple. However, tattooing can be used to make the nipple look more natural.

Contact details

Hospital:	North Manchester General Hospital
Building name:	Outpatient F (April 2021)
Ward/Department location:	Chest Contouring Unit is part of the breast surgery team
Directions (include nearest entrance and car park)
Telephone numbers:	0161 720 2972
Email address:	Chestwall.Contouring@mft.nhs.uk. Chestwall.Contouring@pat.nhs.uk.

Related Services/Links

We are proud to be working closely with the EDI team aiming to provide an open and fair experience for everyone. We also work closely with GICs from around the UK and we are participating in training and educational events provided by BAGIS and WPATH

Patient/ service user testimonials

Written by a patient (From #iWantGreatCare)

20th May 2020

I stayed in the hospital from Monday night until Wednesday morning after having a bilateral mastectomy (transman) performed by Dr Ntanos in a October 2019. I was treated very well, all the staff were very pleasant and respectful of my specific needs and I am very grateful to them for making my time there comfortable, as I had never had surgery or a stint in the hospital before. My recovery was very smooth and overall I am delighted with the experience.

Written by a patient (From #iWantGreatCare)

5th November 2020

Explained the treatment and care I was receiving thoroughly, was straight to the point and always made sure i was comfortable and understood what was happening before proceeding with anything.

Written by a patient at (From #iWantGreatCare)

12th March 2020

I got my top surgery done 2 weeks ago and my bandages removed today, the care I received and treatment was phenomenal and information and knowledge was outstanding. I would recommend this doctor to fellow transgender people and I have had a great experience in starting and ending my top surgery! See you in 6 months!