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Writer's pictureAshton Blyth

More than one way of doing things

I had created the top surgery line on the previous map update based on my memory of the key stops I had towards my own. It was only at the point of looking into all the different lower surgery options available, for creating or removing a penis or vagina, that I realised that actually I know there are a few ways of performing top surgery, which is usually based on your chest size, and that I needed to look at redoing that section.

On the treatment NHS page it didn’t mention all the types of surgery to masculinise a chest, but I found a good break down of the surgeries through a Welsh NHS GIS instead:

Double Incision Technique (bi-pedicled)

Most widely used technique, ideal for medium to large chests, involves surgical incisions and the removal of both glandular tissue and skin, the wound is closed with the aim of leaving as straight a scar as possible, the nipple and areola are then re-attached as a free graft.


Peri-Areolar Technique

Ideal for smaller chests, this involves a small amount of skin being removed to reduce the size of the chest. An incision is made around the areola which can be reduced in size at this time. A stitch is placed around the areola to prevent future stretching. The benefit of this technique is that it can result in only a small scar around the areola. However, it may be difficult to remove the edges of the breast tissue. This can result in the illusion that there is still a circular shape on the chest wall.


So top surgery needs breaking down to include the methods of removing the breasts, as well as how to create or reattach nipples. I knew that the nipples could fall off, and tattooing was a potential option if that happened, as I had discovered that in my own research prior to surgery and was told that it would be an alternative available to me if that were to happen, but I did not realise there were so many ways that they 'created' the new nipples!


Building a new nipple with surrounding skin

This is the most common approach. To create the nipple, the surgeon uses skin from the area on the chest where the new nipple will be located. This involves making small incisions, forming the tissue into a nipple shape, and securing it with stitches. The areola may be created later by tattooing.


Building a new nipple with surrounding skin and an areola with a skin graft

To create the nipple, the surgeon uses skin from the area on the chest where the new nipple will be located. To create areola, the surgeon uses skin from another part of the body, such as the edge of a healed mastectomy scar or from some loose skin on the lower belly.


Free, full-thickness nipple grafting (this is what I had)

The nipple-areolar complex is harvested as a full-thickness skin graft. It is resized and repositioned to look more masculine, less feminine and non-gendered.


Dermal Implants

Another nipple reconstruction option is a dermal implant. A small dermal implant is inserted under the top layer of skin in the centre of the tattooed areola, leaving a tiny post extending above the surface of the skin. A silicone nipple, made to match an individuals skin tone, is then screwed into the post.


Nipple Tattooing / Areola Complex

A new areola (the coloured disc surrounding the nipple) can be created using a technique called “intradermal micropigmentation” – nipple tattooing. A trained practitioner will carry out the procedure approximately 6-8 weeks after nipple reconstruction/your final surgery. Most people will need no anaesthetic at all, some a local anaesthetic cream or in the most sensitive of cases, an injection of local anaesthetic. The nipple tattooing procedure will take about an hour during which a semi-permanent pigment is injected under sterile conditions. You will be given aftercare instructions. Sometimes the procedure will need to be repeated and a couple of coatings will usually last up to 2 years.

So this is the new updated layout of the masculinising surgery section, I also decided to combine both upper and lower surgery for clarity, as there’s a lot of duplication in the stops - referrals, confirmation from GDNRSS, pre-ops, post-ops etc. so it simplifies the look of the map. The only difference between the upper and lower sections (beside which surgery it is) is that you need a second positive recommendation. In the same way I had an extra loop added in the hormone line (to go to the dosage adjustment stop if necessary), I can add the second recommendation stop in this way, and the broken line design shows that it is not always necessary to continue on.

However, as always, I didn't read the full information before rushing into drawing and so didn't read (and remember) about hysterectomies!! Despite wanting a hysterectomy myself, to be rid of the pain these internal organs cause me, I hadn’t thought about that so far when creating the map. That there’s two sides to lower surgery: removing existing organs and/or anatomy, and constructing new anatomy.

It was thinking about a hysterectomy that then led to the realisation I hadn’t considered fertility on the map so far, hence why it’s been squeezed onto this full layout map as an after thought:


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