What is double incision mastectomy?

Surgery to remove the breast tissue, more suitable to larger amounts of breast tissue. Usually the nipples are made smaller and repositioned or removed.

What does double incision mastectomy do?

• Upper body

  Flattens chest, moves or removes nipples

Who can have double incision mastectomy?

• You need to have had persistent dysphoria, but there is no specific time frame

• You must have capacity to consent for this treatment

• If you have significant medical conditions, these need to be “reasonably well-controlled”

• Under 18s cannot have this but can be referred at 17

• You typically need a BMI of less than 40

How long does double incision mastectomy last?

The effects are permanent and cannot be reversed.

What should I be aware of?

Double incision mastectomy carries a risk of loss of sensation in the nipples or loss of the nipples entirely. If a nipple is completely lost, some people use cosmetic tattooing to give the appearance that the nipple is still there.

Are there other options?

Typically, mastectomy is performed using the double incision mastectomy technique in the UK. Around 7% of people have little enough breast tissue and good skin elasticity for periareolar mastectomy to be recommended instead 2, p.261 which can result in less visible scarring 3, p.227. Other techniques are possible, such as buttonhole or inverted T (also known as T-anchor), but are much less common in the UK.

How do I get a mastectomy?

Mastectomy for reasons of gender dysphoria requires a written letter of recommendation from a specialist gender clinician (such as NHS Gender Identity Clinic staff or private specialists) who have assessed you for suitability for surgery 4.

NGICNS maintains a list of NHS surgery providers providing various gender-related surgeries. At the moment, all of these surgeons are based in England, so you will have to travel if you live in another part of the UK. If you have decided to pay for your own surgery, rather than using NHS funding, there are additional options available to you. For more information about these private surgery options read our private surgery page.

Mastectomy usually requires an overnight stay in hospital 4, p.31. Mastectomy is a major surgery and has a significant recovery time. You should expect to spend around 4-6 weeks time recovering before you are ready to resume work or study. When you are discharged from hospital, your surgeon should provide you with a sick note to give to your employer. You will also need to return for a follow up appointment to determine if any further surgery is required to improve the cosmetic appearance.

How do I get ready for surgery?

Doing some preparation in advance can help make sure everything goes smoothly during your hospital stay and recovery. To help you avoid forgetting to do or buy something we have created a Getting ready for gender surgeries page.

Where can I ask questions about surgery?

When you and your clinical team agree that you are ready for surgery on the NHS, the NHS Gender Dysphoria National Referral Support Services (GDNRSS) will process your referral to your chosen surgical provider. They have a Single Point of Access support line that you can call for information about your referral, the status of your chosen provider and practical information such as travel and parking, who can accompany you, what to take with you and where to report when you get there.

You can also book a virtual consultation with one of the GDNRSS Clinical Nurse Advisors who can provide information on:

• Surgical techniques used by various providers and surgeon teams
• Typical recovery times following surgery
• Potential post-surgical complications
• Surgical eligibility criteria, where providers have these in place
• Waiting times for surgical providers
• Supporting patients to change provider

You can contact the service by calling 01522 85 77 99 or by email. The service is open Monday to Friday from 9am until 5pm. You can find out more about the service in this booklet.

How much will it cost?

The cost of a mastectomy and chest reconstruction performed in the UK is currently around £6000-7000 (last updated October 2020).

If you have a formal diagnosis, the NHS will usually provide funding for a mastectomy.

If you're receiving certain benefits, or are on a low income, you may be able to get help with the cost of travel for NHS treatment. Further information about help with travel costs can be found:

• on the NHS website
• on the Welsh Government website
• on the NHS Scotland website
• on the Northern Ireland government website

Where can I learn more?

You can read more about chest surgeries in this booklet from the NHS Gender Dysphoria National Referral Support Service.

You can also read more about mastectomy on the NHS website.

References

1. 1.
   Mahfouda, Simone, Moore, Julia K, Siafarikas, Aris, Hewitt, Timothy, et al. (2019) “Gender-affirming hormones and surgery in transgender children and adolescents.” The Lancet Diabetes & Endocrinology, 7(6), pp. 484–498. Link
2. 2.
   Yelland, Andrew (2017) “Chest Surgery and Breast Augmentation Surgery,” in Bouman, W. P. and Arcelus, J. (eds.), The Transgender Handbook: A Guide for Transgender People, Their Families and Professionals, Nova Science Publishers Inc, pp. 251–264. Link
3. 3.
   Davies, Dai M and Stephenson, AJ (2007) “Breasts,” in Barrett, J. (ed.), Transsexual and other disorders of gender identity: A practical guide to management, Radcliffe Publishing, pp. 227–228. Link
4. 4.
   Royal College of Psychiatrists (2013) “Good practice guidelines for the assessment and treatment of adults with gender dysphoria.” Link

Acknowledgements

This page is illustrated using a photograph by Павел Сорокин available at Pexels.

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