FAQ Gender reassignment:
Here you will find answers
to the most frequently asked questions

I would like to have a mastectomy. What do I need to bring with me for the operation?

In order to be able to perform a mastectomy as gender reassignment surgery on non-binary or transgender people, certain documents and examination results are required. These include a psychological certificate confirming a medical indication for the mastectomy. A gynaecological examination is also necessary, which includes a sonography of the breast.

Can I also present myself at the Wolff and Edusei specialist practice if I have been operated on outside and am unhappy with the results of my operation?

Of course we are happy to support you! We use various corrective surgical methods in our practice clinic. However, corrections after previous breast surgery, e.g. as gender reassignment surgery for non-binary or transgender people, which were not carried out professionally, can sometimes be difficult. Please also note that some surgical adjustments may not be covered by health insurance and must be self-financed.

What do I need to consider after breast surgery or a mastectomy?

After a mastectomy as gender reassignment surgery for non-binary or transgender people, your body needs a period of rest, similar to other surgical procedures. This rest period is essential to ensure that the wounds heal without complications and that you can achieve an optimal result. If too much strain is placed on the upper body, the tissue layers may shift, resulting in wound cavities (so-called seromas). After breast surgery, our patients are fitted with a compression bandage which they must wear for at least 6 weeks. This bandage supports wound healing and helps to reduce swelling.
 
The return to normal social and working life is individual and depends on the respective findings and personal workload. It is advisable to follow the recommendations of our plastic and aesthetic surgery specialists in order to avoid overexertion and ensure optimal recovery.
 
Sporting activities can normally be resumed slowly after about 4 to 6 weeks. However, full weight bearing and more intense exercise should only be considered after about 12 weeks. It is important to be patient and not to overstrain the body so as not to jeopardise the healing process and thus the outcome of the operation.

Do I still have feeling in my nipples after they have been transplanted?

In the case of a mastectomy as gender reassignment surgery for non-binary or transgender people with nipple transplantation, there is no longer any surface sensitivity. However, a deep sensation can often develop over time.

Do you have to have the whole breast removed as part of a mastectomy - or are there variations?

Some patients, especially those with a fluid gender identity, would like to retain part of their breast. At our Berlin clinic, we always aim to fulfil these individual wishes to the best of our technical ability. Our specialists in plastic and aesthetic surgery, Dr Wolff and Dr Edusei, will be happy to advise you personally.

How are scars treated after a mastectomy?

After breast removal or mastectomy as gender reassignment surgery for non-binary or transgender people, various supportive measures are available for scar treatment. The use of scar massages, for example, can improve scar formation. We will be happy to show you how to perform a scar massage in our practice clinic.

What does the incision look like during a mastectomy? Are the scars curved or straight?

In our Berlin clinic, we have found that a mastectomy as a gender reassignment operation for non-binary or transgender people with an almost straight scar in the transverse direction generally fits better into the harmonised body image and is preferred by most patients. In comparison, an incision in which the original breast shape is depicted as a curved scar on the chest wall is not the preferred appearance. Sometimes it is also necessary to extend the incision into the armpit area if the breast is very large, located very far to the side or if there is excess tissue there.

Is it possible to change the shape and size of the nipples during a mastectomy?

The nipple is transplanted to its new position on the chest wall during free transplantation. If the areola and/or the nipple (so-called papilla) are too large or their shape does not match the desired appearance, they can be adapted as part of the mastectomy as gender reassignment surgery for non-binary or transgender people.

Is it possible to have the nipples completely removed during a mastectomy as gender reassignment surgery for non-binary or transgender people?

Yes, in our practice clinic for plastic and aesthetic surgery we can usually fulfil this wish as part of a mastectomy and remove the nipples completely.

What techniques are available for mastectomy as gender reassignment surgery for non-binary or transgender people?

We offer three different techniques for mastectomy at our Berlin practice clinic for plastic and aesthetic surgery. The keyhole technique involves loosening the glandular body with contouring of the breast wall by curettage (a procedure in which a liposuction curette is used as a surgical instrument) and removal of the mammary gland through an incision in the areola. If necessary, a lift around the nipple is performed either immediately or at a later date of at least 6-9 months. Another method is mastectomy as a gender reassignment operation for non-binary or transgender people with free transplantation of the nipple, in which the mammary gland is removed and the original nipple is transplanted back onto the chest wall. Alternatively, a mastectomy can be performed in which the entire nipple is removed along with the mammary gland. The application of each of these techniques depends on the individual situation, the patient’s needs and the anatomical preconditions.

Is a keyhole technique for breast removal an option for me?

A mastectomy as gender reassignment surgery for non-binary or transgender people can be performed using the keyhole technique in certain cases. In this surgical method, excess breast tissue is removed through a small incision at the edge of the nipple. However, the application of this method depends on the size of the breast and the elasticity of the skin and connective tissue. It is particularly suitable for people with small breasts and firm tissue. This technique is not recommended for large breasts or sagging skin. If the skin does not contract sufficiently after mastectomy, a subsequent lift may need to be considered at a later date.

Does health insurance cover the cost of a mastectomy for non-binary patients?

In a judgement in October 2023, the Federal Social Court in Kassel ruled that gender reassignment surgery for non-binary people is not covered by health insurance. Entitlement to cost coverage requires a recommendation from the Federal Joint Committee (G-BA), which has unfortunately not yet been issued. The court emphasised that gender identity is also protected by general personal rights for non-binary people who do not identify as either male or female. However, until a recommendation is made by the G-BA, there is still no entitlement to these interventions and the costs must currently be borne by the patients themselves. Find out more here.

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