When the necessary criteria for carrying out the surgery are met (see above), the person concerned must:

• identify a specialized clinical center (Infotrans.it offers a list of structures, present on the national territory, able to provide this type of services in the "Service Map" section)
• schedule a medical consultation with the surgeon to:
  • evaluate the intervention technique most suited to the person
  • receive information on which pre-operative examinations to do before surgery

In general, if taking any prescription medication, one should discuss it with the health provider. It may be necessary to stop taking it even several days before the surgery. Drug therapy may be resumed at the doctor's discretion.

Mastectomy and creation of a male chest (chest surgery) is a plastic and reconstructive surgery that allows to create a male chest by removing the breast. During the surgery, the breast tissue is removed and the areola and nipple are repositioned and reduced. The choice of surgical technique depends on the characteristics of the person such as the size of the breast, its components and the elasticity of the skin. The surgeon's choices will also be aimed at reducing possible scars. At the end of the surgery, drainages are placed (thin tubes that allow liquids to escape from the thoracic cavity in a bag connected to them). Chest surgery and hysterectomy/ovariectomy can be performed together in the same surgical session.
Chest surgery lasts about 2-3 hours and takes place under general anesthesia.

The hospitalization for the chest surgery can be as long as only 2 days, if performed together with the hysterectomy/ovariectomy it lasts an average of 3-4 days, depending on the characteristics of the person and the post-operative recovery.

• Pain and/or discomfort in the hours and days following the surgery are normal
• An elastic band should be worn for 4 weeks
• In the first few days it is recommended to avoid raising your arms, making efforts with them and lifting loads
• Walking without getting tired is also recommended to prevent the risk of deep vein thrombosis
• The first check-up check with the surgeon is usually scheduled within the first week after the operation
• After four weeks from the operation, it is generally possible to return to the usual activities
• It is recommended to apply products on the scars to minimize the scarring of the surgery, such as gels or silicone sheets and creams
• It is advisable to avoid exposing the scar to the sun for at least one year after surgery.

Like any surgery, there is a risk of bleeding, infections and adverse reactions to anesthesia.
Other specific risks and complications of this surgery are:

• formation of hematomas (collections of blood) and/or seromas (accumulation of fluid) despite the use of drainages (thin tubes that allow liquids to escape from the chest cavity in a small bag connected to them) and compression bandages
• necrosis of the areola and nipple.

Adjustments may be needed to improve the aesthetic result.
Although the mammary gland is removed, it is good to remember that this type of surgery does not completely protect from the risk of developing breast cancer because a small part of the mammary gland may remain. It is therefore advisable to follow the guidelines for the prevention of breast cancer. For more information on breast cancer screening you can visit the "Prevention and Health" page.

National Health Service (NHS): no cost.
Freelance: at the discretion of the health provider.

Coleman E, Bockting W, Botzer M, et al. Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7. Int J Transgend. 2012; 13(4): 165-232.
Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017;102(11):3869-3903. Erratum in: J Clin Endocrinol Metab. 2018; 103(2): 699. J Clin Endocrinol Metab. 2018; 103(7): 2758-2759.