Using an ultrasonic scalpel to perform mastectomy through the inframammary incision enables precise dissection without pain or bleeding, creating a flat, compact chest contour while minimizing visible scarring after reconstruction.
What Is Mastectomy / Breast Reduction Surgery?
Breast reduction surgery, also known as female-to-male top surgery, is an aesthetic procedure with a technique that is quite similar to inverted-T mastopexy. The objective of the surgery is to remove all glandular tissue, excess fat, and excess skin to create a strong, flat chest contour. However, this technique always carries potential risks of complications such as bleeding, fluid accumulation, infection, skin flap necrosis, loss of sensation or prolonged numbness, unfavorable scarring, and others. Below are Dr. Ho Cao Vu’s in-depth insights into the common complications of female-to-male breast reduction surgery:
1. Hematoma
Hematoma usually occurs immediately after surgery, mainly because hemostasis during the operation was not thorough. If the amount of bleeding is small, the body may gradually absorb it over time. However, if a large amount of bleeding occurs, it will cause a hematoma to form within the chest cavity.
Anatomically, the breast is a complex organ composed of skin, fat, glandular tissue, and stromal tissue. Within the stromal tissue is a dense vascular network consisting of arteries, veins, and lymphatic vessels. Of these, the largest blood supply comes from branches of the lateral thoracic artery, which originate from the axillary region, and perforating branches of the internal thoracic artery. These vascular branches do not follow a fixed glandular duct system but instead form a complex vascular plexus within the anterior fatty tissue layer. Because of this anatomical characteristic, breast reduction surgery generally carries a significantly higher risk of bleeding than conventional breast augmentation surgery.
When a hematoma occurs, the breast will show signs of swelling, sharp pain, and extensive bruising. This condition reduces blood perfusion to the tissues, increases the risk of infection, and causes prolonged inflammation. If not treated promptly, the hematoma complication will directly affect the viability of the skin flap, prolong the wound-healing process, cause fibrous tissue organization, and lead to postoperative breast deformity.
2. Infection
Infection is one of the early complications following female-to-male mastectomy surgery. During the initial stage, this condition commonly presents as redness, warmth, swelling, and localized pain at the surgical incision. At this stage, it can be effectively treated with oral antibiotics combined with wound care.
However, in cases where a large seroma or complicated hematoma develops, bacteria can easily become localized and proliferate, forming an abscess. At this point, the doctor must indicate surgical intervention to completely drain the pus and thoroughly treat the site of infection. If the infection persists and cannot be controlled with conventional medical treatment, delaying surgical intervention will increase the risk of extensive tissue necrosis.
3. Nipple-Areola Complex Necrosis
Nipple-areola complex necrosis can easily occur when the blood supply to this area is severely reduced or completely interrupted. The main cause stems from aggressive cutting and coagulation techniques, which cause excessively deep thermal damage and destroy the superficial microcirculatory system surrounding the nipple-areola complex.
4. Loss of Sensation in the Breast and Nipple
This is one of the very common consequences following aesthetic breast surgeries that involve deep intervention in the structures surrounding the nipple and areola. This risk is specifically classified according to each physical condition:
• For cases with small breasts (little breast tissue and glandular tissue): patients should prioritize choosing a surgical method combined with the optimal incision to fully preserve the sensory nerve branches in the nipple area.
• For cases of hypertrophic, sagging breasts (a large amount of breast glandular tissue and aging skin): The risk of early and late complications related to the healing process of the nipple-areola complex is always very high. When the surgeon uses a conventional electrosurgical device to reduce the glandular tissue, the extremely high heat generated will seriously damage the intercostal nerve branches. This results in a significant reduction in sensitivity, causing numbness, persistent paresthesia, or even complete loss of sensation in the nipple.
5. Unfavorable scar complications
To control and minimize the risk of postoperative unfavorable scar formation, the surgeon must conduct a comprehensive examination and assessment of the patient’s current breast shape. This process includes a detailed evaluation of glandular tissue density, screening for abnormal masses, careful analysis of the skin characteristics, including skin laxity, skin thickness, and the amount of excess skin, assessment of thoracic cage anatomy, including prominence or depression, and precise determination of the shape of the inframammary fold, whether curved, horizontal, or asymmetrical.
Based on these anatomical data, the surgeon can then design an appropriate incision, calculate a safe glandular tissue reduction plan, and accurately reposition the nipple-areola complex.
In particular, for cases involving severe breast ptosis or a large amount of hypertrophic glandular tissue extending significantly beyond the inframammary fold, accompanied by a considerable amount of excess skin, the surgeon must be extremely skillful during dissection. Excessive removal of stromal tissue will damage the superficial vascular network, resulting in localized ischemia, wound-edge necrosis, nipple necrosis, and permanently contracted long scars.
Using an ultrasonic scalpel to perform mastectomy through a periareolar incision..
Advantages of using an ultrasonic scalpel in breast reduction surgery
According to Dr. Ho Cao Vu, the new-generation Ultrasonic Surgical Scalpel system is integrated with an intelligent chip that optimally controls the coagulation, sealing, and cutting energy of the scalpel tip. This improvement provides superior safety for hypertrophic breast reduction surgery or female-to-male mastectomy, techniques that require the removal of a large volume of glandular tissue and excess skin and always carry a high risk of bleeding.
Unlike a conventional electrosurgical device, this device uses high-frequency ultrasonic waves to separate and cut tissue with absolute precision, providing maximum protection for the surrounding healthy tissues and minimizing unwanted damage. In mastopexy and female-to-male mastectomy, minimizing tissue damage is the key factor that helps patients experience less pain, shorten their recovery time, and effectively preserve the blood supply to the skin flap.
Based on clinical practice, Dr. Vu stated that the application of new-generation ultrasonic scalpel technology in breast reduction surgery and mastopexy has achieved outstanding results:
• Optimal pain control: Reduces postoperative sharp pain by up to 90%; most patients do not need to use additional analgesics or high-dose postoperative antibiotics.
• Rapid recovery: patients quickly regain full alertness, maintain a stable physical condition, and can be safely discharged on the same day, only 4–6 hours after surgery.
• Superior scar aesthetics: The incision heals quickly, while the scar becomes soft, faint, and natural-looking significantly faster than with dissection using a conventional electrosurgical device.
• Clinical safety: Minimizes the incidence of early and late complications, such as seroma, hematoma, skin flap necrosis, or loss of nipple sensation.
Mastectomy surgical procedure
A mandatory and indispensable step before every breast reduction surgery is for the patient to undergo all required in-depth screening tests. This step aims to examine and completely rule out medical conditions included in the list of surgical contraindications, such as blood clotting disorders and uncontrolled hypertension. At the same time, the patient must stop using anticoagulants, dietary supplements, or certain herbal medicines for at least two weeks before surgery.
In addition, although the incidence is very low, general anesthesia always carries certain health risks, including airway obstruction, abnormal heart rhythm, allergic reactions (anaphylactic shock), brain damage, stroke, and even death. To minimize these risks as much as possible, patients should prioritize undergoing breast reduction surgery at reputable hospitals licensed to operate by the Ministry of Health. Among them, general hospitals with all necessary specialties are always the leading choice to ensure absolute personal safety and to be fully prepared to respond to and promptly manage any emergency that may occur.
Step 1: Designing the Surgical Plan
Dr. Ho Cao Vu will directly perform the measurements and markings, calculate the proportion of glandular tissue that needs to be removed, reposition the nipple-areola complex, and design the most optimal incision, personalized according to each patient’s chest condition and degree of breast hypertrophy or ptosis.
Step 2: Reduction of glandular tissue using a new-generation Ultrasonic Scalpel
The surgeon uses a new-generation Ultrasonic Surgical Scalpel system to perform dissection, release the tissue structures, and reduce the breast glandular tissue according to the designed surgical plan.
Thanks to the simultaneous “Coagulation – Sealing – Cutting” mechanism, ultrasonic energy seals blood vessels and lymphatic vessels immediately upon contact, provides absolute bleeding control, and limits extensive fluid secretion with high precision. This point dissection procedure minimizes collateral thermal damage, accelerates wound healing, and prevents postoperative complications such as seroma, skin flap necrosis, or unfavorable scarring at their source.
Breast glandular tissue resection in female-to-male mastectomy using an ultrasonic scalpel.
Step 3: Recovery suturing technique and aesthetic scar control
The incision is skillfully sutured layer by layer according to the anatomical structures to ensure the fastest wound-healing rate and achieve maximum aesthetic effectiveness.
MD, MSc. Ho Cao Vu directly performs wound closure in mastectomy surgery.
Creating a fine, aesthetically pleasing scar depends greatly on the surgeon’s suturing technique, combined with clinical experience in assessing skin elasticity and the risk associated with the patient’s individual predisposition. Based on these factors, Dr. Vu will establish a comprehensive scar-control protocol, from preoperative preparation and intraoperative dissection techniques to preventive postoperative scar treatment, helping the incision achieve the highest possible aesthetic outcome while minimizing the risk of hypertrophic scars, contracted scars, or scar deformities.
