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One important consideration is that any trans man who develops vaginal bleeding after successfully ceasing menses on testosterone, must be evaluated by a gynecologist. In addition, there is less denervation damage to the nerves supplying the skin of the chest wall with a peri-areolar mastectomy, and less time is required for sensation to return. If the cervix is removed, it is called a 'total hysterectomy. Bilateral salpingo-oophorectomy BSO is the removal of both ovaries and fallopian tubes. Mastectomy[ edit ] Many trans men seek bilateral mastectomy , also called "top surgery", the removal of the breasts and the shaping of a male contoured chest. Hysterectomy without BSO in women is sometimes erroneously referred to as a 'partial hysterectomy' and is done to treat uterine disease while maintaining the female hormonal milieu until natural menopause occurs. This avoids the larger scars of a traditional mastectomy, but the nipples may be larger and may not be in a perfectly male orientation on the chest wall. It is unknown whether the risk of ovarian cancer is increased, decreased, or unchanged in transgender men. Completely removing and grafting often results in a loss of sensation of that area that may take months to over a year to return, or may never return at all; and in rare cases in the complete loss of this tissue. For trans men with smaller breasts, a peri-areolar or "keyhole" procedure may be done where the mastectomy is performed through an incision made around the areola. While the rates of endometrial and cervical cancer are overall higher than ovarian cancer, and these malignancies occur in younger people, it is still highly unlikely that this question will ever be definitively answered. Trans men with moderate to large breasts usually require a formal bilateral mastectomy with grafting and reconstruction of the nipple-areola. The risk will probably never be known since the overall population of transgender men is very small;[ improper synthesis? Though like breast cancer , the risk does not become zero, but is drastically decreased. See Male Chest Reconstruction. By some doctors, the surgery is done in two steps, first the contents of the breast are removed through either a cut inside the areola or around it, and then let the skin retract for about a year, where in a second surgery the excess skin is removed. This is particularly the case for trans men who:

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