Background: Shoulder narrowing surgery is commonly performed in transfemale and thus is often perceived as an exclusive transgender surgery. But in reality it is an aesthetic structural body contouring surgery that can be performed on anyone regardless of their gender identity. There may be slightly different motivations for undergoing the surgery, whether it is a cis- or transfemale, but in the end the goal is a reduction in the shape of the shoulders.
Regardless of one’s gender there are known differences in the lengths of the clavicles resulting in shoulder asymmetry. While not everyone has different clavicle lengths many patients presenting for shoulder narrowing surgery do up to 30% in my experience. Studies have shown that the human right clavicle tends to be shorter than the left. This appears to be due to the inhibition of longitudinal growth of the clavicle on the dominant side due to increased mechanical loading, particularly in axial compression. With these different lengths also comes some differences in the height of the shoulders
Case Study: This cis-female desired to have her shoulders less wide. She had always been teased for her wide shoulders and it had been a lifelong concern for her. Her bideltoid distance was 48cms at 5’ 6” tall.
Under general anesthesia and through 3.5cm incisions in the supraclavicular fossa segments of the clavicle were removed with 2.5cms on the right and 2.75cms on the left. Double plate fixation was applied with a 6 hole 3.5cm plate on top and a 2.5mm plate on the anterior surface of the repposed bone.
When seen the next day after surgery the changes in her shoulder shape were apparent.
Her postoperative x-ray showed good alignment of the segments with bicortical screw placements.
In shoulder narrowing surgery it is not uncommon to see asymmetry…and to date in my experience has always been on the left side. While conceptually removing more bone on the longer left side would help with the asymmetry…but there are limits as to how different the resections between the two sides can be. This is typically in the range of only 2.5 to 4.0mms as it is hard to resect much more than 2.5cms per side unless one is very tall. This has to do with being able to get the fixation plates in place before the bend on each end of the clavicle is reached.
Case Highlights:
1) Cis-females undergo shoulder narrowing surgery but at a lower incidence than transfemales.
2) Shoulder asymmetry due to different clavicle lengths is not uncommon amongst all patient populations seeking this surgery, most commonly on the left side.
3) Differential clavicle length reductions can be done and are usually not greater than 0.5cm on the longer side.
Dr. Barry Eppley
World-Renowned Plastic Surgeon