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Shoulder feminization is a surgical procedure where the bideltoid width of the upper body is narrowed. This is achieved by reducing the horizontal length of the clavicles by removing an intervening bone segment. This removed bone usually measures 2.5 to 3 cms in length which translates fairly directly into the same amount of shoulder narrowing. Interestingly this is one of the very few plastic surgery procedures where the effect you trying to create is removed from the actual site of the surgery. (which means the target site does not get swollen and the result is seen immediately)

Patients considering this surgery understandably inquire about the recovery since upper arm movement is going to have some initial limitations. Because it involves the clavicle many assume that the recovery is very similar to that of a clavicle fracture…but this is actually not a good correlation even though it involves the same bone.

In a clavicle fracture there is generalized trauma to the shoulder area from the mechanism of the injury. (e.g., fall) This causes a lot of soft tissue trauma to the shoulder joint and may involve associated joint injuries as well. The portion of the clavicle bone that is fractured is usually mid-shaft or more towards the shoulder joint where its diameter is the thinnest. Such fractures are often spiral and/or comminuted. While the open treatment of clavicle fractures has waxed and waned in popularity, open and internal fixation typically involves a long incision and plate fixation over its length. Recovery from these type of traumatic clavicle bone fractures, by definition, is more substantial as the zone of injury and surgically-induced trauma is greater. BUT most clavicle fractures involve just one side. Bilateral clavicle fractures is very rare.

Conversely a clavicle osteotomy causes a very small and specific zone of bone injury. It is performed on the medial or inner third of the clavicle where the cross-sectional diameter of the bone is the thickest. It involves a discrete clean bone cut with good strong bone on both sides of it. Plate and screw fixation may involve one or two plates but the bone healing is expected to be fairly quick and complete because of the quality of the two bone ends. There is also no associated soft tissue or shoulder joint trauma. BUT all clavicle reduction osteotomies involve both sides.

What separates clavicle osteotomies from fractures more than anything else is its bilateral nature. Despite the greater injury from clavicle fractures at least the patient has one good arm. In clavicle osteotomies both arms are affected which has a greater impact on the immediate after surgery recovery. Keeping one’s elbows close to the sides for the first few weeks after surgery allows one to function a bit like a T Rex dinosaur by having to short arm it for awhile. I don’t put patients in any slings or arm restraints, patients just have to remember to limit the movement of their elbows from the sides of their body for the first few weeks after surgery. The greatest limitation that this poses is an inability to wash or comb one’s hair as well as some challenges in putting on/off clothing. But once one gets to two weeks after surgery elbow motion can be increased to 45 degrees. By four weeks after surgery the arms can be raised to the level of the shoulder. By six weeks after surgery one can then raise their arms above their head.

Despite apparent similar breaks in the integrity of the clavicles, the recovery from each type is a bit different. While clavicle reduction osteotomies involves both sides it is associated with less postoperative discomfort and a more complete functional recovery sooner than that of displaced comminuted fractures. It is just a little more taxing in the first few weeks due to bilateral arm motion restrictions which should be accounted for in one’s early surgery recovery planning.

Dr. Barry Eppley

Indianapolis, Indiana

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