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Female to male transgender mastectomy can be performed with low complication rates and high satisfaction. Nipple-sparing mastectomy were more likely to have a hematoma than patients undergoing MFNG.

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Reconstitution of the amputated ear remains a challenge to the plastic surgeon. Reattachment as a composite graft of the total or subtotal amputated ear is unreliable. Microsurgical replantation can be performed in a minority of cases; however, difficulty with adequate venous drainage complicates the technical complexity of these cases. To enhance survival of a reattached ear segment, Mladick et al. advocated use of the retroauricular pocket principle. This technique involves deepithelialization of the amputated part, followed by anatomic reattachment to the amputation stump and then burial in a retroauricular pocket. This simple technique increases the surface area of the avulsed segment in contact with surrounding nutrients, maximizing the probability of "take." The relationship between the dermis and cartilage is preserved, thus minimizing the deformity from cartilage warping. The undisturbed dermis on the involved segment can reepithelialize spontaneously, negating the need for a skin graft. We have used this technique successfully in five of six patients.

Testosterone therapy (TT) is administered to enhance masculinization in transgender individuals. The long term effect of exogenous testosterone on breast tissues remains unclear. Our study evaluated the modulation of breast morphology by TT in transgender individuals with special attention to duration of TT. We reviewed 447 breast surgical specimens from gender affirming chest-contouring surgery, and compared histopathological findings including degree of lobular atrophy, and atypical and non-atypical proliferations between subjects who did ( n =367) and did not ( n =79) receive TT. TT for one patient was unknown. TT for >12 months was associated with seven histopathological features. Longer duration of TT was significantly associated with higher degrees of lobular atrophy ( p <0.001). This relationship remained significant after accounting for age at surgery, ethnicity, body mass index, and pre-surgical oophorectomy (adjusted p <0.001). Four types of lesions were more likely to be absent in breast tissues exposed to longer durations of TT: cysts (median=16.2 months; p <0.01; adjusted p =0.01), fibroadenoma (median=14.8 months; p =0.02; adjusted p =0.07), pseudoangiomatous stromal hyperplasia (median=17.0 months; p <0.001; adjusted p <0.001), and papillomas (median=14.7 months; p =0.04; adjusted p =0.20). Columnar cell change and mild inflammation were also less likely to occur in subjects receiving TT ( p <0.05), but were not linked to the duration of TT. Atypia and ductal carcinoma in situ (DCIS) were detected in 11 subjects (2.5%) all of whom received TT ranging from 10.1 to 64.1 months. The incidental findings of high-risk lesions and carcinoma as well as the risk of cancer in residual breast tissue after chest-contouring surgery warrant the consideration of culturally sensitive routine breast cancer screening protocols for transgender men and masculine-centered gender non-conforming individuals. Long-term follow-up studies and molecular investigations are needed to understand the breast cancer risk of transgender individuals who receive TT.