Body Image in Transmen: Multidimensional Measurement and the Effects of Mastectomy

Plastic &Amp; Reconstructive Surgery

Bouman

et al. 2017

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Background:Although transgender surgery constitutes a growing field within plastic surgery, prospective studies on masculinizing mastectomies are lacking. The objectives of the present study were to prospectively follow a cohort of transmen undergoing mastectomy to assess technical and self-reported outcomes and to evaluate surgical decision-making.Methods:Fifty-four transmen were recruited during a 10-month period at the Department of Plastic Surgery of the Centre of Expertise on Gender Dysphoria. Preoperative assessment included standardized chest examination. Six months postoperatively, participants rated their satisfaction with surgery, and 12-month postoperative surgical outcomes were reviewed independently. Surgical decision-making was evaluated by comparing indications and outcomes per technique, and assessing the clinical validity of the most-used decision aid (using the Cohen's kappa statistic).Results:One periareolar mastectomy, 26 concentric circular mastectomies, and 22 inframammary skin resections with free nipple graft were performed in the authors’ cohort. Five participants were still to be operated on. Concentric circular mastectomy was performed in smaller or medium-size breasts with low ptosis grade and good elasticity, whereas the inframammary skin resection group showed a wider range of physical characteristics. Despite being performed in better quality breasts, concentric circular mastectomy was associated with more secondary corrections (38.5 percent), dehiscence, seroma, and lower postoperative satisfaction compared with inframammary skin resections. Clinical decision-making was generally in line with the published decision aid.Conclusions:Compared with inframammary skin resections, concentric circular mastectomy—despite being performed in favorable breast types—appears to produce poorer technical and self-reported outcomes. Surgical indications and preoperative counseling regarding secondary corrections may therefore be subject to improvement.CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, IV.

Section: Methodsmentioning

confidence: 99%

Surgical Indications and Outcomes of Mastectomy in Transmen: A Prospective Study of Technical and Self-Reported Measures

Plastic &Amp; Reconstructive Surgery

Bouman

et al. 2017

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“…Bilateral subcutaneous mastectomy, or chest wall masculinization surgery, is the most requested and usually the first gender affirming surgical treatment in trans men. Trans men are generally dissatisfied with their breasts, and often opt for this type of surgery to get a more masculine looking and esthetically pleasing chest (Hage & van Kesteren, 1995;van de Grift et al, 2016). Masculinizing mastectomy aims at the removal of feminine breast tissue and excessive skin, a proper reduction and positioning of the nipple-areola complex, obliteration of the inframammary fold, and minimization of chest-wall scars (Cregten-Escobar et al, 2012;Hage & Bloem, 1995;Hage & van Kesteren, 1995;Monstrey et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

Combining total laparoscopic hysterectomy and bilateral salpingo-oophorectomy with subcutaneous mastectomy in trans men: The effect on safety outcomes

International Journal of Transgender Health

Bouman

et al. 2020

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Background: Masculinizing mastectomy is the most requested gender affirming surgery (GAS) in trans men, followed by genital GAS. Mastectomy and total laparoscopic hysterectomy, with or without bilateral salpingo-oophorectomy (TLH ± BSO), can both be performed in one single operation session. However, data on complication rates of the combined procedure is scarce and no consensus exists on the preferred order of procedures. Aims: To compare safety outcomes between mastectomy performed in a single procedure with those when performed in a combined procedure and assess whether the order of procedures matters when they are combined. Methods: A retrospective chart review was performed of trans men who underwent masculinizing mastectomy with or without TLH ± BSO in a combined session. The effects of the surgical procedure on complication and reoperation rate of the chest were assessed using logistic regression. Results: In total, 480 trans men were included in the study. Of these, 212 patients underwent the combined procedure. The gynecological procedure was performed first in 152 (71.7%) patients. In the total sample, postoperative hematoma of the chest occurred in 11.3%; 16% in the combined versus 7.5% in the single mastectomy group (p ¼ 0.001). Reoperations due to hematoma of the chest were performed in 7.5% of all patients; 10.8% in the combined versus 4.9% in the single mastectomy group (p ¼ 0.017). The order of procedures in the combined group had no significant effect on postoperative hematoma of the chest (p ¼ 0.856), and reoperations (p ¼ 0.689). Conclusion: Combining masculinizing mastectomy with TLH ± BSO in one session was associated with significantly more hematoma and reoperations compared with separately performing mastectomy. This increased risk of complications after a combined procedure should be considered when deciding on surgical options. The order of procedures in a combined procedure did not have an effect on safety outcomes.

“… 7 Masculinizing chest surgery is considered the most important surgical intervention for many trans men. 8 Past studies of the effectiveness of mastectomy found that body image improved after surgery, 8 , 9 as did psychological well-being and experienced gender dysphoria. 10 Factors associated with treatment satisfaction and quality of life included treatment expectations, 11 physical appearance, 9 health care experiences and complications, 11 , 12 psychological distress, 9 and social support and discrimination.…”

mentioning

confidence: 99%

Subcutaneous Mastectomy Improves Satisfaction with Body and Psychosocial Function in Trans Men: Findings of a Cross-Sectional Study Using the BODY-Q Chest Module

Plastic &Amp; Reconstructive Surgery

Greijdanus

et al. 2018

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