Breastfeeding grief after chest masculinisation mastectomy and detransition: A case report with lessons about unanticipated harm

Abstract

An increasing number of young females are undergoing chest masculinsation mastectomy to affirm a gender identity and/or to relieve gender dysphoria. Some desist in their transgender identification and/or become reconciled with their sex, and then revert (or detransition). To the best of our knowledge, this report presents the first published case of a woman who had chest masculinisation surgery to affirm a gender identity as a trans man, but who later detransitioned, became pregnant and grieved her inability to breastfeed. She described a lack of understanding by maternity health providers of her experience and the importance she placed on breastfeeding. Subsequent poor maternity care contributed to her distress. The absence of breast function as a consideration in transgender surgical literature is highlighted. That breastfeeding is missing in counselling and consent guidelines for chest masculinisation mastectomy is also described as is the poor quality of existing research on detransition rates and benefit or otherwise of chest masculinising mastectomy. Recommendations are made for improving maternity care for detransitioned women1. Increasing numbers of chest masculinsation mastectomies will likely be followed by more new mothers without functioning breasts who will require honest, knowledgeable, and compassionate support.

A qualitative metasummary of detransition experiences with recommendations for psychological support

“…When transition involves irreversible medical treatments, permanent physical changes can become a continuous reminder of the decisions made and thus complicate the grieving process (e.g., Gribble et al, 2023 ). The nostalgia for the pre-transition self and its perceived conflict with the post-transition self may be a painful and recurrent experience.…”

Puberty Suppression for Pediatric Gender Dysphoria and the Child’s Right to an Open Future

“…The growing awareness of detransitioners who deeply regret their transition and feel they were harmed by those who facilitated it attests to our inability to reliably distinguish between those who will derive net benefit from medical transition and those who will be harmed (Butler & Hutchinson, 2020 ; Entwistle, 2021 ; Exposito-Campos, 2021 ; Gribble et al, 2023 ; Jorgensen, 2023a , 2023b ; Littman, 2021 ; Vandenbussche, 2022 ). The overall rates of detransition and regret in people who began medical transition as children are largely unknown; there are no large-scale studies with long-term follow-up on this cohort (Cohn, 2023 ; MacKinnon et al, 2023 ).…”

Transition Regret and Detransition: Meanings and Uncertainties

“…Many young people adopted a transgender identity in the context of family dysfunction or psychosocial issues (Bonfatto & Crasnow, 2018 ; D'Angelo, 2018 ; Kaltiala-Heino et al, 2015 ; Zucker, 2019 ). Precursors have included sexual assault and trauma (Evans, 2023 ; Gribble et al, 2023 ; Littman, 2018 , 2021 ; Marchiano, 2021 ; Pullen Sansfaçon et al, 2023 ; Respaut et al, 2022 ). Parents have reported the onset of gender dysphoria in the context of heavy engagement with social media and cases have clustered within peer groups where one or multiple members identified as transgender or non-binary (Haltigan et al, 2023 ; Kornienko et al, 2016 ; Littman, 2018 ; Sanders et al, 2023 ).…”

“…Gaps in the quality and accessibility of medical and mental healthcare have consistently been highlighted in studies and personal testimonies of detransitioners (Littman, 2021 ; MacKinnon et al, 2022b ; Vandenbussche, 2022 ). Many detransitioners reported not feeling properly informed about health implications of treatments before undergoing them (Gribble et al, 2023 ; Littman, 2021 ; Pullen Sansfaçon et al, 2023 ; Vandenbussche, 2022 ). Likewise, many felt that they did not receive sufficient exploration of preexisting psychological and emotional problems and continued to struggle post-transition when they realized gender transition was not a panacea (Littman, 2021 ; Pullen Sansfaçon et al, 2023 ; Respaut et al, 2022 ; Sanders et al, 2023 ; Vandenbussche, 2022 ).…”