Chest Surgery in Female to Male Transgender Individuals

Frederick, Michael J.; Berhanu, Aaron E.; Bartlett, Richard A.

doi:10.1097/sap.0000000000000882

Cited by 71 publications

(75 citation statements)

References 10 publications

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“…To begin, the first case series of masculinizing mastectomy was not published until 1995; 30 despite the recent increase in similar studies, the vast majority are single institution in nature. 5,11,12,14,30,31 Furthermore, these projects are largely related to technique and aesthetic outcome, with fewer reporting on epidemiology and complication rates. In contrast, there is an abundance of literature pertaining to mastectomy for indications other than masculinizing chest reconstruction, including cancer prophylaxis 20 and correction of gynecomastia.…”

Section: Discussionmentioning

confidence: 99%

“…Numerous studies have been published on the technical considerations and aesthetic outcomes following mastectomy in the transmasculine population. 10 However, the majority of this literature comprises single-institution studies with relatively small sample sizes, 5,11–17 thus limiting generalizability. Furthermore, much of the transgender epidemiologic data arise from survey-based studies, 18,19 thereby precluding a direct assessment of surgical patient demographics and outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Mastectomy in Transgender and Cisgender Patients: A Comparative Analysis of Epidemiology and Postoperative Outcomes

Cuccolo

Kang

Boskey

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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Background: Mastectomy is a commonly requested procedure in the transmasculine population and has been shown to improve quality of life, although there is limited research on safety. The aim of this study was to provide a nationwide assessment of epidemiology and postoperative outcomes following masculinizing mastectomy and compare them with outcomes following mastectomy for cancer prophylaxis and gynecomastia correction in cisgender patients. Methods: The American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2017 was queried using International Classification of Diseases and Current Procedural Terminology codes to create cohorts of mastectomies for 3 indications: transmasculine chest reconstruction, cancer risk-reduction (CRRM), and gynecomastia treatment (GM). Demographic characteristics, comorbidities, and postoperative complications were compared between the 3 cohorts. Multivariable regression analysis was used to control for confounders. Results: A total of 4,170 mastectomies were identified, of which 14.8% (n = 591) were transmasculine, 17.6% (n = 701) were CRRM, and 67.6% (n = 2,692) were GM. Plastic surgeons performed the majority of transmasculine cases (85.3%), compared with the general surgeons in the CRRM (97.9%) and GM (73.7%) cohorts. All-cause complication rates in the transmasculine, CRRM, and GM cohorts were 4.7%, 10.4%, and 3.7%, respectively. After controlling for confounding variables, transgender males were not at an increased risk for all-cause or wound complications. Multivariable regression identified BMI as a predictor of all-cause and wound complications. Conclusion: Mastectomy is a safe and efficacious procedure for treating gender dysphoria in the transgender male, with an acceptable and reassuring complication profile similar to that seen in cisgender patients who approximate either the natal sex characteristics or the new hormonal environment.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mastectomy in Transgender and Cisgender Patients: A Comparative Analysis of Epidemiology and Postoperative Outcomes

Cuccolo

Kang

Boskey

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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“…Image D places the NAC at the fourth to fifth ICS about 11 cm from the sternal midline. 22 Image E utilized the fourth ICS and lateral border of the pectoralis muscle as landmarks for the ideal NAC placement, which is the preferred algorithm of the senior author (J.D.K.). 17 For Image F, we initially calculated the suprasternal notch (STN) to nipple distance as 16.9 cm, using the average ratio of the STN-to-nipple distance to the patient’s height of 0.104 and assuming that the average female height is 162.56 cm.…”

Section: Methodsmentioning

confidence: 99%

Crowdsourcing the Ideal Nipple-Areolar Complex Position for Chest Masculinization Surgery

Cohen

Maisner

Hazim

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Background: Chest masculinization surgery is increasing in prevalence. However, the ideal location of the nipple-areolar complex (NAC) is unknown. Our purpose was to determine the most aesthetically favorable male NAC position for use in chest masculinization through crowdsourcing. Methods: Using Adobe Photoshop CC 2017, 8 locations for the NAC were created based on previous literature descriptions. Amazon Mechanical Turk was utilized as a crowdsourcing interface—respondents were asked to rank the top 3 most favorable and least favorable images. Analysis of variance with subsequent Tukey HSD was used for a statistical comparison of favorability scores for different NAC localizations. Values were considered significant with P < 0.05. Results: Eight hundred nineteen respondents participated in the survey. NAC positions of Images C (mean score = 1.9222) and A (mean score = 1.7365) received higher favorability scores than those of Images D, E, F, G, and H (all P < 0.05). There were no significant differences between Images C and A (C versus A: P = 0.6412). NAC localizations from Images G (mean score = −2.0353) and H (mean score = −1.6908) received lower favorability scores than Images A, B, C, D, E, and F (all P < 0.05). There were no significant differences between Images G and H (P = 0.2279). Conclusions: Most respondents preferred Images C and A, and few favored Images G and H, suggesting that lateral NAC placement is favored over more medial localizations. Additionally, both Images C and A utilize relatively inferior NAC placements. Therefore, we recommend a location inferior and lateral to the NAC. Ultimately, NAC localization during chest masculinization will be the result of shared decision-making between the patient and the surgeon to fulfill each patient’s aesthetic goals.

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“…Our department applied lessons learned from a double incision female‐to‐male mastectomy (FTTM) to this patient population, as postoperative goals are similar with the removal of breast tissue with a postoperative esthetically pleasing breast concavity. Common reasons to pursue revisionary surgery in FTTM with a double incision include surgical dog‐ears and residual axillary tissue . These are also concerns in women undergoing mastectomy without reconstruction.…”

Section: Mastectomy Closure In Non‐reconstructive Patientsmentioning

confidence: 99%

Collaboration between breast and reconstructive surgery in optimizing outcomes for women with breast cancer

Djohan

Knackstedt

2019

Breast J

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Performing successful breast reconstruction after mastectomy requires communication and collaboration between the breast and reconstruction surgery teams. This allows for oncologic safety while providing esthetic and functional reconstruction. In this article, we discuss the numerous techniques we have adopted successfully into our breast reconstructive practice that were possible due to this collaboration including prophylactic lymphaticovenous bypass (LVB), tumor ultrasound-guided incision (TUGI), esthetic closure in patients not eligible or desiring reconstruction, nerve identification at time of mastectomy to allow for sensate reconstruction, and the prevention of chronic pain and strategic oncoplasty. K E Y W O R D S breast cancer, collaboration, reconstructive surgery How to cite this article: Djohan R, Knackstedt R.Collaboration between breast and reconstructive surgery in optimizing outcomes for women with breast cancer. Breast J.

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Chest Surgery in Female to Male Transgender Individuals

Abstract: 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.

Cited by 71 publications

References 10 publications

Mastectomy in Transgender and Cisgender Patients: A Comparative Analysis of Epidemiology and Postoperative Outcomes

Mastectomy in Transgender and Cisgender Patients: A Comparative Analysis of Epidemiology and Postoperative Outcomes

Crowdsourcing the Ideal Nipple-Areolar Complex Position for Chest Masculinization Surgery

Collaboration between breast and reconstructive surgery in optimizing outcomes for women with breast cancer

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