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

Abstract

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.

Feasibility, Safety, and Satisfaction of Combined Hysterectomy with Bilateral Salpingo-Oophorectomy and Chest Surgery in Transgender and Gender Non-Conforming Individuals

“…The order of surgeries did not affect the complication rate (16.4% vs. 15% in the HBSO first versus mastectomy first group, respectively). The frequency of thoracic hematoma in this sample of combined surgery was 7.6%, which is lower than that described by Elfering and previous reports of combined surgery (12-17%) [7,9]. The analysis did not detect any significant difference in the complication rate according to the order of surgeries (9.7% in chest surgery first vs. 2.8% HBSO surgery first p = n.s.…”

“…Res. Public Health 2021, 18, of 13 transmen in terms of scarring, hospitalization time, and conservation of vasculature for potential future gender affirming surgeries [3,7,8].…”

“…All routes of hysterectomy are feasible and safe when performed for gender affirmation, with no documented increased risk of complications compared to the cisgender population and are associated with an improved quality of life [ 3 , 4 , 5 , 6 ]. Minimally invasive approaches are the most common (laparoscopy, vaginal, laparoscopic-assisted vaginal, and robot-assisted laparoscopic route), each with particular benefits for transmen in terms of scarring, hospitalization time, and conservation of vasculature for potential future gender affirming surgeries [ 3 , 7 , 8 ].…”

“…Combining chest masculinization and hysterectomy with bilateral salpingo-oophorectomy (HBSO) in the same operation may carry some advantages such as lower level of anxiety and stress and lower cost. Four studies have been published on this topic and outcomes on less than 400 combined surgeries have been reported [ 3 , 7 , 8 , 9 ]. However, there is no agreement as to whether the combined surgery is associated with a higher complication rate when compared to the single surgery.…”

“…In studies that have described combined surgery, the complication rates range from 7.4 to 25.3%. Elfering et al reported an increased risk of complications after combined surgery compared with separately performed chest surgery, while other authors did not find significant differences in the complication rate when comparing the combined procedure to chest masculinizing surgery alone [ 3 , 7 , 8 , 9 ]. It is not clear whether the order of surgeries has an influence on the complication rate.…”