Gender-affirming Mastectomy: Comparison of Periareolar and Double Incision Patterns

Abstract

Background: Gender-affirming mastectomy has become one of the most frequently performed procedures for transgender and nonbinary patients. Although there are a variety of potential surgical approaches available, the impact of technique on outcomes remains unclear. Here we present our experience performing periareolar and double incision mastectomies, with a focus on comparing patient demographics, preoperative risk factors, and surgical outcomes and complication rates between techniques. Methods: Retrospective review identified patients undergoing gender-affirming mastectomy by the senior author between 2017 and 2020. Patients were stratified according to surgical technique, with demographics and postoperative outcomes compared between groups. Results: In total, 490 patients underwent gender-affirming mastectomy during the study period. An estimated 96 patients underwent periareolar mastectomy, whereas 390 underwent double incision mastectomy. Demographics were similar between groups, and there were no differences in rates of hematoma (3.1% versus 5.6%, respectively; P = 0.90), seroma (33.3% versus 36.4%; P = 0.52), or revision procedures (14.6% versus 15.8% P = 0.84) based on technique. Conclusions: Our results demonstrate no difference in the rates of postoperative complications or revision procedures based on surgical technique. These results also suggest that with an experienced surgeon and proper patient selection, both techniques of gender-affirming mastectomy can be performed safely and with comparable outcomes.

Tranexamic Acid in Facial Feminization Surgery: Quantifying a High-risk Setting With Exogenous Estrogen Supplementation

“…This complication should serve as a reminder to physicians that care should be taken in patients with a history of VTE, with close attention paid to history taking. Furthermore, in a previous study, TXA use in patients undergoing gender-affirming mastectomy did not show an increase in risk for postoperative VTEs 18 . Overall, given the small rate of adverse events, in our cohort, TXA was safe to use in FFS.…”

“…Furthermore, in a previous study, TXA use in patients undergoing gender-affirming mastectomy did not show an increase in risk for postoperative VTEs. 18 Overall, given the small rate of adverse events, in our cohort, TXA was safe to use in FFS. Its use should follow standard practice and be recommended with consideration of other risk factors, such as previous history of VTEs.…”

One in Three Chance of Finding A Plastic Surgeon on Major Hospital Websites

“…10,[18][19][20] As the number of plastic surgeons offering gender-affirming mastectomies continues to rise, inclusion of plastic surgeons in mastectomy search results is important for patients seeking this operation. 21 It is not surprising that the h-index of physicians listed under the term "autologous breast reconstruction" has a higher PRS Global Open • 2023 6 h-index than those under other search terms, as patients undergoing such procedures are likely to be cared for at large medical centers, which typically emphasize and have support for research for academic surgeons.…”

A Relative Value Unit–Based Model for Targeted Nipple–Areola Complex Neurotization in Gender-Affirming Mastectomy

“…Double-incision mastectomy with free nipple grafts is the technique most often used to address dysphoria of the chest, and it has been shown to achieve an acceptable cosmesis, while improving gender congruence as well as body image satisfaction. 7 The dominant sensory innervation to the anterior chest wall and nipple areolar complex (NAC) is from the lateral cutaneous branches of the third through fifth intercostal nerves. 8,9 These nerves are traditionally transected during gender-affirming mastectomy, resulting in nearly all patients reporting decreased anterior chest wall and nipple sensation at more than 1 year postoperatively.…”

“…3 Double-incision mastectomy with free nipple grafts is the technique most often used to address dysphoria of the chest, and it has been shown to achieve an acceptable cosmesis, while improving gender congruence as well as body image satisfaction. 7 The dominant sensory innervation to the anterior chest wall and nipple areolar complex (NAC) is from the lateral cutaneous branches of the third through Gender-Affirming Surgery…”