Gender-Affirming Mastectomy in Transmasculine Patients

Rothenberg, Kara A.; Gologorsky, Rebecca C.; Hojilla, J Carlo; Tang, Annie; Cohan, Caitlin M.; Beattie, Genna; Yokoo, Karen M.

doi:10.1097/sap.0000000000002712

Cited by 15 publications

(17 citation statements)

References 34 publications

(65 reference statements)

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“…This is consistent with other retrospective studies by Rothenberg et al 13 and Cuccolo et al 21 Current literature on the association between BMI and postoperative complications after CMS is limited to case series and single institution studies with small sample sizes and little representation of patients within the morbidly obese and super obese categories. 4,[11][12][13] This has led to difficulty in delineating BMI cutoffs for CMS and variability across providers. A single surgeon retrospective case review of 27 obese CMS patients, with a mean BMI of 39.5 kg/m 2 (range, 30.7-50 kg/m 2 ), found that the rate of acute complications was comparable with that of nonobese patients.…”

Section: Discussionsupporting

confidence: 90%

“…11 A single institution retrospective study on 948 patients, including only 27 patients with BMI >40 kg/m 2 , also found no significant difference in complication rate between obese versus nonobese patients undergoing CMS. 13 Another single surgeon review of 145 CMS patients, including only 5 patients with BMI >50 kg/m 2 , found a significant increase in postoperative infections among patients with BMI >40 kg/m 2 compared with nonobese patients. 12 Our study is advantageous in that it is based on a national registry and includes the largest number of CMS patients to date, as well as the largest proportion of patients who belong to the morbidly obese and super obese categories.…”

Section: Discussionmentioning

confidence: 99%

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Association of High Body Mass Index With Postoperative Complications After Chest Masculinization Surgery

Hassan,

Schuster,

Ascha

et al. 2023

Ann Plast Surg

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Purpose Body mass index (BMI) requirements for transgender and nonbinary patients undergoing chest masculinization surgery (CMS) are not standardized and based on small sample sizes. This is the largest and first national retrospective study to determine the association between BMI and postoperative complications. Methods The National Surgical Quality Improvement Program 2012–2020 was queried for CMS patients. The primary outcome was incidence of at least one complication within 30 days. Secondary outcomes were incidence of major and minor complications. Body mass index (in kilograms per square meter) was categorized as category 0 (<30), 1 (30–34.9), 2 (35–39.9), 3 (40–44.9), 4 (45–49.9), and 5 (≥50). Logistic regression was used to evaluate the association between BMI and outcomes. Results Of 2317 patients, median BMI was 27.4 kg/m2 (interquartile range, 23.4–32.2 kg/m2). Body mass index range was 15.6 to 64.9 kg/m2. While increasing BMI was significantly associated with greater odds of at least one complication, no patients experienced severe morbidity, regardless of BMI. Patients with BMI ≥50 kg/m2 had an adjusted odds ratio [aOR, 95% confidence interval (CI)] of 3.63 (1.02–12.85) and 36.62 (2.96–>100) greater odds of at least one complication and urinary tract infection compared with nonobese patients, respectively. Patients with BMI ≥35 kg/m2 had an adjusted odds ratio (95% CI) of 5.06 (1.5–17.04) and 5.13 (1.89–13.95) greater odds of readmission and surgical site infection compared with nonobese patients, respectively. Conclusions Chest masculinization surgery in higher BMI patients is associated with greater odds of unplanned readmission. Given the low risk for severe complications in higher BMI individuals, we recommend re-evaluation of BMI cutoffs for CMS patients.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Association of High Body Mass Index With Postoperative Complications After Chest Masculinization Surgery

Hassan,

Schuster,

Ascha

et al. 2023

Ann Plast Surg

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“…Although studies have evaluated the increase in gender-affirming surgery in adults, 28,29 we know of none that report the incidence of gender-affirming mastectomy in adolescents. Similarly, complications of gender-affirming mastectomy have been described in adults, 30–32 whereas studies in adolescents are limited to self-reported outcomes 33,34 . A few small case series indicated that adolescents who underwent gender-affirming surgeries, including mastectomy, have improvement in their gender dysphoria, which resulted in improved psychological well-being comparable with that of the general population 33–38 .…”

mentioning

confidence: 99%

Gender-Affirming Mastectomy Trends and Surgical Outcomes in Adolescents

Tang,

Hojilla,

Jackson

et al. 2022

Ann Plast Surg

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Background There are more than 150,000 transgender adolescents in the United States, yet research on outcomes after gender-affirming mastectomy in this age group is limited. We evaluated gender-affirming mastectomy incidence and postoperative complications, including regret, in adolescents within our integrated health care system. Methods Gender-affirming mastectomies performed from January 1, 2013, to July 31, 2020, in adolescents 12 to 17 years of age at the time of referral were identified. The incidence of gender-affirming mastectomy was calculated by dividing the number of patients undergoing these procedures by the number of adolescents assigned female at birth aged 12 to 17 years within our system at the beginning of each year and amount of follow-up time within that year. Demographic information, clinical characteristics (comorbidities, mental health history, testosterone use), surgical technique, and complications, including mention of regret, of patients who underwent surgery were summarized. Patients with and without complications were compared to evaluate for differences in demographic or clinical characteristics using χ2 tests. Results The incidence of gender-affirming mastectomy increased 13-fold (3.7–47.7 per 100,000 person-years) during the study period. Of the 209 patients who underwent surgery, the median age at referral was 16 years (range, 12–17 years) and the most common technique was double incision (85%). For patients with greater than 1-year follow-up (n = 137; 65.6%), at least one complication was found in 7.3% (n = 10), which included hematoma (3.6%), infection (2.9%), hypertrophic scars requiring steroid injection (2.9%), seroma (0.7%), and suture granuloma (0.7%); 10.9% underwent revision (n = 15). There were no statistically significant differences in patient demographics and clinical characteristics between those with and without complications (P > 0.05). Two patients (0.95%) had documented postoperative regret, but neither underwent reversal surgery at follow-up of 3 and 7 years postoperatively. Conclusions Between 2013 and 2020, we observed a marked increase in gender-affirming mastectomies in adolescents. The prevalence of surgical complications was low, and of more than 200 adolescents who underwent surgery, only 2 expressed regret, neither of which underwent a reversal operation. Our study provides useful and positive guidance for adolescent patients, their families, and providers regarding favorable outcomes with gender-affirming mastectomy.

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“…Our overall complication rates for these three groups (4.3%, 6.9%, and 5.8%, respectively) compares favorably with previously published data on gender-affirming mastectomy, which is cited as between 3% and 21.3% in recent large-volume cohorts. 3,19,[22][23][24][25][26][27][28][29] Patients who continued perioperative testosterone were observed to have a 2.8% rate of hematoma. This is consistent with previously reported gender-affirming mastectomy data, in which hematoma rates are cited to range from 0.3% to 49%.…”

Section: Discussionmentioning

confidence: 99%

“…This is consistent with previously reported gender-affirming mastectomy data, in which hematoma rates are cited to range from 0.3% to 49%. 19,21–27,29…”

Section: Discussionmentioning

confidence: 99%

Perioperative Hormone Management in Gender-Affirming Mastectomy: Is Stopping Testosterone before Top Surgery Really Necessary?

Robinson

Rifkin

Kloer

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Gender-affirming mastectomy, or “top surgery,” has become one of the most frequently performed procedures for transgender and nonbinary patients. However, management of perioperative testosterone therapy remains controversial. Despite a lack of supporting evidence, many surgeons require cessation of testosterone before top surgery. This is the first study to compare complication rates in patients undergoing gender-affirming mastectomy with and without discontinuation of perioperative testosterone. Methods: This retrospective review included patients undergoing top surgery by the senior author between 2017 and 2020. Reflecting a change in the senior author’s practice, before May of 2019, all patients were required to discontinue testosterone before surgery; all patients treated after this point continued their testosterone regimens throughout the perioperative period. Patients were stratified according to testosterone regimen and perioperative hormone management, with demographic characteristics and postoperative outcomes compared among groups. Results: A total of 490 patients undergoing gender-affirming mastectomy during the study period were included. Testosterone was held perioperatively in 175 patients and continued in 211 patients; 104 patients never received testosterone therapy. Demographic characteristics were similar among groups and there was no difference in rates of hematoma (2.9% versus 2.8% versus 2.9%, respectively; P = 0.99), seroma (1.1% versus 0% versus 1%, respectively; P = 0.31), venous thromboembolism (0% versus 0.5% versus 0%, respectively; P = 0.99), or overall complications (6.9% versus 4.3% versus 5.8%, respectively; P = 0.54). Conclusions: Our results demonstrate no difference in postoperative complication rates among groups. Whereas further investigation is warranted, our data suggest that routine cessation of testosterone in the perioperative period is not necessary for patients undergoing gender-affirming mastectomy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

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Gender-Affirming Mastectomy in Transmasculine Patients

Cited by 15 publications

References 34 publications

Association of High Body Mass Index With Postoperative Complications After Chest Masculinization Surgery

Association of High Body Mass Index With Postoperative Complications After Chest Masculinization Surgery

Gender-Affirming Mastectomy Trends and Surgical Outcomes in Adolescents

Perioperative Hormone Management in Gender-Affirming Mastectomy: Is Stopping Testosterone before Top Surgery Really Necessary?

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