Hematoma following gender-affirming mastectomy: A systematic review of the evidence

Bekisz, Jonathan M.; Boyd, Carter J.; Daar, David A.; Cripps, Courtney N.; Bluebond-Langner, Rachel

doi:10.1016/j.bjps.2022.04.081

Cited by 6 publications

(6 citation statements)

References 38 publications

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“…21 Two frequent postoperative complications in patients undergoing gender-affirming mastectomy are seroma and hematoma, with the latter being the most common overall and the most common cause for return to the operating room. 3 Despite frequent use in other surgical specialties and increasing popularity within plastic surgery, 18,19 this study represents the first to evaluate the effect of TXA among patients undergoing gender-affirming mastectomy. Our results demonstrated significantly reduced rates of both hematoma and seroma in patients who received intravenous TXA without increased rates of VTE or other adverse events.…”

Section: Discussionmentioning

confidence: 98%

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Use of Tranexamic Acid in Gender-Affirming Mastectomy Reduces Rates of Postoperative Hematoma and Seroma

Rifkin

Parker

Bluebond-Langner

2023

Plastic &Amp; Reconstructive Surgery

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BACKGROUND: The established safety and efficacy of tranexamic acid (TXA) in minimizing perioperative blood loss has led to increased interest within plastic surgery. Prior studies demonstrate decreased edema, ecchymosis, and reduced rates of postoperative collections with administration of TXA, however its use has not been reported in gender-affirming mastectomy. This represents the first study to evaluate the impact of TXA on postoperative outcomes in patients undergoing gender-affirming mastectomy. METHODS: A single-center cohort study was performed analyzing all consecutive patients undergoing top surgery with the senior author between February 2017 and October 2022. Beginning in June 2021, all patients received 1000 mg intravenous TXA prior to incision and 1000 mg at the conclusion of the procedure. Patients were stratified according to intraoperative administration of TXA, with demographics, surgical characteristics, and postoperative outcomes compared between groups. RESULTS: A total of 851 patients underwent gender-affirming mastectomy. Of these, 646 cases were performed without TXA, while 205 patients received intravenous TXA intraoperatively as above. Patients who received TXA had significantly lower rates of seroma (20.5% vs. 33.0%; p<0.001), and hematoma (0.5% vs. 5.7%; p=0.002). There was no difference in rates of surgical site infection (p=0.74), and use of TXA was not associated with increased rates of venous thromboembolism (p=0.42). CONCLUSIONS: Intraoperative administration of TXA in patients undergoing top surgery may safely reduce the risk of postoperative seroma and hematoma without increased risk of thromboembolic events. Additional data collection and prospective studies are warranted to corroborate these findings.

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Section: Discussionmentioning

confidence: 98%

“…1,2 Postoperative seroma and hematoma are two common complications of gender-affirming mastectomy, with the latter being the most frequently reported, occurring in up to 31.2% of patients, which is substantially higher than in other types of breast surgery. 3…”

mentioning

confidence: 99%

Use of Tranexamic Acid in Gender-Affirming Mastectomy Reduces Rates of Postoperative Hematoma and Seroma

Rifkin

Parker

Bluebond-Langner

2023

Plastic &Amp; Reconstructive Surgery

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“…1,14,15 In addition, a large systematic review demonstrated there is no association between usage of testosterone and hematoma in gender-affirming mastectomy. 16 Rather, the strongest risk factor of developing a hematoma is due to the surgical technique of limited incision such as periareolar or circumareolar approaches. 16 A recently published study comparing complication profiles in patients who discontinued testosterone versus patients who maintained on HRT found that there was no difference in postoperative complication rates including hematoma, seroma, VTE, and overall complications.…”

Section: Discussionmentioning

confidence: 99%

“…16 Rather, the strongest risk factor of developing a hematoma is due to the surgical technique of limited incision such as periareolar or circumareolar approaches. 16 A recently published study comparing complication profiles in patients who discontinued testosterone versus patients who maintained on HRT found that there was no difference in postoperative complication rates including hematoma, seroma, VTE, and overall complications. 17 Boskey et al 4 synthesized all the surgical risks of exogenous hormones in transgender and gender-diverse patients and concluded that the current evidence does not support routine discontinuation of HRT before GAS.…”

Section: Discussionmentioning

confidence: 99%

“…Current evidence shows that there is no increased perioperative rate of VTE for patients who are on HRT, compared with patients who discontinued HRT in the perioperative period 1,14,15 . In addition, a large systematic review demonstrated there is no association between usage of testosterone and hematoma in gender-affirming mastectomy 16 . Rather, the strongest risk factor of developing a hematoma is due to the surgical technique of limited incision such as periareolar or circumareolar approaches 16 .…”

Section: Discussionmentioning

confidence: 99%

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Patterns of Perioperative Hormone Therapy for Gender-Affirming Surgery

Hung,

Assi,

Park

et al. 2024

Ann Plast Surg

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Introduction There is no consensus regarding perioperative hormone replacement therapy (HRT) for gender-affirming surgery (GAS). Common concerns for continuing perioperative HRT included risk of deep vein thrombosis (DVT) or hematoma. However, discontinuing HRT is not risk free and may cause mood swing or increased anxiety. Our study aimed to investigate current patterns of HRT before GAS worldwide. Methods The first stage of Delphi technique was implemented by sending a 27-item survey to all surgeons (total n = 150; 94 plastic surgeon, 35 urologist, and 21 gynecologists) of the World Professional Association for Transgender Health who perform GAS. Survey themes included the hormone type, duration, and usage of DVT prophylaxis. Results Overall survey response rate was 34% (total n = 51; 8 urologists, 35 plastic surgeons, and 8 gynecologists). The majority of surgeons are US-based (n = 39, 76%). The most common HRTs are in injection form (n = 28, 55%). The majority of surgeons do not stop HRT before GAS and do provide DVT prophylaxis to all patients <1 week after GAS. The most common procedure that surgeons discontinue HRT is feminizing bottom surgery (43%). For surgeons who discontinue HRT before GAS, there is a wide variation on discontinuation schedule. Conclusions There is considerable variation in perioperative HRT patterns for GAS. Further research is needed to develop a data-driven consensus guideline to provide high quality of care for transgender and nonbinary patients.

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Gender‐affirming surgeries for transgender and gender diverse individuals and associated health outcomes

Rezaei,

Miller,

Miranda

et al. 2024

Behavioral Sci & The Law

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Gender‐affirming care is treatment that recognizes and affirms the gender identity of transgender and gender‐diverse (TGD) individuals. Though not all TGD people choose to surgically transition, gender‐affirming surgeries (GAS) are an important part of many TGD people's transition. GAS can include a wide array of procedures aimed at aligning an individual's physical characteristics and gender identity. This review describes the most common procedures considered to be GAS, detailing important relevant considerations for each procedure. These include transfeminine procedures (i.e., breast augmentation, penile inversion vaginoplasty, orchiectomy, tracheal shave, and facial feminization); transmasculine procedures (i.e., chest masculinization, hysterectomy, phalloplasty, and metoidioplasty); and other procedures (i.e., fertility preservation and hair removal). Patient outcomes and the legal landscape for GAS are also discussed to contextualize these procedures within largest discourses surrounding gender‐affirming care.

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Hematoma following gender-affirming mastectomy: A systematic review of the evidence

Cited by 6 publications

References 38 publications

Use of Tranexamic Acid in Gender-Affirming Mastectomy Reduces Rates of Postoperative Hematoma and Seroma

Use of Tranexamic Acid in Gender-Affirming Mastectomy Reduces Rates of Postoperative Hematoma and Seroma

Patterns of Perioperative Hormone Therapy for Gender-Affirming Surgery

Gender‐affirming surgeries for transgender and gender diverse individuals and associated health outcomes

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