Low Risk of Persistent Pain, Sensory Disturbances, and Complications Following Mastectomy After Gender-Affirming Surgery

Lang, Christian; Day, Deborah-Leigh; Klit, Anders; Mejdahl, Mathias Kvist; Holmgaard, Rikke

doi:10.1089/trgh.2020.0070

Cited by 13 publications

(5 citation statements)

References 20 publications

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“…Although further research is required, one retrospective study discussed that 27.4% of patients report persistent pain after gender mastectomy. 19 …”

Section: Discussionmentioning

confidence: 99%

“…Although further research is required, one retrospective study discussed that 27.4% of patients report persistent pain after gender mastectomy. 19 Further, the distal nerve graft end is split into fascicles, rather than being placed on the dermis as one unit. When grafts are placed as a single unit, all axons converge in one small area, which may result in focal hypersensitivity.…”

Section: Discussionmentioning

confidence: 99%

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Targeted Nipple Areola Complex Reinnervation in Gender-affirming Double Incision Mastectomy with Free Nipple Grafting

Gfrerer

Winograd

Austen

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: Restoration of breast sensation has become an important goal in autologous and implant-based breast reconstruction after cancer-related mastectomy. Although gender-affirming mastectomy with free nipple grafting (FNG) results in similar sensory deficits, chest reinnervation concepts have not been applied to this procedure. Methods: This article describes a novel technique to reinnervate the FNG in patients undergoing double incision gender mastectomy. Results: Our technique differs from previously described reinnervation techniques in several aspects: (1) the donor axon count is maximized by preserving the third to fifth lateral cutaneous nerves for coaptation to the nipple areola complex, (2) the reinnervation approach varies and is based on patient anatomy, (3) the distal graft or donor nerve is split into fascicles to increase the reinnervation zone, and (4) the split fascicles are coapted to the dermatosensory peripheral nerve elements of the dermis. Conclusion: Chest reinnervation is technically feasible in patients undergoing double incision gender mastectomy with FNG (please also see the video abstract).

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“…Although further research is required, one retrospective study discussed that 27.4% of patients report persistent pain after gender mastectomy. 19 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Targeted Nipple Areola Complex Reinnervation in Gender-affirming Double Incision Mastectomy with Free Nipple Grafting

Gfrerer

Winograd

Austen

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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“…In both studies, patients received pectoralis nerve blocks. A retrospective chart review ( 120 ) evaluated complication rates following top surgery, and surveyed patients about their experience with persistent postoperative pain. More than 25% of top surgery patients reported chronic pain, but 95% ( n = 77) of these patients did not require analgesics.…”

Section: Medical Care For Transgender Pain Patientsmentioning

confidence: 99%

“…This may be explained by the effects of prior ongoing gender affirming hormone therapy (GAHT) on pain scores but more research is needed to confirm this (118). Similarly, Robinson et al (119) prospectively compared top surgery to oncologic mastectomy without reconstruction and to mammoplasty breast reduction. They found that patients who underwent oncologic mastectomy consumed similar quantities of opioids to top surgery patients.…”

Section: Pain Phenotypes In Patients Undergoing Gender Affirmation Su...mentioning

confidence: 99%

Pain mechanisms in the transgender individual: a review

Anger,

Case,

Baranowski

et al. 2024

Front. Pain Res.

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Specific AimProvide an overview of the literature addressing major areas pertinent to pain in transgender persons and to identify areas of primary relevance for future research.MethodsA team of scholars that have previously published on different areas of related research met periodically though zoom conferencing between April 2021 and February 2023 to discuss relevant literature with the goal of providing an overview on the incidence, phenotype, and mechanisms of pain in transgender patients. Review sections were written after gathering information from systematic literature searches of published or publicly available electronic literature to be compiled for publication as part of a topical series on gender and pain in the Frontiers in Pain Research.ResultsWhile transgender individuals represent a significant and increasingly visible component of the population, many researchers and clinicians are not well informed about the diversity in gender identity, physiology, hormonal status, and gender-affirming medical procedures utilized by transgender and other gender diverse patients. Transgender and cisgender people present with many of the same medical concerns, but research and treatment of these medical needs must reflect an appreciation of how differences in sex, gender, gender-affirming medical procedures, and minoritized status impact pain.ConclusionsWhile significant advances have occurred in our appreciation of pain, the review indicates the need to support more targeted research on treatment and prevention of pain in transgender individuals. This is particularly relevant both for gender-affirming medical interventions and related medical care. Of particular importance is the need for large long-term follow-up studies to ascertain best practices for such procedures. A multi-disciplinary approach with personalized interventions is of particular importance to move forward.

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“…In relation to members of the transgender community, many experience distress, depression and anxiety which may contribute to the development of persistent pain states, such as fibromyalgia ( 44 ). Whether or not transgender individuals are more prone to PPP is still unknown due to the underrepresentation of minority groups in clinical research, although one recent study demonstrated 27.4% of trans-men undergoing bilateral mastectomy reported either unilateral or bilateral persistent pain after surgery ( 45 ). Studies with larger cohorts and documented medications such as hormone therapies are required to identify susceptibility of transgender individuals to PPP.…”

Section: Risk Factors For Postsurgical Painmentioning

confidence: 99%

The mechanisms and management of persistent postsurgical pain

2023

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An estimated 10%–50% of patients undergoing a surgical intervention will develop persistent postsurgical pain (PPP) lasting more than 3 months despite adequate acute pain management and the availability of minimally invasive procedures. The link between early and late pain outcomes for surgical procedures remains unclear—some patients improve while others develop persistent pain. The elective nature of a surgical procedure offers a unique opportunity for prophylactic or early intervention to prevent the development of PPP and improve our understanding of its associated risk factors, such as pre-operative anxiety and the duration of severe acute postoperative pain. Current perioperative pain management strategies often include opioids, but long-term consumption can lead to tolerance, addiction, opioid-induced hyperalgesia, and death. Pre-clinical models provide the opportunity to dissect mechanisms underpinning the transition from acute to chronic, or persistent, postsurgical pain. This review highlights putative mechanisms of PPP, including sensitisation of peripheral sensory neurons, neuroplasticity in the central nervous system and nociceptive signalling along the neuro-immune axis.

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Low Risk of Persistent Pain, Sensory Disturbances, and Complications Following Mastectomy After Gender-Affirming Surgery

Cited by 13 publications

References 20 publications

Targeted Nipple Areola Complex Reinnervation in Gender-affirming Double Incision Mastectomy with Free Nipple Grafting

Targeted Nipple Areola Complex Reinnervation in Gender-affirming Double Incision Mastectomy with Free Nipple Grafting

Pain mechanisms in the transgender individual: a review

The mechanisms and management of persistent postsurgical pain

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