Surgical Treatment of Granulomatous Breast Deformities Caused by Injection of Foreign Substances in Transgender Women: A Case Series and Algorithm

Abstract

lthough breast augmentation using largevolume free foreign substance injections has been associated with devastating consequences, many patients continue to seek it out as a more affordable alternative to surgical augmentation. [1][2][3][4][5][6] Transgender women have been disproportionately affected by this practice (often referred to as "pumping"), with an estimated prevalence ranging from 16 percent to over 60 percent in some cities. [7][8][9][10][11][12] Though recent revisions to historically exclusionary public policies have increased access to gender-related care, many barriers remain. [13][14][15][16][17] Thus, many transgender women continue to receive illicit injections for breast augmentation and require care for the complications that arise.Large-volume injections of foreign substances to the breast have a wide spectrum of clinical presentations, from asymptomatic to chronic pain with severe deformity. Currently, there is little guidance in the literature on the management of

Discussion: Surgical Treatment of Granulomatous Breast Deformities Caused by Injection of Foreign Substances in Transgender Women: A Case Series and Algorithm

“…[2][3][4] The authors of this study share their experience treating a series of patients with significant granulomatous breast disease secondary to injection of foreign materials. 5 Cordero et al demonstrate that appropriate patient selection and choice of reconstructive modality based on the extent of tissue involvement allow for good results utilizing both implant-based and autologous techniques. As the authors point out, patients with severe skin involvement are best suited for free or pedicled tissue transfer for coverage, as initially described by Murariu et al 6 They also emphasize the importance of delayed reconstruction in patients presenting with infection, which is key in minimizing complications.…”

“…The authors should be commended for providing a foundation from which to develop evidence-based protocols for treating granulomatous disease secondary to illicit breast injections. 5 Improving the treatment of this morbid disease will significantly advance our care of transgender and nonbinary patients, who continue to face stigma and discrimination, which portends greater use of illicit interventions for gender affirmation. 11 Future, multicenter studies with longer-term outcomes will help solidify treatment algorithms for these reconstructive challenges.…”