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BackgroundGender-affirming mastectomy is a common surgery for the treatment of gender incongruence and gender dysphoria and improves quality of life. Hematoma rates for gender-affirming double incision mastectomies are between 2.8% and 8.1%. This study aims to investigate the utility of a blood pressure challenge, whereby the patient's blood pressure is medically increased intraoperatively to reveal bleeding vessels that can be addressed with additional hemostasis before skin closure, to reduce postoperative hematoma.MethodsA retrospective chart review of patients who underwent gender-affirming double incision mastectomies over a 6-year period by a single surgeon was conducted. Surgeries were separated into a blood pressure challenge experimental group and a non–blood pressure challenge control group. Demographics, surgical characteristics, and postoperative complications were compared between the 2 cohorts using Pearson χ2, Fisher exact, t tests, univariate logistic regression, and multivariable logistical regression. Significance was established at P < 0.05.ResultsA total of 92 patients (184 breasts) were included with 32 patients (64 breasts) in the control group and 60 (120 breasts) in the blood pressure challenge group. In the control group, there were 5 hematomas (7.81%) compared with 1 (0.83%) in the blood pressure challenge group (P = 0.02). On univariate logistical regression analysis, blood pressure challenge was the only variable significantly associated with hematoma (odds ratio, 0.1; 95% confidence interval, 0.01–0.63; P = 0.04). On multivariable logistical regression, after controlling for age, body mass index, smoking status, and mass of excised breast tissue, patients who underwent blood pressure challenge demonstrated lower hematoma rates (odds ratio, 0.08; 95% CI, 0.004–0.59; P = 0.04).ConclusionsUsing an intraoperative blood pressure challenge was associated with reduced hematoma rates. Guidelines for blood pressure challenge goals should be established to standardize care and reduce complications in gender-affirming mastectomies.

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PURPOSE In response to muscle contraction, irisin, a myokine released by skeletal muscle and white adipose tissue (WAT), is cleaved from the transmembrane protein fibronectin type III domain‐containing protein 5 (FNDC5) and has been shown to upregulate expression of uncoupling of protein 1 (UCP 1), inducing the browning of WAT. Prior research has demonstrated the protective role of irisin against insulin resistance, ischemic injury, and inflammation. We aimed to investigate the effects of Irisin on the differentiation of skeletal muscle myocytes. METHODS Mouse C2C12 skeletal muscle cells were incubated in Dulbecco’s Modified Eagle Medium (DMEM) until cell confluency reached 60%. Once the plates reached 60% confluency, 2% Horse Serum was added to the medium to induce differentiation. The cells were incubated at 37 degrees C. and 5% CO2 for three days. Cells were then incubated in medium containing irisin at differing concentrations: 0 ng/mL, 10 ng/mL, and 20 ng/mL for an additional three days. Significance was established at p < 0.05. The number of myotubes were compared days three and six in each group. Immunofluorescent staining of actinin, myosin heavy chain, myocyte enhancing factor‐2C (MEF2C), and mitochondrial capture was performed for each group. RESULTS The average number of myotubes per field for the no‐irisin group was 8.95 (+/‐ 7.85), compared to 13.6 myotubes (+/‐ 11.02 myotubes) in the 10 ng/mL irisin group and 30.5 myotubes (+/‐ 9.92 myotubes) in the 20 ng/mL irisin group. There was no statistical significance between the no‐irisin group and the 10 ng/mL group, however the number of myotubes in the 20 ng/mL group was statistically greater than both the no‐irisin group and the 10 ng/mL irisin group at p < 0.05. CONCLUSION Treatment of C2C12 myocytes with irisin at 20 ng/mL concentration induced increased myotube differentiation. Irisin appears to play a significant role in muscle regeneration and growth.