(003) The Impact of Gender Affirming Mastectomy on the Sexual Health and Satisfaction of Trans Patients

Abstract

Introduction Gender-affirming mastectomy (GAM) is the most commonly performed gender-affirming surgery. Unfortunately, many areas of sexual health for transmasculine people are understudied. In particular, there are few studies that assess how chest and nipple stimulation, or lack of sensation, affect the sexual health and satisfaction of trans patients after GAM. Objective This study aims to 1) assess the importance of chest and nipple stimulation for trans patients before any chest surgery, 2) evaluate how GAM affects patients’ sexual health postoperatively, and 3) investigate how chest and nipple sensation change after GAM. Methods This is a prospective study performed at one institution. All participants are patients recruited at their GAM consultation or follow-up appointment. Pre-operative and post-operative surveys were developed based on previous validated Patient Reported Quality of Life Survey with multiple rounds of editing by two gender affirming surgeons. Surveys were distributed through Qualtrics (Qualtrics XM, Seattle, Washington). Results Since July 2021, 144 unique surveys (45 unique pre-operative and 99 unique post-operative) have been completed. The three most common gender identities are man (43%), non-binary (25%), and transgender man (9%). Eighty-four to 89% of pre-operative patients reported being able to sense normal pressure, light touch, and temperature on their chests. Sixty-two percent of preoperative patients were not concerned about potential loss of nipple sensation after surgery. Compared to their sensation before top surgery, 43 – 65% of post-operative patients reported they had decreased sensation of normal pressure, light touch, and temperature on their chests and nipples. Regarding sexual satisfaction levels, 76% of pre-operative patients reported that nipple stimulation is sometimes, rarely, or never involved in their sexual activities. Seventy-six percent of preoperative patients also stated that nipple and chest stimulation is slightly important or not at all important to their sexual activity. Compared to their sexual health pre-operatively, 59% of post-operative patients reported that the importance of their nipple and chest stimulation stayed the same, is little less, or much less important to their sexual life after the operation. After surgery, 40% of patients thought their sexual satisfaction was much or a little better. Less than 1% of patients reported that their sexual satisfaction was much worse. One hundred percent of post-operative patients were satisfied having undergone GAM and agreed that top surgery had changed their life for the better. Conclusions Sexual health of patients undergoing GAM has rarely been studied before. This study shows that nipple stimulation for the majority of top surgery patients is not heavily involved in their sexual activities and may actually decrease after surgery. Although most patients report decreased sensation postoperatively, patients’ overall sexual satisfaction does not change and for some may even improve after surgery. GAM can immensely improve quality of life while preserving or even improving patients’ sexual health. Disclosure No

A Relative Value Unit–Based Model for Targeted Nipple–Areola Complex Neurotization in Gender-Affirming Mastectomy

“…A survey of transmasculine patients conducted by Song et al found that nipple sensation was important to 76% of the respondents. 13 …”

“…A survey of transmasculine patients conducted by Song et al found that nipple sensation was important to 76% of the respondents. 13 Advances in peripheral nerve surgery have allowed for the pioneering of new strategies to neurotize the chest during gender-affirming mastectomy. 14 Rochlin et al and Gfrerer et al describe techniques that use either direct coaptation or an allograft interposition to reinnervate the NAC with the lateral cutaneous branches of the intercostal nerves preserved during dissection.…”