Comprehensive Reconstructive Care for Patients of All Gender Identities After Cancer of the Breast

Abstract

Breast cancer can affect anyone; therefore, it affects people of all gender identities. Reconstructive options after breast cancer must then address the needs of all people. Our institution is unique in its provision of both high-level comprehensive breast and gender affirmation care. In our practice, patients have expressed gender diverse identities during their breast cancer reconstructive journey. In these cases, goals have deviated from traditional breast restoration, gravitating toward gender-affirming mastectomy, or results often seen with "top surgery." We present a framework for the administration of breast cancer care and discussions of reconstruction from a lens of gender inclusivity. Breast cancer is a diagnosis that has been gendered, resulting in the erasure and exclusion of reconstructive needs for people affected by breast cancer that are not cisgender women. This is illustrated through the case of a nonbinary individual seen in breast cancer clinic for multifocal ductal carcinoma in situ. Our standard review of options of "going flat," implant-based reconstruction, and autologous reconstruction led to initial confusion given their early exploration of gender identity co-occurring with a new diagnosis of breast cancer. These scenarios can be challenging when viewed solely from the perspective of a breast reconstructive surgeon or a gender-affirming surgeon alone. Both perspectives are often needed. Our gender-affirming and breast reconstructive teams have discussed methods to identify patients who require more robust discussion of gender identity and reconstructive options in the setting of breast cancer, such as chest masculinization. By adding gender-affirming surgeons to the list of providers available to counsel breast cancer patients, we may be able to better provide early education on all reconstructive options and appropriately address the needs of transgender and gender diverse people affected by breast cancer.

Beyond Mastectomy: The Incidence of Subsequent Aesthetic Procedures after Mastectomy with and without Breast Reconstruction

“…Men are beginning to seek more cosmetic procedures, 13 , 14 and understanding that patients of different ages, generations, and genders may have different expectations and aesthetic goals is important in aligning surgical strategies with patient desires. 15 There is ample literature around these elements of gender-affirming chest surgery and mastectomy as well as mastectomy for breast cancer in non-cis individuals, 16 , 17 but a lack of published work describing chest reconstruction after mastectomy in cis-men.…”

“…Men are beginning to seek more cosmetic procedures, 13,14 and understanding that patients of different ages, generations, and genders may have different expectations and aesthetic goals is important in aligning surgical strategies with patient desires. 15 There is ample literature around these elements of gender-affirming chest surgery and mastectomy as well as for breast cancer in non-cis individuals, 16,17 but a lack of published work describing chest reconstruction after mastectomy in cis-men. The emphasis on abdominoplasty, particularly in the reconstruction group, aligns with trends noted in the literature describing how postreconstruction patients often seek procedures that enhance overall body contour and symmetry.…”