Female-to-Male Gender-Affirming Chest Reconstruction Surgery

Ammari, Tareq; Sluiter, Emily C.; Gast, Katherine M.; Kuzon, William M.

doi:10.1093/asj/sjy098

Cited by 64 publications

(47 citation statements)

References 45 publications

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“…Of note, a 2018 Continuing Medical Education article on various techniques in masculinizing chest reconstruction reported rates of hematoma formation in masculinizing chest reconstruction that ranged between 4.5% and 33%. 41 It is possible that, given larger numbers, this difference in rates would be statistically, if not necessarily clinically, significant. If so, it may be due to the differences in technique used for transmasculine chest reconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…As expected, BMI and smoking were identified as independent predictors of postoperative complications in our study. The association between BMI and postoperative complications has been extensively documented, including studies on mastectomy for transgender chest reconstruction, 30,41 cancer prophylaxis, 49 and gynecomastia. 44 Smoking has also been shown to adversely impact outcomes following risk-reduction mastectomy.…”

Section: Discussionmentioning

confidence: 99%

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Mastectomy in Transgender and Cisgender Patients: A Comparative Analysis of Epidemiology and Postoperative Outcomes

Cuccolo

Kang

Boskey

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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Background: Mastectomy is a commonly requested procedure in the transmasculine population and has been shown to improve quality of life, although there is limited research on safety. The aim of this study was to provide a nationwide assessment of epidemiology and postoperative outcomes following masculinizing mastectomy and compare them with outcomes following mastectomy for cancer prophylaxis and gynecomastia correction in cisgender patients. Methods: The American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2017 was queried using International Classification of Diseases and Current Procedural Terminology codes to create cohorts of mastectomies for 3 indications: transmasculine chest reconstruction, cancer risk-reduction (CRRM), and gynecomastia treatment (GM). Demographic characteristics, comorbidities, and postoperative complications were compared between the 3 cohorts. Multivariable regression analysis was used to control for confounders. Results: A total of 4,170 mastectomies were identified, of which 14.8% (n = 591) were transmasculine, 17.6% (n = 701) were CRRM, and 67.6% (n = 2,692) were GM. Plastic surgeons performed the majority of transmasculine cases (85.3%), compared with the general surgeons in the CRRM (97.9%) and GM (73.7%) cohorts. All-cause complication rates in the transmasculine, CRRM, and GM cohorts were 4.7%, 10.4%, and 3.7%, respectively. After controlling for confounding variables, transgender males were not at an increased risk for all-cause or wound complications. Multivariable regression identified BMI as a predictor of all-cause and wound complications. Conclusion: Mastectomy is a safe and efficacious procedure for treating gender dysphoria in the transgender male, with an acceptable and reassuring complication profile similar to that seen in cisgender patients who approximate either the natal sex characteristics or the new hormonal environment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mastectomy in Transgender and Cisgender Patients: A Comparative Analysis of Epidemiology and Postoperative Outcomes

Cuccolo

Kang

Boskey

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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“…6 The breadth of gender-affirming surgeries has increased in recent years. The most common among transgender men include chest masculinization (removal of breast tissue, contouring of pectoralis major muscle 7 ), metoidioplasty (creation of neophallus using clitoral growth 8 ), and phalloplasty (creation of a neophallus using an autologous tissue flap 8 ). 7 According to the 2015 U.S. Transgender Survey, of the 8037 respondents who identified as transgender men, 97% had undergone or desired chest masculinization surgery, 27% metoidioplasty, and 22% phalloplasty.…”

Section: Introductionmentioning

confidence: 99%

Facial Masculinization from Procedures to Payment: A Review

2021

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As the demand for gender-affirming procedures continues to increase, patients and providers have a greater imperative to understand the current state of facial masculinization. Facial reconstruction for transgender women has been shown to treat gender dysphoria effectively and reduce rates of discrimination and victimization. Although facial masculinization surgery for transgender men is less common, there are multiple surgical and nonsurgical options to supplement the effect of hormone therapy on facial appearance, including but not limited to: receding the hair line, flattening the forehead, expanding the supraorbital ridge, increasing the dorsal nasal projection, squaring the jaw, and augmenting the chin. This review aims to summarize these techniques for providers who wish to inform transgender male patients about their options and discuss them in the context of patient satisfaction and availability of insurance coverage.

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“…In doing so, an improved sense of self-confidence, safety, psychological well-being, and sexual satisfaction (9-14) may be conferred. These considerations are addressed through several mechanisms: (I) removal of breast tissue and excess skin, (II) appropriate reduction in size and placement of the nipple-areolar complex to a more typical masculine position, (III) elimination or diminishment of the inframammary fold, (IV) minimization of anterolateral chest skin/fat folds, and (V) low complication/revision rates and efficiency of the procedure (15)(16)(17)(18)(19). While the appropriate reconstruction details vary among individual patients, chest masculinization surgery is performed in order to achieve an aesthetic result that resembles a cis-masculine chest.…”

Section: Introductionmentioning

confidence: 99%

“…These approaches include the semicircular peri-areolar, otherwise known as the "keyhole mastectomy," mastectomy with peri-areolar skin excision, trans-areolar, concentric circular extended concentric circular, and inferior pedicle tunnelized nipple-areolar complex (NAC) (21)(22)(23)(24)(25)(26). Choice of technique principally depends on patient-specific characteristics, which include overall body habitus, position of the NAC, breast volume, skin envelope, grade of ptosis, and skin elasticity (15,24,27).…”

Section: Introductionmentioning

confidence: 99%

Hockey stick incision: a modified technique for chest wall masculinization

Junn¹,

Khetpal²,

Smetona³

et al. 2021

Ann Transl Med

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Background: Chest wall masculinization is often performed for transgender men in order to address gender dysphoria. Peri-areolar and double-incision mastectomy with free nipple grafts, are the most common techniques employed in chest masculinization surgery, but are limited by their relative inconsistency and inefficiency in reconstructing a natural anterior contour that comprehensively resembles that of a cismasculine chest. The purpose of this study is two-fold. The first is to describe the "hockey stick" approach, which expands on the widely performed double-incision mastectomy to the axilla, with an additional step of revising lateral chest wall folds of tissue excess. This technique is scalable to the degree of pre-operative excess tissue on the anterior and lateral chest wall. The second is to compare the "hockey stick" incision to existing reconstructive options, with respect to clinical outcomes and patient satisfaction.Methods: Patients who received chest masculinization surgery at Yale-New Haven Hospital were included.A retrospective chart review, comprising demographic variables, procedural details, and post-operative events, was conducted. Selected modules from a validated survey instrument, the BODY-Q, were measured.Patients were classified by body mass index and incision, which included peri-areolar, inframammary fold, and "hockey stick" incision by date.Results: Twenty-seven of 73 (37.0%) participants completed the full survey and were included in the analysis. The "hockey stick" incision had comparable patient satisfaction and post-operative outcomes, compared to peri-areolar and double-incision mastectomy with free nipple graft techniques. Greater BMI patients had a higher incidence of wound dehiscence, compared to other weight classifications. Conclusions:The "hockey stick" incision is a readily performed, effective surgical technique for building a cis-masculine appearing chest in transgender men with efficient and predictable outcomes. While performed in patients with higher BMI, the "hockey stick" confers equivalent patient satisfaction and clinical outcomes to peri-areolar and double-incision mastectomy.

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Female-to-Male Gender-Affirming Chest Reconstruction Surgery

Cited by 64 publications

References 45 publications

Mastectomy in Transgender and Cisgender Patients: A Comparative Analysis of Epidemiology and Postoperative Outcomes

Mastectomy in Transgender and Cisgender Patients: A Comparative Analysis of Epidemiology and Postoperative Outcomes

Facial Masculinization from Procedures to Payment: A Review

Hockey stick incision: a modified technique for chest wall masculinization

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