Female-to-Male Gender Affirming Top Surgery: A Single Surgeon’s 15-Year Retrospective Review and Treatment Algorithm

McEvenue, Giancarlo; Xü, Fang; Cai, Runting; Mclean, Hugh A

doi:10.1093/asj/sjx116

Cited by 84 publications

(68 citation statements)

References 20 publications

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“…The lower incidence of breast cancer found in the studies can be attributed to the performed mastectomies. Mastectomy is often the first and only step of gender reassignment surgery of FtM transsexuals [ 35 ]. After mastectomy with nipple reimplantation, the risk of breast cancer in an FtM is reduced by nearly 90% [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Breast malignancy in female-to-male transsexuals: systematic review, case report, and recommendations for screening

et al. 2020

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Background Female-to-male (FtM) transsexuals may use testosterone therapy for masculinization, which potentially influences the risk of breast cancer development. Guided by our case report, we aimed to investigate the evidence regarding the risk of testosterone therapy on breast malignancy in female-to-male transsexuals and evaluate breast cancer screening in this subgroup. Methods We conducted a systematic literature search according to the PRISMA checklist in June 2020 in PubMed/MEDLINE and Ovid/EMBASE. Reference lists of included articles were screened to find additional articles that met the inclusion criteria. All cohort studies and case reports evaluating breast cancer in FtM transsexuals after testosterone therapy were included. Results We found 23 cases of FtM transsexuals who developed breast cancer after testosterone therapy, including our own case. Moreover, we evaluated ten retrospective cohort studies investigating breast malignancy in the transsexual population. The cohort studies showed no elevated risk in FtM transsexuals compared to natal women. Including our own case, nine cases were described in which breast malignancy was incidentally found during routine histological examination after mastectomy. High-level evidence for a correlation between testosterone therapy and breast malignancy is missing. Conclusion Few cases are described of FtM transsexuals with breast malignancy. However, cases such as these make physicians aware of the possibility of breast cancer in FtM transsexuals. Radiological screening of FtM transsexuals for breast cancer prior to mastectomy and histological screening of the mammalian tissue after mastectomy should be considered; physicians should decide together with every individual FtM transsexual if screening is necessary.

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Section: Discussionmentioning

confidence: 99%

Breast malignancy in female-to-male transsexuals: systematic review, case report, and recommendations for screening

et al. 2020

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“…To begin, the first case series of masculinizing mastectomy was not published until 1995; 30 despite the recent increase in similar studies, the vast majority are single institution in nature. 5,11,12,14,30,31 Furthermore, these projects are largely related to technique and aesthetic outcome, with fewer reporting on epidemiology and complication rates. In contrast, there is an abundance of literature pertaining to mastectomy for indications other than masculinizing chest reconstruction, including cancer prophylaxis 20 and correction of gynecomastia.…”

Section: Discussionmentioning

confidence: 99%

“…Chest wall contouring, typically via mastectomy, is often the first and the only surgical intervention that transgender males will undergo. 5 Importantly, masculinizing chest reconstruction has been shown to significantly improve psychosocial functioning and quality of life. 6–8 Expanded access to care and improvements in social stigma have led to a substantial rise in the number of gender-affirming surgeries (GAS) performed in the United States over the past 5 years, opening up new avenues for quality improvement.…”

Section: Introductionmentioning

confidence: 99%

“…Numerous studies have been published on the technical considerations and aesthetic outcomes following mastectomy in the transmasculine population. 10 However, the majority of this literature comprises single-institution studies with relatively small sample sizes, 5,11–17 thus limiting generalizability. Furthermore, much of the transgender epidemiologic data arise from survey-based studies, 18,19 thereby precluding a direct assessment of surgical patient demographics and outcomes.…”

Section: Introductionmentioning

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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“…Research suggests that nipple-sparing mastectomies have greater complication rates and decreased outcome satisfaction than procedures involving free nipple grafts. 4,5 Nipple sparing has also higher rates of reoperation and revision than free nipple graft procedures. 4,5 This implies that free nipple graft procedures may actually be less expensive in the long run, even if initial procedural costs are higher.…”

mentioning

confidence: 99%

Congruence Is Not Cosmetic: Denials of Nipple Grafts for Chest Reconstruction Surgery

Boskey

Jolly

Semnack³

et al. 2019

Plastic and Reconstructive Surgery - Global Open

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Female-to-Male Gender Affirming Top Surgery: A Single Surgeon’s 15-Year Retrospective Review and Treatment Algorithm

Abstract: 3.

Cited by 84 publications

References 20 publications

Breast malignancy in female-to-male transsexuals: systematic review, case report, and recommendations for screening

Breast malignancy in female-to-male transsexuals: systematic review, case report, and recommendations for screening

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

Congruence Is Not Cosmetic: Denials of Nipple Grafts for Chest Reconstruction Surgery

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