A Review of Our Experience on Gender Affirmation Top Surgeries

With increasing acceptance, more transmen or non binary patients are seeking gender affirmation subcutaneous mastectomy (top surgery).  The goal of subcutaneous mastectomy is to create a flatter chest contour by removing excess chest tissue and skin, as well as the reducing and re-positioning of the nipple-areola complex. While data is accumulating on top surgery in transmen or non-binary patients, there is a paucity of large cohort studies on top surgery in this patient population ^1-4.

OBJECTIVES:

Our primary goal is to determine whether top surgery can be safely performed in transgender patients seeking gender affirmation chest surgery.

METHODS:

This is a retrospective cohort study to describe our experience in top surgery on transmen or non-binary patients between 1^st May, 2012 to 31^st December, 2016. Several surgical techniques, were used, including double incision, peri-areola  incision, breast reduction and buttonhole incision. Complications and revisions were evaluated. Complications included but were not limited to seroma, hematoma, infection, wound dehiscence that required re-operation, hospitalization or medical treatment.  Revisions included any operative intervention to modify or improve the contour of the chest, nipple areola complex or scars after the initial top surgery. Patients who were interested in further revision surgeries were also evaluated.  

RESULTS:

Of the 538 patients, 93.1% had double incision, 4.5% had peri-areola incision, 1.5% underwent breast reduction and the remaining 0.9% had buttonhole incision.  Mean age was 29.7 years for double incision, 25.6 years for peri-areola incision, 29.9 for breast reduction and 32 years for buttonhole incision (non significant). Mean BMI was 27.9 for double incision, 23.5 years for peri-areola incision, 27.6 for breast reduction and 25.8 for buttonhole incision (non significant). Mean ASA classification was 1.6 for double incision, 1.3 years for peri-areola incision, 1.7 for breast reduction and 1.7 for buttonhole incision (non significant). Complications occurred at 15.7% for double incision, 21.3% for peri-areola incision, 0% for breast reduction and at 60% for buttonhole incision (p=0.2). Revisions were performed in 18.7% of patients who had double incision, 30.4% of those who had peri-areola incision , 14.3% of those with breast reduction and 40% of those who had buttonhole incision technique respectively.  Patients who had complications or revisions were significantly more likely than their counterparts to seek further revisions (47% versus 0%, p=0.049).

CONCLUSIONS:

Top surgery can be safely performed in transmen or non-binary patients. Patients should be carefully selected for the appropriate surgical technique and be educated about the associated risks.   

 

REFERENCES

1. Berry MG, Curtis R, Davies D. Female-to-male transgender chest reconstruction: a large consecutive, single-surgeon experience. J Plast Reconstr Aesthet Surg. 2012 Jun;65(6):711-9. 

 

2. Frederick MJ, Berhanu AE, Bartlett R. Chest Surgery in Female to Male Transgender Individuals. Ann Plast Surg. 2017 Mar;78(3):249-253. 

 

3. Monstrey S, Selvaggi G, Ceulemans P, Van Landuyt K, Bowman C, Blondeel P, Hamdi M, De Cuypere G. Chest-wall contouring surgery in female-to-male transsexuals: a new algorithm. Plast Reconstr Surg. 2008 Mar;121(3):849-59.

 

4. Monstrey SJ, Ceulemans P, Hoebeke P. Sex Reassignment Surgery in the Female-to-Male Transsexual. Semin Plast Surg. 2011 Aug;25(3):229-44.