American Association of Plastic Surgeons

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Transcending BMI: Surgical Outcomes In Gender-affirming Surgery
Sriya V. Nemani, BA, Patrick E. Assi, MD, Mariam Saad, MD, Aubree Ford, MD, Eliana Dash, BA, Helen Ismail, MSc, Nicholas R. O'Sick, DO, Ronnie N. Mubang, MD, Wesley P. Thayer, MD, PhD, Salam al-Kassis, MD;
Vanderbilt University Medical Center, Nashville, TN, USA

PURPOSE: Gender-affirming mastectomy is a crucial procedure for transmasculine individuals seeking to alleviate gender dysphoria. However, many surgeons refuse to operate on obese patients. While common practice, research to support this guideline is lacking.
METHODS: This study is a retrospective analysis of the impact of BMI on postoperative complications in patients undergoing gender-affirming mastectomy. Patients were classified as normal, overweight, Class I obese, Class II obese, and Class III obese. Additionally, patients with obesity were organized as metabolically healthy obese (MHO) and metabolically unhealthy obese (MUO). Patients were monitored for postoperative complications for 30 days after surgery.
RESULTS: 644 patients were included (187 normal, 175 overweight, 130 Class I obese, 75 Class II obese, and 77 Class III obese). Univariate analysis revealed a difference in total hematoma rates (p = 0.037). Upon multivariate analysis, BMI was not associated with an increased risk of any complications. Diabetes was associated with increased rates of total hematoma (Odds ratio (OR): 6.33, 95% CI: 1.76 - 22.84, p = 0.005), and hematoma requiring evacuation (OR: 5.36, 95% CI: 1.20 - 23.97, p = 0.028). Of the 282 obese patients, 240 patients had MHO, while 42 had MUO. MUO patients had a higher incidence of total hematoma (p = 0.005). In a logistic regression, MUO was associated with an increased risk of hematoma formation (OR: 3.60, 95% CI: 1.01 - 12.87, p = 0.048).
CONCLUSION: BMI alone should not exclude patients from receiving gender-affirming mastectomy, but other factors, such as pre-existing comorbidities, should be considered.
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