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Under The Microscope: A Look At Relative Risk Of Malignancy In Transgender Mastectomy
Madeleine K. Bruce, BA1, Walter Joseph, MD1, Lorelei Grunwaldt, MD2, Vu T. Nguyen, MD1, Carolyn De La Cruz, MD1.
1UPMC, Pittsburgh, PA, USA, 2Private Practice, Pittsburgh, PA, USA.

PURPOSE: Chest masculinization surgeries are one of the most common gender-affirming procedures performed. There is a need for better understanding of the risk of breast cancer and post-surgical screening in female to male (FtM) individuals. This study aimed to evaluate the incidence of high-risk pathologic findings in FtM transgender patients undergoing gender-affirming chest reconstructive surgery.
METHODS: Medical records were reviewed from all FtM patients undergoing gender-affirming chest reconstructive surgery from January 2010-February 2021 by three plastic surgeons at the University of Pittsburgh Medical Center. Relative risk of malignant progression was used to stratify pathologic data. Subsequent management of atypical, in situ, and invasive pathology were recorded.
RESULTS: A total of 318 patients were included in this study; the average age at surgery was 24.6 8.1 years. Eighty-six patients (27%) had a family history of breast and/or ovarian cancer. Overall, 21 patients (6.6%) had some increased risk of breast cancer: 17 (5.3%) had proliferative lesions, mean age 38.212.4 years; 2 had atypical ductal hyperplasia, ages 33.4 and 38.3 years; and 2 had invasive ductal carcinoma, ages 35.4 and 40.6 years.
CONCLUSION: This is the largest study to date to look at high-risk pathologic findings in FtM patients undergoing gender-affirming chest reconstructive surgery. In this study we found that 6.6% of patients had an elevated risk of breast cancer, with 1.2% of patients having a greater than 2 times risk of breast cancer. Evidence based guidelines for breast cancer screening for patients who have undergone gender-affirming chest masculinization surgery are needed.


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