Blood Pressure Challenge Reduces Complications In Female To Male Gender-Affirming Chest Reconstruction: A Retrospective Chart Review
John J. Slate-Romano, B.S.1, Victoria G. Zeyl, B.A.1, Paul Y. Liu, M.D.2, Daniel Kwan, M.D.2, Joseph Crozier, MA2.
1Warren Alpert School of Medicine, Providence, RI, USA, 2Department of Plastic Surgery, Rhode Island Hospital, Warren Alpert School of Medicine, Providence, RI, USA.
PURPOSE: Within gender-affirming surgery, chest surgery for transgender males (FTM) involves removing breast tissue to create a masculinized chest. Complication rates for top surgery are between 11%-33%; commonly being hematoma, infection, wound dehiscence, and areolar necrosis. We aimed to investigate the utility of using a "blood pressure challenge" (BPC), which increases blood pressure prior to skin closure to reveal and cauterize potential bleeding vessels, to reduce post-operative complications.
METHODS: We performed a retrospective chart review of patients with FTM gender-affirming mastectomy between January 2015 and June 2021. Fischer's Exact Test and Chi Squared were used to determine the difference in hematoma rates and overall complication rates between patients who received a BPC and patients who did not receive a BPC. We established significance at 95%.
RESULTS: 119 patients were included [mean age: 24.6, mean BMI: 29.2]. Of these surgeries, 18.5% were peri-areolar keyhole incisions, 4.2% were circum-areolar incisions, and 77.3% were double incision mastectomies. 58% of patients received a BPC, of which 43.5% used phenylephrine alone, 30% used phenylephrine and ephedrine, and 4.3% used ephedrine alone. The mean systolic blood pressure achieved with BPC was 154.7 mmHg. Hematoma rate differed significantly between BPC group, 1.5%, and no-BPC group, 20% (p M< 0.05) and overall complication rate differed significantly between BPC group, 10.1%, and no-BPC group, 32% (p < 0.05).
CONCLUSION: Blood pressure challenges were associated with reduced hematoma rates and total complication rates. Guidelines for BPC goals should be established to standardize care and reduce complications for FTM chest surgery.
Back to 2022 Posters