A Single Surgeon Retrospective Review Of Chest Masculinization Surgery In Transgender And Non-binary Adolescents And Young Adults
Maxine S. Garcia, B.A.1, Essie S. Ghafoor, M.B.S.1, Mona Ascha, M.D.2, Julia Corcoran, M.D.1.
1University of Illinois at Chicago College of Medicine, Chicago, IL, USA, 2Northwestern University, Chicago, IL, USA.
Background: Gender-affirming surgery improves the quality of life of transgender and non-binary (TGNB) individuals. Individuals designated female at birth (DFAB) may pursue chest-masculinization surgery to alleviate chest dysphoria. Top surgery is safe in adults, but outcomes and safety of top surgery among TGNB adolescents and young adults (AYA) remain unknown.
Methods: A single-surgeon identified 88 consecutive TGNB AYA patients undergoing top surgery over 4.5 years for review. Demographic variables were collected. Outcomes of interest included hematoma/seroma incidence, infection, nipple graft loss and pigmentation, and operating room return. Descriptive statistics were calculated. For patients with nipple-areola complex (NAC) grafts, repigmentation quality was rated on a scale from 1 to 5.
Results: Median (interquartile range) age was 18.3 (17.0-20.0) years. Most patients underwent double-incision free nipple graft technique (n=59, 67.0%) with drain placement (n=63, 71.6%). Seventeen patients (19.3%) experienced hematoma, 24 (27.3%) seroma, and two (2.3%) infection. Six patients (6.8%) underwent unplanned reoperation, all for hematoma evacuation. Nine patients (10.2%) underwent planned reoperation, for scar revision or excess tissue excision. Most scars healed appropriately (n=76, 86.4%). Median (IQR) NAC pigmentation score was 6 (4-8.3).
Conclusion: Top surgery among TGNB AYA is a safe procedure with comparable complication incidence to those in TGNB adult patients, (Berry et al., 2011; Frederick et al., 2017). Our findings provide healthcare practitioners, insurers, public health officials and legislators evidence of safety and efficacy in chest-masculinizing surgery in TGNB AYA patients.
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