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Gender Affirming Mastectomy: Risk Factors For Complications
Hanaa Shihadeh, MD1, Ishan Patel, BS
2, Mason Horne, DPT
2, Kavya Kotha, BS
2, Dzifa Kpodzo, MD
1.
1Albany Medical Center, Albany, NY, USA, 2Albany Medical College, Albany, NY, USA.
PURPOSE: Gender-affirming mastectomy (GAM) is part of a multidisciplinary approach in treatment of gender dysphoria. Improved acceptance of transexual individuals has led to increased rates of GAM procedures. Reported complications include seroma, hematoma, and skin necrosis. The purpose of this study is to determine risk factors of these common complications.
METHODS: A retrospective review analyzed consecutive patients receiving GAM from September 2022 to October 2024. Patient demographics, preoperative factors, and operative details were collected and analyzed to determine significant predictors of complications.
RESULTS: A total of 77 patients were included, with 154 breasts analyzed. Complications included 29 (18.8%) seromas, wound dehiscence 14 (9.1%), 5 (3.2%) hematomas, infection 2 (1.2%), and nipple loss 1 (0.06%). Variables significant for seroma included BMI (p=0.018), sternal notch to nipple length (p=0.033), nipple to inframammary fold (p<0.001), blood loss (p=0.006), liposuction (p=0.027), and tumescent volume (p=0.045). After controlling for confounding variables nipple to inframammary fold (OR 1.18, CI 1.04-1.34) and tumescent volume (OR 1.01, CI 1.00-1.10) were still positive predictors for seroma formation. Variables significant for dehiscence were age (0.003), BMI (p<0.001), breast base width (p=0.009), and intravenous fluids (0.003). After controlling for confounding variables, blood loss was a positive predictor for dehiscence (OR 1.02, CI 1.01-1.03).
CONCLUSION: Seroma and wound dehiscence are common complications following GAM, with higher BMI, greater nipple-to-inframammary fold distance, and increased blood loss identified as key risk factors. Awareness of these predictors may guide clinicians in intraoperative management decisions, such as the use of drains, to potentially reduce complication rates.
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