BACKGROUND: Reconstruction of the chest is an important component of transition in the transmasculine population that can substantially improve gender incongruence. Recent improvements in social stigma and changes to insurance legislation have led to a sharp rise in gender affirmation surgeries across the country, the most common of which being chest reconstruction. However, there is still debate regarding the optimal technique for transmasculine chest contouring and few studies have explored complication rates between the various approaches. The aim of this study was to evaluate the demographic characteristics, surgical technique, and postoperative outcomes following transmasculine chest contouring.
METHODS: Using International Classification of Diseases codes, we isolated all cases of gender affirmation surgery from the American College of Surgeons National Surgical Quality Improvement Program database (2010–2017). Current Procedural Terminology codes were used to categorize patients by reconstructive modality: reduction versus mastectomy (± free nipple grafting [FNG]). Univariate analysis was conducted to assess for differences in demographics, comorbidities, and postoperative complications. The 2-sided unpaired t test was used to assess the difference in means of continuous variables, whereas categorical data were compared using the chi-square test. Multivariable regression analysis was used to control for confounders.
RESULTS: A total of 755 cases were isolated, of which 591 (78.3%) were mastectomies and 164 (21.7%) were reductions. Compared with mastectomies, a higher rate of obesity was noted in the reduction cohort (34.4% versus 43.5%; P = 0.031). No significant differences were noted in terms of age or other comorbidities. Mastectomies had shorter operative times but similar length of stay when compared to reductions. Plastic surgeons performed the majority of procedures overall (87.2%). General surgeons performed nearly 10 times as many mastectomies as they did reductions (P < 0.001). Rates of postoperative complications were low, with 4.7% (n = 28) of mastectomies and 3.7% (n = 6) of reductions experiencing ≥1 all-cause complications. Postoperative complication rates were not statistically different between mastectomy with FNG (3.4%) and skin-sparing mastectomies (5.6%). After controlling for confounders, there was no difference in terms of risk of all-cause complications between mastectomy and reduction or between FNG and skin-sparing mastectomy.
CONCLUSION: Mastectomy and reduction mammaplasty are both safe procedures for chest reconstruction in the transmasculine population. Furthermore, mastectomy techniques involving FNG had comparable postoperative complication profiles when compared to techniques that did not involve FNG. Overall, these results may be used to encourage shared decision-making between patient and surgeon such that the reconstructive modality of choice best aligns with the desired esthetic outcome.