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KA Kelly-Schuette, K Wempe, GD Fritz, A Hop, GP Wright
Spectrum Health Hospitals

Masculinizing chest surgery (top surgery) is the most common gender-affirming surgery. Current literature demonstrates that most gender-affirming mastectomies are completed by plastic and reconstructive surgeons. The objective of our study is to report the surgical and patient reported outcomes after top surgery performed by a breast surgical oncology practice.

Between June 1, 2017 and December 31, 2019 a total of eight-one patients underwent top surgery at a single university-affiliated hospital by two surgeons. Patients were evaluated according to World Professional Association for Transgender Health guidelines. We performed a retrospective review of surgical outcomes including complications, reoperation, readmission, and plan for revision. In addition to the retrospective chart review, an anonymous survey was distributed to all patients, with a valid email address, undergoing top surgery during this timeframe. The survey included patient reported healthcare experiences and surgical outcomes.

Eighty-one patients underwent surgery during the study timeframe. Six patients (7.4%) had previous genital reconstruction and 73 (90.1%) were on hormones at the time of top surgery. Most patients underwent inframammary double incision mastectomies 75 (92.6%) with 50 (61.7%) undergoing nipple reconstruction. Sixteen patients (19.8%) had a surgical complication including hematoma, seroma, nipple necrosis, skin/scar complication (1.2%, 9.9%, 2.5%, 10.1%, respectively). There were two (2.5%) patients who underwent reoperation within 30 days of surgery and two (2.5%) who were readmitted postoperatively. Median follow up was 9 months (IQR 5;16). The anonymous survey was distributed to 72 of the 81 patients three months after surgery. There was a response rate of 47.2% (34/72). Patients were asked to rate their satisfaction with the cosmetic appearance after surgery on a numeric scale from 0-100 and the median score was 90 (IQR 81;100). Patients strongly agreed or agreed that surgery improved their mental health (76.5% and 17.6%, respectively) and overall quality of life (82.3% and 14.7%, respectively). Only two patients reported having a revision surgery.

Masculinizing chest surgery performed by surgeons trained in breast surgical oncology had a low rate of surgical complications and positive patient reported outcomes. Expanding the role of non-plastic surgeons in gender-affirming mastectomies can help improve access to gender-affirming surgery for transgender patients.

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