Our Summary

This research paper sought to understand the safety and outcomes of removing breast tissue (mastectomy) in transgender men who had previously undergone breast reduction surgery. The researchers were concerned that having a breast reduction prior to a mastectomy could increase the risk of complications and the need for additional surgeries. They examined the medical records of all transgender men who had breast reduction surgery and then a mastectomy at their hospital between 1990 and 2021.

Out of 1,362 mastectomies performed during this time, 36 were on transgender men who had previously had a breast reduction. On average, these individuals had their mastectomy around 37 years old and about 6.3 years after their breast reduction.

Some complications did occur: 3% needed an immediate second surgery due to bleeding, 7% experienced partial loss of nipple tissue, and 4% had issues with nipple grafts not taking. Additional surgeries were also needed to correct the appearance of scars in 9% of cases, excess skin folds (dogears) in 20% of cases, and the shape of the nipple and surrounding area in 6% of cases.

However, when the researchers compared these outcomes to other studies, they did not find that having a breast reduction before a mastectomy led to more complications or the need for more additional surgeries. They concluded that mastectomies are safe for transgender men who have had a breast reduction.

FAQs

  1. Does having a breast reduction prior to a mastectomy increase the risk of complications in transgender men?
  2. What types of complications can occur after a mastectomy in transgender men who previously had a breast reduction?
  3. Do transgender men who have had a breast reduction require more surgeries after a mastectomy compared to those who haven’t had a breast reduction?

Doctor’s Tip

One helpful tip a doctor might tell a patient about mastectomy is to follow post-operative care instructions carefully to promote healing and reduce the risk of complications. This may include proper wound care, avoiding certain activities, and attending follow-up appointments with your healthcare provider. It’s also important to communicate any concerns or changes in your recovery process to your doctor.

Suitable For

Patients who are typically recommended mastectomy include:

  1. Transgender individuals seeking gender-affirming surgery to align their physical appearance with their gender identity.
  2. Patients with a high risk of breast cancer, such as those with a strong family history of the disease or carriers of BRCA gene mutations.
  3. Patients with large or multiple benign breast lumps (fibroadenomas) that cause discomfort or affect breast appearance.
  4. Patients with severe breast asymmetry that cannot be corrected through other means.
  5. Patients with recurrent breast infections (mastitis) that do not respond to other treatments.
  6. Patients with a history of breast cancer who have completed treatment and are seeking prophylactic mastectomy to reduce the risk of cancer recurrence.

It is important for patients considering mastectomy to discuss their individual medical history, risk factors, and treatment goals with their healthcare provider to determine if this procedure is the best option for them.

Timeline

Before the mastectomy, a patient may have undergone breast reduction surgery to reduce the size of their breasts. They may have experienced dysphoria related to their chest and desired a more masculine appearance. They would have consulted with a healthcare provider specializing in transgender healthcare to discuss their options and determine if they are a candidate for mastectomy.

After the decision is made to proceed with the mastectomy, the patient would have undergone pre-operative evaluations and consultations to ensure they are healthy enough for surgery. They would have discussed the surgical procedure, potential risks and complications, and the expected outcome with their healthcare provider.

During the mastectomy surgery, the breast tissue is removed, and in some cases, the nipple and areola may also be removed and reconstructed. The patient would have been under anesthesia during the procedure and would have been monitored closely by medical staff.

After the mastectomy, the patient would have had a recovery period where they may experience pain, swelling, and limited range of motion in their arms. They would have been instructed on how to care for their surgical incisions and when to follow up with their healthcare provider.

Over time, the patient would have seen changes in their chest appearance as the surgical site healed and scars faded. They may have undergone additional surgeries or procedures to address any complications or concerns with the appearance of their chest. They would have also received support from their healthcare provider and possibly a mental health professional to navigate the emotional and psychological aspects of undergoing a mastectomy.

What to Ask Your Doctor

Some questions a patient should ask their doctor about mastectomy include:

  1. What are the potential risks and complications associated with mastectomy in transgender men who have previously undergone breast reduction surgery?
  2. How long should I wait after my breast reduction surgery before considering a mastectomy?
  3. Will having a breast reduction prior to a mastectomy affect the aesthetic outcome of my chest?
  4. What are the chances of needing additional surgeries after a mastectomy if I have previously had a breast reduction?
  5. How will my nipple and areola be affected by the mastectomy, especially if I have had a breast reduction?
  6. What is the recovery process like for a mastectomy in transgender men who have had a breast reduction?
  7. Are there any specific considerations or techniques that will be used during the mastectomy due to my previous breast reduction surgery?
  8. How will my hormone therapy or other transgender-related treatments affect my mastectomy and recovery process?
  9. What are the long-term implications or considerations I should be aware of regarding mastectomy after breast reduction surgery?
  10. Are there any support resources or post-operative care plans specifically tailored for transgender men who have had a breast reduction and are considering a mastectomy?

Reference

Authors: Timmermans FW, Elfering L, Steensma TD, Bouman MB, van der Sluis WB. Journal: J Plast Surg Hand Surg. 2023 Feb-Dec;57(1-6):483-487. doi: 10.1080/2000656X.2022.2164293. Epub 2023 Jan 9. PMID: 36621980