Dataset Information

Gender-Affirming Mastectomy in Transmasculine Patients: Does Obesity Increase Complications or Revisions?

ABSTRACT:

Background

Obesity can often be a barrier to gender-affirming top surgery in transmasculine patients because of concern for increased surgical site complications.

Study design

All adult patients (N = 948) within an integrated health care system who underwent gender-affirming mastectomy from 2013 to 2018 were retrospectively reviewed to evaluate the relationship between obesity and surgical site complications or revisions.

Results

One third of patients (n = 295) had obese body mass index (BMI), and those patients were further stratified into obesity class I (BMI of 30-34.9 kg/m2, 9.4%), class II (BMI of 35-39.9 kg/m2, 8.9%), and class III (BMI of ≥40 kg/m2, 2.9%). A majority of patients across BMI categories underwent double incision surgery. There were no significant differences in complications or revisions between patients with obesity versus those with normal BMI, when BMI was treated as a categorical or continuous variable and when evaluating only patients who underwent double incision surgery.

Conclusions

Obesity alone should not be considered a contraindication for gender-affirming mastectomy. Attention should be given to several modifiable risk factors identified in this study, including lesser incision surgical techniques, tobacco use, and testosterone use. Further research is needed to understand risks associated with the highest BMI (≥40 kg/m2) patients and to assess patient satisfaction with surgical outcome.

SUBMITTER: Rothenberg KA

PROVIDER: S-EPMC8936918 | biostudies-literature | 2021 Jul

REPOSITORIES: biostudies-literature

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Publications

Gender-Affirming Mastectomy in Transmasculine Patients: Does Obesity Increase Complications or Revisions?

Rothenberg Kara A KA Gologorsky Rebecca C RC Hojilla J Carlo JC Tang Annie A Cohan Caitlin M CM Beattie Genna G Yokoo Karen M KM

Annals of plastic surgery 20210701 1

<h4>Background</h4>Obesity can often be a barrier to gender-affirming top surgery in transmasculine patients because of concern for increased surgical site complications.<h4>Study design</h4>All adult patients (N = 948) within an integrated health care system who underwent gender-affirming mastectomy from 2013 to 2018 were retrospectively reviewed to evaluate the relationship between obesity and surgical site complications or revisions.<h4>Results</h4>One third of patients (n = 295) had obese bo ...[more]

PMID: 33559996

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Project description:ImportanceDuring gender-affirming mastectomy, nerves are transected, resulting in sensory loss. Nerve preservation using targeted nipple-areola complex (NAC) reinnervation (TNR) may restore sensation.ObjectiveTo determine the quantitative and patient-reported sensory outcomes of TNR.Design, setting, and participantsProspective matched cohort study of patients undergoing gender-affirming mastectomy from August 2021 to December 2022 at Weill Cornell Medicine and Massachusetts General Hospital. Data were analyzed from January to March 2023.ExposurePatients who underwent TNR and matched patients who did not.Main outcomes and measuresMechanical detection measured with monofilaments and patient-reported outcome questionnaires were completed preoperatively and at 1, 3, 6, 9, and 12 months postoperatively. Additional quantitative sensory testing was performed preoperatively and at 12 months postoperatively. The primary outcome was mechanical detection while secondary outcomes were the additional quantitative sensory testing variables and patient-reported outcomes. Exclusion criteria included peripheral nerve disorders, unmatched patients, and incomplete follow-up.ResultsA total of 25 patients who underwent TNR and 25 matched patients who did not were included. The mean (SD) age was 24.9 (5.5) years, BMI was 26.6 (5.2), and mastectomy weight was 608.9 (326.5) g; 6 patients (12.0%) were Asian, 5 patients (10.0%) were Black or African American, and 33 patients (66.0%) were White. Repeated measures analysis of variance (ANOVA) showed that the outcomes of TNR on improving mechanical detection over time was significant at the NAC (F = 35.2; P < .001) and chest (F = 4.2; P = .045). At 12 months, mean quantitative sensory values in patients who underwent TNR reached baseline and were improved compared with patients who did not undergo TNR for monofilaments (mean [SD] NAC, 3.7 [0.5] vs 4.9 [0.9]; [data]; P < .001; chest, 3.3 [0.4] vs 3.6 [0.6]; [data]; P = .002), vibration (mean [SD] NAC, 7.7 [ 0.4] vs 7.3 [0.4]; t96 = 6.3; P < .001; chest, 7.8 [0.3] vs 7.5 [0.3]; t96 = 5.1; P < .001), 2-point discrimination (NAC, 40% vs 0%; r = 20; P = .02); chest, 4.1 [1.2] cm vs 5.7 [1.8] cm; P < .001), pinprick (mean [SD] NAC, 24.9 [21.2] mN vs 82.6 [96.7] mN; t98 = 4.1; P < .001; chest, 22.5 [25.6] mN vs 54.1 [45.4] mN; t98 = 4.6; P < .001), cold (mean [SD] NAC, 23.1 [4.7] °C vs 12.0 [7.6] °C; t98 = 8.8; P < .001; chest, 23.6 [3.1] °C vs 19.7 [5.6] °C; t98 = 4.4; P < .001), warm (mean [SD] NAC, 39.9 [5.0] °C vs 45.8 [4.2] °C; t98 = 6.3; P < .001; chest, 39.4 [3.1] °C vs 42.9 [4.0] °C; t98 = 4.9; P < .001), and pressure pain detection (mean [SD] NAC, 89.9 [45.6] kPa vs 130.5 [68.9] kPa; t86 = 3.9; P < .001; chest, 128.5 [38.0] kPa vs 175.5 [49.3] kPa; t96 = 4.0; P = .001). ANOVA demonstrated that TNR significantly improved patient-reported nipple sensation (F = 60.5; P < .001), chest light touch (F = 8.1; P = .01) and erogenous sensation (F = 8.3; P = .01). Significantly more patients who underwent TNR than those who did not reported nipple hypersensitivity until 3 months postoperatively (8% vs 4% at 12 months).Conclusion and relevanceIn this prospective matched cohort study, TNR was associated with improved quantitative and patient-reported sensation. Patients should be counseled about the risk of transient NAC hypersensitivity.

Project description:ImportanceThere has been increasing legislative interest in regulating gender-affirming surgery, in part due to the concern about decisional regret. The regret rate following gender-affirming surgery is thought to be approximately 1%; however, previous studies relied heavily on ad hoc instruments.ObjectiveTo evaluate long-term decisional regret and satisfaction with decision using validated instruments following gender-affirming mastectomy.Design, setting, and participantsFor this cross-sectional study, a survey of patient-reported outcomes was sent between February 1 and July 31, 2022, to patients who had undergone gender-affirming mastectomy at a US tertiary referral center between January 1, 1990, and February 29, 2020.ExposureDecisional regret and satisfaction with decision to undergo gender-affirming mastectomy.Main outcomes and measuresLong-term patient-reported outcomes, including the Holmes-Rovner Satisfaction With Decision scale, the Decision Regret Scale, and demographic characteristics, were collected. Additional information was collected via medical record review. Descriptive statistics and univariable analysis using Fisher exact and Wilcoxon rank sum tests were performed to compare responders and nonresponders.ResultsA total of 235 patients were deemed eligible for the study, and 139 responded (59.1% response rate). Median age at the time of surgery was 27.1 (IQR, 23.0-33.4) years for responders and 26.4 (IQR, 23.1-32.7) years for nonresponders. Nonresponders (n = 96) had a longer postoperative follow-up period than responders (median follow-up, 4.6 [IQR, 3.1-8.6] vs 3.6 [IQR, 2.7-5.3] years, respectively; P = .002). Nonresponders vs responders also had lower rates of depression (42 [44%] vs 94 [68%]; P < .001) and anxiety (42 [44%] vs 97 [70%]; P < .001). No responders or nonresponders requested or underwent a reversal procedure. The median Satisfaction With Decision Scale score was 5.0 (IQR, 5.0-5.0) on a 5-point scale, with higher scores noting higher satisfaction. The median Decision Regret Scale score was 0.0 (IQR, 0.0-0.0) on a 100-point scale, with lower scores noting lower levels of regret. A univariable regression analysis could not be performed to identify characteristics associated with low satisfaction with decision or high decisional regret due to the lack of variation in these responses.Conclusions and relevanceIn this cross-sectional survey study, the results of validated survey instruments indicated low rates of decisional regret and high levels of satisfaction with decision following gender-affirming mastectomy. The lack of dissatisfaction and regret impeded the ability to perform a more complex statistical analysis, highlighting the need for condition-specific instruments to assess decisional regret and satisfaction with decision following gender-affirming surgery.

Dataset Information

Gender-Affirming Mastectomy in Transmasculine Patients: Does Obesity Increase Complications or Revisions?

Background

Study design

Results

Conclusions

Publications

Gender-Affirming Mastectomy in Transmasculine Patients: Does Obesity Increase Complications or Revisions?

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