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Masculinizing Chest Reconstruction in Transgender and Nonbinary Individuals: An Analysis of Epidemiology, Surgical Technique, and Postoperative Outcomes

  • Original Article
  • Body Contouring
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Abstract

Background

Chest reconstruction (‘top surgery’) is an important component of transition in the transmasculine population that can substantially improve gender incongruence. The aim of this study was to evaluate the demographic characteristics, surgical technique, and postoperative outcomes following transmasculine chest surgery.

Methods

Using ICD codes, we identified all cases of gender-affirming transmasculine chest surgery from the ACS NSQIP database (2010–2017). CPT 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. Multivariable regression analysis was used to control for confounders.

Results

A total of 755 cases were identified, of whom 591 (78.3%) were mastectomies and 164 (21.7%) were reductions. No significant differences were noted in terms of age or BMI. Mastectomies had shorter operative times, but similar length of stay compared to reductions. Rates of postoperative complications were low, with 4.7% (n = 28) of mastectomies and 3.7% (n = 6) of reductions experiencing at least one all-cause complications. Postoperative complication rates were not statistically different between mastectomy with (3.4%) and without (5.6%) FNG. After controlling for confounders, there was no difference in terms of risk of all-cause complications between reduction and mastectomy, with or without FNG.

Conclusion

Mastectomy and reduction mammaplasty are both safe procedures for chest reconstruction in the transmasculine population. 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 aesthetic outcome.

Level of Evidence IV

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Funding

There was no internal or external financial support for this study.

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Authors and Affiliations

  1. Department of Plastic and Oral Surgery, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02215, USA

    Nicholas G. Cuccolo, Christine O. Kang, Elizabeth R. Boskey, Amir Taghinia & Oren Ganor

  2. Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 5A, Boston, MA, 02215, USA

    Nicholas G. Cuccolo, Christine O. Kang, Ahmed M. S. Ibrahim, Louise L. Blankensteijn, Bernard T. Lee & Samuel J. Lin

  3. Center for Gender Surgery, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02215, USA

    Elizabeth R. Boskey, Amir Taghinia & Oren Ganor

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  1. Nicholas G. Cuccolo
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  2. Christine O. Kang
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  3. Elizabeth R. Boskey
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  4. Ahmed M. S. Ibrahim
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Corresponding author

Correspondence to Elizabeth R. Boskey.

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Conflict of interest

None of the authors have a financial interest in any of the products, devices, drugs, or procedures mentioned in this manuscript.

Ethical Approval

The patient information in this study is deidentified and available to all institutions complying with the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Data Use Agreement.

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For this type of study, informed consent is not required.

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Disclaimer The ACS NSQIP databases are the source of information used in this study. Data extrapolated, statistical analysis performed, and conclusions reached have not been verified by the ACS NSQIP but rather are the result of the work done by the authors of this study.

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Cuccolo, N.G., Kang, C.O., Boskey, E.R. et al. Masculinizing Chest Reconstruction in Transgender and Nonbinary Individuals: An Analysis of Epidemiology, Surgical Technique, and Postoperative Outcomes. Aesth Plast Surg 43, 1575–1585 (2019). https://doi.org/10.1007/s00266-019-01479-2

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