American Association of Plastic Surgeons Meeting 2022

A Single Surgeon Retrospective Review of Chest Masculinization Surgery in Transgender and Non-Binary Adolescents and Young Adults

Maxine S. Garcia, B.A., Essie S. Ghafoor, M.B.S., Mona Ascha, M.D., Julia Corcoran, M.D.

Plastic, Reconstructive and Cosmetic Surgery

University of Illinois College of Medicine - Chicago

BACKGROUND

Transgender and non-binary (TGNB) individuals assigned female at birth (AFAB) may pursue chest-masculinization surgery (top surgery) to alleviate chest and gender dysphoria.

Outcomes and safety of top surgery among TGNB adolescents and young adults (AYA) remains largely unknown.

The aim of this study was to assess surgical characteristics, outcomes and safety of top surgery in TGNB AFAB AYA patients and compare them to published outcomes in TGNB adults.

METHODS

This is a single-surgeon retrospective cohort study.

Inclusion criteria:

16 to 24 years of age

AFAB

English speaking

Variables of interest:

Demographic variables

Surgical characteristics

Complications

Outcomes: revisions, nipple pigmentation

RESULTS

• Median age of 18.3 years with majority identifying as White, non-Hispanic and transgender man.

•

• Total number of re-operations:

–Planned: 10

–Unplanned: 6

–

• Multivariate analysis of hematoma outcome indicated BMI is predictive of greater odds of hematoma (OR 1.18, p=0.037)

CONCLUSIONS

• Our findings provide healthcare professionals, insurers and legislators with evidence of safety in top surgery among TGNB AYA and complication rates comparable to those in TGNB adult patients

•Frederick et al., 2017: patient median age of 24 years

•

• We present the largest retrospective review of top surgery outcomes in TGNB AFAB AYA patients thus far.

•

• Limitations to our study include:

–Data collected relies on accurate EMR documentation

–Limited generalizability

–Lack of patient-reported outcomes

REFERENCES

1. Olson-Kennedy J, Warus J, Okonta V, Belzer M, Clark LF. Chest reconstruction and chest dysphoria in transmasculine minors and young adults comparisons of nonsurgical and postsurgical cohorts. JAMA Pediatr. 2018. doi:10.1001/jamapediatrics.2017.5440

2. Coleman E, Bockting W, Botzer M, et al. Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7. Int J Transgenderism. 2012. doi:10.1080/15532739.2011.700873

3. Park BC, Das RK, Drolet BC. Political Issues Surrounding Gender-Affirming Care

for Transgender Youth-Reply. JAMA Pediatr. December 2021.

doi:10.1001/jamapediatrics.2021.5345

4. Cucculo NG, Kang CO, Boskey ET, et al. Masculinizing Chest Reconstruction in Transgender and Nonbinary Individuals: An Analysis of Epidemiology, Surgical Technique, and Postoperative Outcomes. Aesth Plast Surg. 2019. doi:10.1007/s00266-019-01479-2

5. Berry MG, Curtis R, Davies D. Female-to-male transgender chest reconstruction: A large consecutive, single-surgeon experience. J Plast Reconstr Aesthetic Surg. 2012. doi:10.1016/j.bjps.2011.11.053

6. Frederick MJ, Berhanu AE, Bartlett R. Chest Surgery in Female to Male Transgender Individuals. Ann Plast Surg. 2017. doi:10.1097/SAP.0000000000000882

7. McEvenue G, Xu FZ, Cai R, McLean H. Female-to-Male gender affirming top surgery: A single surgeon’s 15-Year retrospective review and treatment algorithm. Aesthetic Surg J. 2018. doi:10.1093/asj/sjx116

8. Cohen WA, Shah NR, Iwanicki M, Therattil PJ, Keith JD. Female-to-Male Transgender Chest Contouring: A Systematic Review of Outcomes and Knowledge Gaps. Ann Plast Surg. 2019. doi:10.1097/SAP.0000000000001896

American Association of Plastic Surgeons Meeting 2022

A Single Surgeon Retrospective Review Of Chest Masculinization Surgery In Transgender And Non-binary Adolescents And Young Adults

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