Preoperative Breast Imaging Before Gender-Affirming Chest Masculinization Surgery
Introduction
•Patients undergoing chest masculinization surgery (CMS) are at risk for breast cancer
•Prior studies have evaluated postoperative histology and incidence of breast cancer in transgender men overall, but there is limited data on preoperative screening practices
•Decision-making process for preoperative breast imaging has yet to become nationally standardized
ØThere are no screening guidelines to inform preoperative breast imaging pre-CMS
ØPrior to standardization, there was considerable inter-surgeon variability in work-up at this institution
•Detecting malignancy before CMS:
ØAlters surgical planning
ØCan prevent reoperation
•Lack of standardization in preoperative screening can lead to missed diagnoses
Objectives
1.Characterize current preoperative breast cancer screening practices: describe the frequency, indication, and modality of preoperative breast imaging before CMS at a large academic tertiary care center
2.Describe outcome of preoperative breast imaging: identify and describe the outcome of preoperative breast imaging for CMS, including BIRADS and indication for follow-up procedures (biopsy, additional imaging, etc.)
3.Compare time to surgery with and without preoperative breast imaging: evaluate the impact of preoperative breast imaging on surgical timing, given the distress that surgical delays could have on patients
4.Assess prevalence of abnormal preoperative and postoperative findings: describe preoperative detection and incidental postoperative detection of malignancy and benign breast disease on pathology
5.Describe impact of preoperative vs. postoperative detection of breast cancer: assess alteration to surgical planning following preoperative detection of malignancy and reoperation following postoperative detection
6.Develop and implement a standardized decision-making algorithm: utilize interdisciplinary collaboration between surgical oncology and plastic surgery to develop and implement a tool for standardized breast cancer screening before CMS
Conclusion
Preoperative breast imaging remains a unique challenge to transgender patients, making this algorithm a critical resource for gender-affirming surgeons. Most cisgender women undergoing mastectomy receive an oncologic mastectomy that removes more subcutaneous tissue than CMS, and most people undergoing reduction mammoplasty can continue to receive regular screening via mammography postoperatively. Patients who undergo CMS generally do not return for future breast cancer screening and are not able to receive mammograms. Detecting breast cancer preoperatively helps surgeons and patients avoid additional oncologic surgeries at a future date, as it allows gender-affirming surgeons and surgical oncologists to collaborate in advance of CMS to ensure that one surgery meets all necessary oncologic and gender-affirming goals.
