Mastectomy is a safe procedure in transgender men with a history of breast reduction

Figures & data

Table 1. Demographics of included individuals.

Mean age at mastectomy ± SD	37 ± 10
Mean BMI at mastectomy, kg/m^2 ± SD	28.0 ± 3.7
Documented history of smoking, n (%)	15 (42%)
Somatic comorbidities
Chronic obstructive pulmonary disease	1 (3%)
Pulmonary embolism	1 (3%)
Sarcoidosis	1 (3%)
Hypothyroidism	1 (3%)
Hepatitis A	1 (3%)
Inflammatory bowel disease	1 (3%)
Ischemic stroke	1 (3%)
Hypertension	2 (6%)
Breast reduction technique
Bilateral	35
Wise pattern with pedicled nipple-areolar complex	33
Wise pattern with nipple graft	1
Regnault B	1
Unilateral	1
Wise pattern with pedicled nipple-areolar complex	1
Median time between reduction and mastectomy, (range)	6.3 (1.0-31.1)
Cup size at mastectomy, n (%)
A	1 (3%)
B	6 (17%)
C	14 (39%)
D	4 (11%)
>D	11 (31%)
Breast ptosis, n (%)
Grade 1	1 (3%)
Grade 2	14 (39%)
Grade 3	18 (50%)
Unknown	3 (3%)
Concurrent surgical procedures, n (%)
Mastectomy only	29 (81%)
Mastectomy combined with TLH-BSO	6 (17%)
Mastectomy combined with abdominoplasty	1 (3%)
Mastectomy subtechnique, n (%)
Double incision	31 (86%)
Free nipple graft	27 (75%)
Pedicled nipple areolar complex	4 (11%)
Donut	1 (3%)
Regnault B	1 (3%)
Wise	3 (8%)
Free nipple graft	1 (3%)
Pedicled nipple-areolar complex	1 (3%)
Wise reduction pattern with free nipple graft and additional liposuction^a	1 (3%)
Mean resection weight per breast, g ± SD	597 ± 292

^aConversion from a pedicled nipple-areolar complex to nipple grafting due to intraoperative vascular compromise.

Figure 1. Results after the breast reduction and sequential gender-affirming mastectomy at one year follow-up.

Table 2. Complications and revision surgery after gender-affirming mastectomy.

Complications
Hemorrhage, for which return to theatre^a^,c	1 (3%)
Surgical site infection^a	–
Seroma, for which aspiration^a	6 (17%)
Infected seroma, for which aspiration and antibiotical treatment^a	1 (3%)
(Partial) necrosis of pedicled nipple-areolar complex^b	1/14 (7%)
Partial non-take of nipple graft^b	2/58 (4%)
Revision surgery^a
Surgical scar revision	3 (8%)
Under local anesthesia	1 (3%)
Under general anesthesia during other gender-related operation	1 (3%)
Under general anesthesia	1 (3%)
Surgical dogear correction	7 (20%)
Under local anesthesia	5 (14%)
Under general anesthesia during other gender-related operation	1 (3%)
Under general anesthesia	1 (3%)
Secondary nipple correction	2 (6%)
Tattoo	1 (3%)
Correction of nipple shape under local anesthesia	1 (3%)
Secondary contour correction	2 (6%)
Liposuction/lipofilling under general anesthesia	2 (6%)

^aDepicted per individual, ^bdepicted per breast, ^cMastectomy type: Double incision with free nipple grafts.