Chest-wall contouring surgery in female-to-male transgender patients: A one-center retrospective analysis of applied surgical techniques and results.
OBJECTIVE
Chest-wall contouring surgery is an important part of the gender reassignment process that contributes to strengthening the self-image and facilitating living in the new gender role. Here, we analyze the surgical techniques used in our clinic and report the results.


METHODS
Female-to-male transgender patients (n = 57) undergoing chest-wall contouring surgery at Tampere University Hospital between January 2003 and April 2015 were enrolled in the study. Breast appearance was evaluated and either a concentric circular approach or a transverse incision technique was used for mastectomy. Patient characteristics and data regarding the technique and postoperative results were collected and analyzed retrospectively.


RESULTS
In addition to the transgender diagnosis, 40.4% of the patients had another psychiatric diagnosis. For mastectomy, a concentric circular approach was used in 50.9% and a transverse incision approach in 49.1% of the patients. In the transverse incision group, 21.4% of the patients underwent pedicled mammaplasty and 78.6% mastectomy with a free nipple-areola complex graft. Compared with the transverse incision group, breasts were smaller (p < 0.001) and body mass index value was lower in the concentric circular group (p = 0.001). One-third of the patients had complications (hematoma, infection, seroma, fistula, or partial necrosis of nipple-areola complex) and the reoperation rate was 8.8%. Hematoma was the most frequent reason for reoperation. Corrections were required for the scar in 14.0% of the patients, the contour in 28.0%, the areola in 15.8%, and the nipple in 5.3%. Secondary corrections were needed more often in the concentric circular (55.2%) than in the transverse incision group (25.0%; p = 0.031).


CONCLUSIONS
The larger the breast, poorer the skin quality, and greater the amount of excess skin, the longer the required incision and resulting scar is for mastectomy of female-to-male patients. Hematoma is the most common reason for acute reoperation and secondary corrections are often needed.
1 Department of Plastic and Reconstructive Surgery, Tampere University Hospital, Tampere, Finland.
M
M
Kääriäinen
1 Department of Plastic and Reconstructive Surgery, Tampere University Hospital, Tampere, Finland.
K
K
Salonen
2 School of Health Sciences, University of Tampere and Science Centre, Pirkanmaa Hospital District, Tampere, Finland.
M
M
Helminen
1 Department of Plastic and Reconstructive Surgery, Tampere University Hospital, Tampere, Finland.
U
U
Karhunen-Enckell
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D016462:Mammaplasty / Q000379:methods*; D008408:Mastectomy / Q000379:methods*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D057830:Gender-Affirming Surgery / Q000379:methods*; D035441:Thoracic Wall / Q000601:surgery*; D063106:Transgender Persons; D014189:Transsexualism / Q000601:surgery*; D055815:Young Adult
Transgender patient; breast augmentation; chest-wall contour; female-to-male; male-to-female; mastectomy