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Female-to-male transgender chest reconstruction: A large consecutive, single-surgeon experience

Published:December 21, 2011DOI:https://doi.org/10.1016/j.bjps.2011.11.053

      Summary

      Introduction

      Chest reconstruction in the female-to-male transgender individual is not a common procedure due to the low prevalence of intractable gender dysphoria. It means that few surgeons acquire sufficient expertise and many UK patients find themselves travelling abroad to centres such as Singapore, Amsterdam and the United States.

      Patients and methods

      This study retrospectively evaluated 100 consecutive patients of a single surgeon over a 3-year period with prime outcome measures including surgical technique, complications, surgical revision and patient-reported satisfaction, using a simple, 1–5 linear analogue scoring system.

      Results

      The median age was 28 years with a median excision of 345 g per breast. Complications occurred in 11 patients, five of which required surgical haematoma evacuation. Chi2 analysis failed to show a correlation between testosterone supplementation and haemorrhagic sequelae (p>0.1). To date, 16 patients have undergone supplementary surgery, predominantly axillary dog-ear revision. Overall patient-reported satisfaction was 4.25.

      Conclusions

      Whilst only a part of the process in gender transitioning, chest reconstruction is important as it is frequently the initial surgical procedure and enables the large-breasted to live in their chosen role much more easily. Historically associated with high rates of both complication and revision surgery, this study demonstrates that both may be appreciably lower and associated with high levels of patient satisfaction so that there is a realistic, high-quality option for British patients who might otherwise feel the need to travel abroad for their surgery.

      Keywords

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      References

        • Sutcliffe P.A.
        • Dixon S.
        • Akehurst R.L.
        • et al.
        Evaluation of surgical procedures for sex reassignment: A systematic review.
        J Plast Reconstr Aesth Surg. 2009; 62: 294-308
        • Landén M.
        • Wålinder J.
        • Lundström B.
        Incidence and sex ratio of transsexualism in Sweden.
        Acta Psychiatr Scand. 1996; 93: 261-263
        • Tsoi W.F.
        The prevalence of transsexualism in Singapore.
        Acta Psychiatr Scand. 1988; 78: 501-504
        • Edgerton M.T.
        • Knorr N.J.
        • Callison J.R.
        The surgical treatment of transsexual patients.
        Plast Reconstr Surg. 1970; 45: 38-46
      1. http://www.gires.org.uk/assets/Medpro-Assets/GenderVarianceUK-report.pdf [accessed 10.12.11].

        • Lim S.M.
        Surgery in transsexuals.
        Ann Acad Med Singapore. 1986; 15: 122-126
        • Hage J.J.
        • Bloem J.J.A.M.
        Chest wall contouring for female-to-male transsexuals: Amsterdam experience.
        Ann Plast Surg. 1995; 34: 59-66
        • Colić M.M.
        • Colić M.M.
        Circumareolar mastectomy in female-to-male transsexuals and large gynaecomastias: A personal approach.
        Aesth Plast Surg. 2000; 24: 450-454
        • Takayanagi S.
        • Nagakawa C.
        Chest wall contouring for female-to-male transsexuals.
        Aesth Plast Surg. 2006; 30: 206-212
        • Nelson L.
        • Whallett E.J.
        • McGregor J.C.
        Transgender patient satisfaction following reduction mammaplasty.
        J Plast Reconstr Aesth Surg. 2009; 62: 331-334
        • Monstrey S.
        • Selvaggi G.
        • Ceulmana P.
        • et al.
        Chest-wall contouring surgery in female-to-male transsexuals: A new algorithm.
        Plast Reconstr Surg. 2008; 121: 849-859
        • Harry Benjamin International Gender Dysphoria Association
        Standards of care for gender identity disorders. 6th ed. Symposium Press, Düsseldorf2001
        • Hage J.J.
        • van Kesteren P.J.M.
        Chest-wall contouring in female-to-male transsexuals: Basic considerations and review of the literature.
        Plast Reconstr Surg. 1995; 96: 386-391
      2. ([accessed 10.12.11])
        • Metaxotos N.G.
        • Asplund O.
        • Hayes M.
        The efficacy of bupivacaine with adrenaline in reducing pain and bleeding associated with breast reduction: A prospective trial.
        Br J Plast Surg. 1999; 52: 290-293
        • McGregor J.C.
        • Whallett E.J.
        Some personal suggestions on surgery in large or ptotic breasts for female to male transsexuals.
        J Plast Reconstr Aesth Surg. 2006; 59: 893-896
        • Thorek M.
        Plastic reconstruction of the breast and free transplantation of the nipple.
        J Int Coll Surg. 1946; 9: 194-224
        • Murphy T.P.
        • Ehrlichman R.J.
        • Seckel B.R.
        Nipple placement in simple mastectomy with free nipple grafting for severe gynaecomastia.
        Plast Reconstr Surg. 1994; 94: 818-823
        • Beckenstein M.S.
        • Windle B.H.
        • Stroup Jr., R.T.
        Anatomical parameters for nipple position and areolar diameter in males.
        Ann Plast Surg. 1996; 36: 33-36
        • Beer G.M.
        • Budi S.
        • Seifert B.
        • Morgenthaler W.
        • Infanger M.
        • Meyer V.E.
        Configuration and localisation of the nipple–areola complex in men.
        Plast Reconstr Surg. 2001; 108: 1947-1952
        • Lindsay W.R.N.
        Creation of a male chest in female transsexuals.
        Ann Plast Surg. 1979; 3: 39-46
      3. Fischer BA. Personal communication; 3 February 2011.

        • Pusic A.L.
        • Klassen A.F.
        • Scott A.M.
        • Klok J.A.
        • Cordiero P.G.
        • Cano S.J.
        Development of a new patient-reported outcome measure for breast surgery: The BREAST-Q.
        Plast Reconstr Surg. 2009; 124: 345-353
        • Bockting W.
        • Robinson B.
        • Benner A.
        • Sceltema K.
        Patient satisfaction with transgender health services.
        J Sex Marital Ther. 2004; 30: 277-294
        • Rakic Z.
        • Starcevic V.
        • Maric J.
        • Kelin K.
        The outcome of sex reassignment surgery in Belgrade: 32 patients of both sexes.
        Arch Sex Behav. 1996; 25: 515-525
        • Barrett J.
        Psycological and social function before and after phalloplasty.
        Int J Transgender. 1998; 2 (unpaginated)
        • Landén M.
        • Wålinder J.
        • Hambert G.
        • et al.
        Factors predictive of regret in sex reassignment.
        Acta Psychiatr Scand. 1998; 97: 284-289
        • Smith Y.L.S.
        • van Goozen S.H.M.
        • Kuiper A.J.
        Sex reassignment: Outcomes and predictors of treatment for adolescent and adult transsexuals.
        Psychol Med. 2005; 25: 89-99