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Subcutaneous mastectomy in female-to-male transsexuals: Optimizing perioperative and operative management in 8 years clinical experience

  • Andreas Wolter
    Correspondence
    Corresponding author. Department of Plastic and Aesthetic Surgery, Florence-Nightingale Hospital – Kaiserswerther Diakonie, Kreuzbergstrasse 79, 40489 Duesseldorf, Federal Republic of Germany
    Affiliations
    Department of Plastic and Aesthetic Surgery, Florence-Nightingale-Hospital – Kaiserswerther Diakonie, Kreuzbergstrasse 79, Duesseldorf, Germany
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  • Till Scholz
    Affiliations
    Department of Plastic and Aesthetic Surgery, Florence-Nightingale-Hospital – Kaiserswerther Diakonie, Kreuzbergstrasse 79, Duesseldorf, Germany
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  • Naja Pluto
    Affiliations
    Department of Plastic and Aesthetic Surgery, Florence-Nightingale-Hospital – Kaiserswerther Diakonie, Kreuzbergstrasse 79, Duesseldorf, Germany
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  • Jens Diedrichson
    Affiliations
    Department of Plastic and Aesthetic Surgery, Florence-Nightingale-Hospital – Kaiserswerther Diakonie, Kreuzbergstrasse 79, Duesseldorf, Germany
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  • Andreas Arens-Landwehr
    Affiliations
    Department of Plastic and Aesthetic Surgery, Florence-Nightingale-Hospital – Kaiserswerther Diakonie, Kreuzbergstrasse 79, Duesseldorf, Germany
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  • Jutta Liebau
    Affiliations
    Department of Plastic and Aesthetic Surgery, Florence-Nightingale-Hospital – Kaiserswerther Diakonie, Kreuzbergstrasse 79, Duesseldorf, Germany
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Published:September 29, 2017DOI:https://doi.org/10.1016/j.bjps.2017.09.003

      Summary

      Introduction

      The incidence of complications, especially acute hematoma requiring surgical revision in female-to-male transsexuals (FTMTS), is consistently highly documented in literature with up to 33%. Since 2008 we perform subcutaneous mastectomies in FTMTS with an annually increasing number of cases. Due to an initially high hematoma revision rate in the previously published cohort (2008–2013), we implemented peri- and postoperative preventive measures and compared the results with the recent patient cohort (2014–2016).

      Patients and methods

      The records of 356 patients (712 mastectomies) were retrospectively reviewed. We compared the first cohort (C1, 01/2008 - 12/2013, 346 mastectomies; peri- and postoperative standard procedure and implementation of an algorithmic care path in our institution) with the recent cohort (C2, 01/2014 - 01/2016, 366 mastectomies) and introduced in C2 the following preventive measures: perioperative administration of tranexamic acid, intraoperative elevation of blood pressure to at least 120 mmHg before wound closure, bedrest and consequent wearing of compression bandage without removal 12 hours postoperatively. Comparison of complication rate, patient satisfaction and secondary revision rate was obtained in both cohorts.

      Results

      The mean operation time could be reduced from 103.6 minutes to 72.5 minutes (p < 0.05). The overall complication rate could be diminished from 11.8% to 5.5% (p < 0.05), the acute hematoma revision rate from 9.2% to 4.1% (p < 0.05). Secondary revisions were similar in both patient cohorts. Patient satisfaction rate was ameliorated from 88% to 93.5% “very satisfied” to “satisfied” patients.

      Conclusion

      Hematoma is the most common reason for reoperation in FTMTS patients. By implementation of peri- and postoperative preventive measures and additional application of an algorithmic care path we could achieve a significant reduction of complications, particularly of the hematoma evacuation rate. During 8 years clinical and operative treatment in FTMTS we could furthermore achieve a decrease in operative time and an ameliorated patient satisfaction with the aesthetic results.

      Keywords

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