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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Article info
Publication history
Published online: September 29, 2017
Accepted:
September 4,
2017
Received:
March 2,
2017
Footnotes
☆Parts of this article have been presented at the following meetings/conferences: 1. 15th October 2016, 1st Symposium Transgender Surgery, Rotkreuzklinikum – Frauenklinik, Munich, Germany; 2. 9th September 2016, 47th Annual Meeting of the German Society of Plastic, Reconstructive and Aesthetic Surgeons (DGPRAEC), 21st Annual Meeting of the Society of German Aesthetic and Plastic Surgeons, Kassel, Germany.
Products/Devices: Waterjet-assisted lipoplasty (WAL) with the BODY-JET® system by Human Med® (1860 Crown Drive, Suite 1408, Dallas Texas 75234, USA).
Identification
Copyright
© 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
