Gender-affirming Chest Surgery in Transgender Adolescents and Young Adults: Technical and Ethical Considerations
Jessica A. Lee, MD1, Joseph E. Losee, MD, FACS, FAAP2, Lorelei J. Grunwaldt, MD, FACS, FAAP2.
1University of Pittsburgh, Pittsburgh, PA, USA, 2Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
While the overall practice of transgender surgery is increasing, many surgeons are reluctant to perform gender-affirming chest surgery in adolescents, despite performing gynecomastia or congenital breast surgery in similar aged patients. We aimed to describe our experience in transgender female-to-male chest surgery in adolescents and young adults.
All patients who underwent gender-affirming bilateral mastectomy at our children's hospital were identified. Patients had at least one referral letter in accordance with WPATH Standards of Care guidelines. Medical history, testosterone treatment, referral pattern, age, surgical approach, resection weight, BMI, and complications were reviewed.
25 patients underwent bilateral mastectomy by a single surgeon over a 17-month period. 22 patients identified as transgender male and 3 as agender/genderqueer. 22 patients had a history of anxiety and/or depression. 21 patients were on testosterone. 20 patients were referred by adolescent medicine or pediatric endocrinology. Average age at surgery was 20.4 years (range 15.1-34.3); 6 patients were under 18 years. Patients who underwent a periareolar approach (n=13) had smaller resection weights (average 204 grams, range 49-476) and lower BMI (average 24, range 19-29) compared to those who required double incision mastectomy with free nipple grafts (n=12), who had an average resection weight of 797 grams (367-1848) and BMI 31 (22-39) (p<0.01). There were 2 seromas and 1 hematoma. All patients expressed satisfaction at postoperative visits.
The combination of team care and an algorithmic approach to surgical technique produces satisfied patients and excellent outcomes in adolescents and young adults seeking gender-affirming chest surgery.
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