Outcomes Following Augmentation Mammoplasty in Transgender and Cisgender Females
Nicholas G. Cuccolo1, Christine O. Kang, MD, MHS, MS1, Elizabeth Boskey, PhD, MPH1, Ahmed M.S. Ibrahim, MD, PhD1, Louise L. Blankensteijn, MD1, Amir Taghinia, MD2, Bernard T. Lee, MD, MPH, MBA1, Samuel J. Lin, MD, MBA1, Oren Ganor, MD2.
1Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA, 2Boston Children's Hospital/Harvard Medical School, Boston, MA, USA.
Background: Gender dysphoria (GD) refers to an incongruence between one's self expressed gender and their birth assigned sex that causes marked distress. In addition to psychological and medical therapy, many patients also seek gender affirmation surgery (GAS). For transgender females, breast augmentation (‘Top Surgery') is typically the first, and in some cases, the only, GAS procedure that they will undergo. Recent legislative changes have significantly expanded access to GAS and the demand for these procedures has increased in parallel. The aim of this study was to compare postoperative outcomes of augmentation mammoplasty in transgender and cisgender females.
Methods: We queried the ACS-NSQIP database from 2006-2017 to establish two cohorts: 1) transgender females undergoing gender affirming top surgery and 2) cisgender females seeking cosmetic breast augmentation (without any other or concurrent procedures). Postoperative
outcomes were compared between the two cohorts. Multivariable regression analysis was used to control for confounders.
Results: A total of 1,360 cases were identified, of which 280 (21%) were male-to-female (MtF) top surgeries and 1,080 (79%) were cosmetic breast augmentation (CBA) cases. The MtF cohort was significantly older (36.8 ± 12.9 years versus 34.8 ± 10.6, p=0.02), had a higher average BMI (26.7 ± 5.6 kg/m2 versus 22.3 ± 3.4 kg/m2, p<0.001), and had a different racial distribution (45.7% white versus 88.2% white, p<0.001) compared with the CBA cohort. MtF patients also had higher rates of smoking (27.1% versus 10.9%, p<0.001), diabetes (4.3% versus 0.9%, p<0.001), and hypertension (10.4% versus 3.1%, p<0.001). The rate of all-cause complications was 1.8% (n=5) in the MtF cohort and 1.6% (n=18) in the CBA cohort (p=0.890). Rates of readmission were also similar between the two groups (1.4% [n=4] in the MtF cohort versus 0.5% [n=5] in the CBA cohort). Multivariable regression analysis revealed no statistically significant predictors for all-cause complications.
Conclusion: Transfeminine breast augmentation is a safe procedure that has a similar complication profile to its cisgender counterpart. As the social climate for transgender individuals in the United States continues to improve and access to care expands, the need for such procedures will continue to rise. The results of this study should reassure and encourage surgeons who are considering performing this procedure
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