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Developing A Graphical Interface To Determine Patient-defined Ideals In Gender Affirming Mastectomy
Gaines Blasdel1, Eugene Matthews2, Oriana Cohen, MD1, Rachel Bluebond-Langner, MD1.
1Hansjörg Wyss Department of Plastic Surgery, New York University School of Medicine, New York City, NY, USA, 2Hunter College, New York City, NY, USA.

PURPOSE:
Mastectomy is one of the most commonly performed surgical procedures in the transgender, two-spirit, nonbinary, intersex, and gender expansive (T/GE) population. While the procedure has analogs in cisgender male and female patients, there are visual and technical aspects to the procedure that are unique to masculinizing chest reconstruction. Previous research has utilized cisgender male chests to derive algorithms for T/GE chest reconstruction. Differences in skeletal dimensions and body fat distribution in T/GE patients assigned female at birth may alter the ability to achieve male-typical feature placement utilizing algorithms derived from cisgender males. Additionally, male-typical feature placement may not be the desired surgical outcome for all T/GE patients seeking surgery. Establishing a model for T/GE-defined ideal chest parameters in a range of body habitus is a necessary groundwork to collect context-sensitive patient centered outcomes, a WPATH identified research priority.
METHODS:
Three dimensional models of multiple female assigned at birth T/GE body habitus were created with reference to a base anatomical human model. Six chest reconstruction parameter variables were isolated: Areola diameter, lateral position of nipple-areola complex (NAC), vertical position of NAC, scar height, scar curvature, and scar angle. Previous anatomical studies of cisgender male chests were used to delineate the median option of each variable. Three versions of each variable were mapped to the base anatomy of the modeling software, and applied to each body habitus.
RESULTS: Three Cartesian planes containing 9 discrete options, each combining manipulation of two isolated variables, were created using three-dimensional modeling software:
1. Areola diameter vs lateral position of the nipple-areola complex. 2. Vertical position of nipple-areola complex vs. scar height 3. Scar angle vs. scar curvature
These three Cartesian planes of variable manipulation were then applied to each female assigned at birth T/GE body habitus. Each discrete option was modeled and visualized as a slowly rotating figure, providing participants multiple views of the resulting chest parameters. The graphical survey was programmed for future data collection.
CONCLUSION:
Utilizing three dimensional modeling software is a feasible method for collecting patient-defined ideals for chest reconstruction. This tool is being developed to record and quantify idealized outcomes defined by patients. Once patient-defined models have been established, further research is needed to measure the concordance of patient-defined ideals, plastic surgeon-defined ideals, and post-surgical outcomes. This graphical survey technique to determine patient ideals can be applied to additional gender affirming surgical interventions such as breast augmentation, facial gender confirming surgery, and genital affirmation surgery.


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