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Top Surgery In Transmasculine And Non-binary Patients With Obesity
Iulianna C. Taritsa, BA1, Cole Roblee, BA2, Joshua Weissman, BA1, Mona Ascha, MD1, Marco Ellis, MD1, Sumanas Jordan, MD, PhD1.
1Feinberg School of Medicine at Northwestern University, Chicago, IL, USA, 2Rosalind Franklin University, Chicago, IL, USA.

Purpose: The number of individuals identifying as transgender and non-binary (TGNB) in the United States is rising. Studies cite higher rates of obesity among this population. TGNB patients undergo top surgery to alleviate chest dysphoria, or discomfort pertaining to one’s chest. Obese patients may experience difficulty achieving clearance for surgery due to body habitus and associated comorbidities. Complication rates among obese TGNB patients designated female at birth (DFAB) undergoing gender-affirming mastectomy are not well studied. We study surgical characteristics and patient reported outcomes following gender-affirming mastectomy in obese versus non-obese TGNB DFAB patients.
Methods: We performed a retrospective review and cross-sectional study of 102 TGNB patients who underwent gender-affirming mastectomy at our institution from March 2018 to June 2021. The following post-operative outcome measures were sent to patients at least three months following top surgery: the Kozee Transgender Congruence Scale (TCS), the Olsen Chest Dysphoria Scale (CDS), and the Gender Congruence and Life Satisfaction survey (GCLS). Descriptive statistics were calculated for demographic and surgical variables. Fisher’s exact test was performed to examine associations between obesity class and complications, revisions, and patient reported outcomes.
Results: Thirty-eight (37.3%) patients responded after two survey deployments. The median (IQR) BMI at time of surgery was 30.3 (25.0, 33.9) kg/m˛. Eighteen patients had a BMI under 30, 15 had a BMI of 30 to 40, and 5 had a BMI of 40 and higher. The most common pre-operative comorbidities included depression (n=19, 50.0%), and anxiety (n=23, 60.5%). Hematoma occurred in 3 cases (7.9%): one in a patient with BMI under 30 and two in patients with BMI 30 to 40. This finding was not significant (p = 0.73). Revision surgery was performed in 11 cases (28.9%), most commonly for scar revision; three in patients with BMI under 30, six in patients with BMI 30 to 40, and 2 in patients with BMI 40 and over. This finding was not significant (p = 0.27). Table 1 outlines outcome scores for each obesity class; there were no significant differences in patient reported outcomes among obesity classes.
Conclusion: Preliminary evidence demonstrates that gender-affirming top surgery results in comparable complication and revision rates among obesity classes. Patient reported outcomes also did not differ based on obesity class. Further data is required to robustly examine how top surgery affects patients with high BMI.
Table 1.

Obesity ClassUnder 3030 to 4040 and Overp
n18155
Chest Dysphoria Measure (median [IQR])5.50 [3.75, 8.25]13.00 [7.00, 15.00]5.00 [4.50, 6.25]0.218
Transgender Congruence Scale (median [IQR])51.00 [44.00, 53.00]42.50 [39.75, 49.50]53.50 [51.00, 55.25]0.072
Gender Congruence and Life Satisfaction (median [IQR])93.00 [80.75, 108.75]95.00 [84.75, 101.00]71.50 [65.25, 80.00]0.083


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