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Effect of Testosterone use in Female to Male (FTM) Mastectomy Patients: A Review of 481 Patients
Karan Chopra, M.D.1, Kashyap K. Tadisina, B.S.2, Danielle Himelfarb, B.S.2, Beverly Fischer, M.D.2, Devinder P. Singh, M.D.2, Rachel Bluebond-Langer, M.D.2.
1University of Maryland/Johns Hopkins University, Baltimore, MD, USA, 2University of Maryland, Baltimore, MD, USA.

Purpose:
Subcutaneous mastectomy is frequently performed for female-to-male (FTM) sexual reassignment. The procedure aims to remove breast tissue and reconstruct the chest to facilitate living in the male gender role. Despite the increasing popularity of this procedure, an examination of the complications of mastectomies in FTM transsexuals is lacking. Furthermore, no group has examined the effect of preoperative testosterone hormone therapy on the complication rate. In this study, we reviewed the largest series of FTM mastectomy patients to date to determine the relationship between testosterone use and complications of FTM mastectomy.
Methods:
A retrospective review of 481 consecutive patients who underwent FTM mastectomy from November 1990 to December 2012 was performed. Data points recorded include: patient demographics, testosterone therapy use, and complications including infection, hematoma, seroma, nipple necrosis, dehiscence and suture related complications. A student's t-test was used to compare demographic parameters between testosterone and non-testosterone groups of patients. Statistical analysis was performed to examine the effect of testosterone on overall complication rate and specific complication rates using a Chi Square analysis with Fisher's Exact 1-sided test.
Results:
Mastectomy was successfully performed in a total of 481 patients. 371 (77%) of patients received testosterone therapy, with average duration of therapy being 20.7 months. The mean patient age was 28.1 years. Preoperatively, average BMI was 25.3 kg/m2, 8.7% were smokers, only 2 patients had diabetes mellitus, and average follow up time was 98.8 days. Demographics are summarized in Table 1. Overall complication rate was 18% (86 patients). The most common complication was hematoma (37 patients, 43% of complications), followed by seroma (24 patients, 28%), infection (11 patients, 13%), nipple necrosis (10 patients, 12%), dehiscence (3 patients, 3%), and suture related (1 patient, 1%). Complications are summarized in Table 2. Testosterone use was not found to be related to complication rate overall or for specific complications (Table 3, p > 0.05).
Conclusion:
Our results show no significant association between testosterone therapy use and any surgical complications in female-to-male transsexual mastectomies. Moving forward, the long-term effects of testosterone therapy on this patient population should be determined.


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