The Impact of American Obesity and Skin Quality on Complications and Patient Reported Outcomes After Chest Masculinization Surgery
Christine O. Kang, MD, MHS, MS, Sivana Barron, BA, Amy Maselli, MD, Carolina Torres, MD, Bernard Lee, MD, MBA, MPH, FACS, Adam M. Tobias, MD, Ryan P. Cauley MD, MPH
Division of Plastic and Reconstructive Surgery. Beth Israel Deaconess Medical Center. Harvard Medical School. Boston, MA
Background: Masculinizing chest reconstruction in the female-to-male transgender and gender non-binary patient populations is integral in the treatment of gender dysphoria. The purpose of this study was to evaluate the demographic characteristics, surgical procedure variables, and post-operative outcomes following chest masculinization surgery.
Methods: Following CPT code search to identify all gender-affirming mastectomies performed by a single surgeon within our institution between August of 2014 and August of 2019, responses to a four-question survey were collected regarding plans for secondary chest correction, feelings of anxiety, feelings of depression, and nipple sensation preservation. Patient demographics, surgical procedure variables, and post-operative variables were obtained following medical record review. Patients were stratified once according to BMI ≤ 29.9 kg/m2 (n = 134) and BMI ≥ 30.0 kg/m2 (n = 43), and then by incision type: Periareolar (n = 15) and Double Incision (n = 162). Statistical analysis used Pearson’s X2 p-value ≤ 0.05 as significant.
Results: This sample provided 177 cases. No significant differences were noted in terms of age, race, ethnicity, or gender identity. When comparing non-obese patients (BMI ≤ 29.9 kg/m2) to obese patients (BMI ≥ 30.0 kg/m2), significantly more non-obese patients had “good” skin elasticity (31.3% vs 4.7%), significantly more did not plan to apply for a secondary correction (79.6% vs 55.8%), more attested to never having feelings of anxiety (14.2% vs. 2.6%), or depression (19.5% vs 5.1%). No significant difference in post-operative complications were noted between BMI groups. After stratifying by incision type, significantly more patients who underwent a periareolar incision had normal ptosis when compared to those who had a double incision (60% vs 15.4%), more had “good” skin elasticity (60% vs 21.6%), and more experienced no postoperative complications (93.3% vs 35.2%).
Conclusions: The present findings indicate that while there was no difference in post-operative complications in non-obese vs. obese patients, surgeons should consider discussing the many benefits of weight loss including mental health wellness and that non-obese patients may have better skin elasticity which may contribute to why a majority do not plan for secondary corrective surgery following chest masculinization. Additionally, patients who underwent a periareolar incision compared to a double incision had fewer postoperative complications. These results may be used to encourage shared decision making between future patients and surgeons such that preoperative variables and desired aesthetic outcome are weighed against risk of complication.
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