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The Association of Race with Scar and Wound Healing Outcomes following Chest Masculinization Surgery
Calvin R. Schuster, Yu Jui Kung
*, Camille F. Blackman, Margaret R. Wang, Fan Liang
Department of Plastic and Reconstructive Surgery, Center for Transgender and Gender Expansive Health, Johns Hopkins University School of Medicine, Baltimore, MD
Background: Chest masculinization surgery (CMS) is the most frequently performed gender-affirming surgery and can result in substantial scarring. Although racial and ethnic differences in hypertrophic and keloid scarring are well established, these differences have not been well characterized in the context of CMS, where scar burden is a primary determinant of aesthetic outcomes and patient satisfaction. Characterizing these differences is critical to inform preoperative counseling and guide strategies in early scar prevention.
Methods: We conducted a retrospective, single-surgeon cohort study of patients who underwent double-incision CMS with free nipple grafting between November 2022-January 2025. The primary outcome was postoperative hypertrophic scarring. Secondary outcomes included other postoperative complications. Multivariable logistic regression assessed associations between race and outcomes, adjusting for age, BMI, smoking history, and testosterone use.
Results: Among 122 patients, 69.7% (n=85) were non-Hispanic White, 21.3% (n=26) were non-Hispanic Black, 3.3% (n=4) were Hispanic, and 2.5% (n=3) were non-Hispanic Asian. The mean age was 27.1±8.7 years. There were no significant differences in age, BMI, smoking history, or testosterone use between racial groups. Black CMS patients had significantly greater odds of postoperative hypertrophic scarring (aOR [95% CI] 5.0 [1.1-26.8], p=0.04) and significantly lower odds of infection requiring antibiotics (aOR 0.09 [0.008-0.6], p=0.02). They did not have significantly greater odds of scar widening, hematoma, dehiscence, skin necrosis, graft failure, or unplanned reoperation. No intraoperative or major postoperative complications occurred for any CMS patients.
Conclusion: Black patients are at increased risk of postoperative hypertrophic scarring following CMS. These findings support tailored preoperative counseling and early scar prevention strategies to optimize aesthetic outcomes and improve patient satisfaction.
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