Breaking the Binary: The Approach to Chest Masculinizing Gender-Affirming Surgery in Trangender Men.

BACKGROUND: The purpose of mastectomy for the transgender patient is to produce a masculine appearance of the chest. A number of algorithms have been proposed for selecting the surgical technique. A holistic and surgical approach to transgender men includes our experience-based classification system for selecting the correct surgical technique. OBJECTIVES: To present and discuss the Transgender Standard of Care and our personal experience. METHODS: Data were collected from the files of female-to-male transgender persons who underwent surgery during 2003-2019. Pictures of the patients were also analyzed. RESULTS: Until May 2021, 342 mastectomies were performed by the senior author on 171 patients. The 220 mastectomies performed on 110 patients until November 2019 were included in our cohort. Patient age was 13.5 to 50 years (mean 22.5 ± 6.1). The excision averaged 443 grams per breast (range 85-2550). A periareolar approach was performed in 14 (12.7%), omega-shaped resection (nipple-areola complex on scar) in 2 (1.8%), spindle-shaped mastectomy with a dermal nipple-areola complex flap approach in 38 (34.5%), and a complete mastectomy with a free nipple-areola complex graft in 56 (50.9%). Complications included two hypertrophic scars, six hematomas requiring revision surgery, three wound dehiscences, and three cases of partial nipple necrosis. CONCLUSIONS: A holistic approach to transgender healthcare is presented based on the World Professional Association for Transgender Health standard of care. Analysis of the data led to Wolf's classification for female-to-male transgender mastectomy based on skin excess and the distance between the original and the planned position of the nipple-areola complex.

Long Term Rigid Retained Foreign Object After Breast Augmentation: A Case Report and Literature Review.

Introduction: Retained foreign object (RFO) is a rare iatrogenic complication. This article presents an unprecedented case of a plastic RFO post-augmentation mammoplasty. Case Presentation: We present the case of a 32-year-old woman, 8 years after breast augmentation surgery, with a 4 year history of a palpable migrating mass in the superior lateral quadrant of her right breast with fluctuating levels of pain. Imaging studies included mammography tests, sonographic examinations, a Magnetic Resonance Imaging scan, and a Computed Tomography scan, all of which did not identify any pathological findings. Exploratory surgery discovered a syringe-tip cover in the implant pocket. Conclusion: Persistent complaints and symptoms accompanied by non-specific imaging studies warrant escalation of diagnostic methods, in line with a high awareness for the possibility of an RFO. As pocket lavage is a common practice in various surgeries, this report can serve as a valuable reminder for surgical teams to account for syringe covers and other disposable items at the end of all operations.

Classification of Transgender Man's Breast for Optimizing Chest Masculinizing Gender-affirming Surgery.

The purpose of mastectomy for the female-to-male transgender patient is to produce a masculine appearance of the chest. A number of algorithms have been proposed for selecting the surgical technique; these have generally been based on the degree of breast ptosis and the quality and elasticity of the skin. We present a series of subcutaneous mastectomies operated on by 1 surgeon during the last 2 decades. Based on our experience, we suggest a classification system for selecting surgical technique. METHODS: Data were collected from the files of female-to-male transgender persons who underwent surgery during 2003-2019. The data included background and surgery information. Pictures from the clinic's archive of the patients before, during, and after surgery were collected and analyzed. RESULTS: In total, 220 mastectomies were performed on 110 patients aged 13.5-50 years (mean 22.5 ±6.1). The excision averaged 443 g per breast (range: 85-2550). A periareolar approach was performed in 14 (12.7%), omega-shaped resection (nipple-areola complex on scar) in 2 (1.8%), spindle-shaped mastectomy with a dermal nipple-areola complex flap approach in 38 (34.5%), and a complete mastectomy with a free nipple-areola complex graft in 56 (50.9%). Complications included 2 hypertrophic scars, 6 hematomas requiring revision surgery, 3 wound dehiscences, and 3 cases of partial nipple necrosis. CONCLUSIONS: Analysis of the data led to a proposed classification for female-to-male transgender mastectomy (Wolf's classification), based on skin excess and the distance between the original and the planned position of the nipple-areola complex.

[DELAYED PERSISTENT BREAST IMPLANT INFECTION WITH MYCOBACTERIUM FORTUITUM].

INTRODUCTION: Non-Tuberculous Mycobacteria (NTM) are opportunistic environmental pathogens that can produce a wide range of diseases, including infection of the skin and soft tissues. Mycobacterium fortuitum is a predominant causative agent of postsurgical wound infection, especially in breast surgery. Peri-prosthetic infection due to Mycobacterium fortuitum are uncommon, but increasingly reported. This report summarizes the case of a young healthy female who underwent bilateral breast mastopexy with insertion of silicone implants. Shortly after the procedure she presented with clinical signs of wound infection that failed to heal completely in spite of repeated drainage and empiric antibiotic therapy. Additional microbiological investigation allowed for a diagnosis of Mycobacterium fortuitum. A prolonged course of anti-mycobacterial therapy, combined with removal of the implants initiated eradication of the infection and enabled re-implantation of the prosthesis. This case report underscores the importance of awareness to this type of pathogen especially in cases of exudative infection with sterile cultures. Timely identification can lead to prompt therapy of patients preventing further complications, costs and remaining aesthetic damage.

[OUR EXPERIENCE IN MASTECTOMY FOR TRANSGENDERS FEMALE TO MALE - A 90 CASES COHORT STUDY].

AIMS: We present our experience in mastectomies for masculine chest contouring, including discussion of techniques, complications and decision-making processes. BACKGROUND: Creating a masculine chest is an important component in the process of gender reassignment, in female to male transgenders. This surgery may be performed using various techniques and the main complication is acute hematoma requiring surgical revision. METHODS: The study population included all the patients operated on during 2013-2018. Data was collected from the medical files and clinical photos. RESULTS: A total of 180 mastectomies were performed on 90 patients, 67 of which were performed in the past 5 years; average age was 22.4 years; average tissue weight was 467 grams per breast and operation length was 2.5 hours; 13 (14%) were operated on with the periareolar approach, 3 (3.3%) using a Nipple Areolar Complex (NAC) on scar approach, 37 (41.1%) using a dermal NAC flap approach and 37 (41.1%) using a free NAC graft (41.1%). Complications included two hypertrophic scars, five hematomas requiring revision surgery, three wound dehiscence and two cases of nipple necrosis. CONCLUSIONS: We will present a series of 90 cases of female to male transgenders operated on by the senior author over the past two decades. DISCUSSION: The choice of technique changed over the years as did the operation length. The two main approaches are dermal NAC flap and a free NAC graft. Future studies will compare these techniques. There is a need for a clinical classification for choosing the tailored type of operation according to the characteristics of the breast.