Breast Surgery in Adolescents: Cisgender Breast Reduction Versus Transgender and Nonbinary Chest Masculinization.


Journal

Annals of plastic surgery
ISSN: 1536-3708
Titre abrégé: Ann Plast Surg
Pays: United States
ID NLM: 7805336

Informations de publication

Date de publication:
18 Jun 2024
Historique:
medline: 19 6 2024
pubmed: 19 6 2024
entrez: 19 6 2024
Statut: aheadofprint

Résumé

Both breast reduction surgery (BRS) in adolescent girls and chest masculinization surgery (CMS) transgender and nonbinary (TGNB) individuals improve physical discomfort and psychological well-being. Nonetheless, CMS in adolescents is highly contested due to concerns regarding safety and capacity for consent. Here, we compare both procedures to quantify trends in incidence, minimum age, and surgical outcomes. The National Surgical Quality Improvement Program database was queried from 2018 to 2021 for cisgender and TGNB adolescents 18 years or younger who underwent BRS or CMS. Our primary outcome was the incidence of postoperative complications within 30 days of surgery. Multivariate logistic regression was performed to determine if CMS was associated with postoperative complications. Of 2504 adolescents, the majority (n = 2186 [87.3%]) were cisgender female patients who underwent BRS, compared with TGNB adolescents (n = 318 [12.7%]) who underwent CMS. BRS patients were younger at time of surgery (mean [SD] 16.7 [1.2], 17.5 [0.9]; P < 0.001). The minimum age for BRS was consistently 2 to 3 years younger than that for CMS (12.1 to 12.6 years vs 14.0 to 15.1 years). A comparable frequency of BRS and CMS patients developed 1 or more complications within 30 days of surgery (n = 98 [4.5%], n = 13 [4.1%]; P = 0.775). Cisgender female adolescents undergo breast surgery at a 7-fold rate compared with TGNB adolescents and do so at significantly younger ages. Given the favorable effects of BRS and CMS on psychosocial well-being and their comparable surgical risk of complications, our data help recontextualize the concerns surrounding adolescent CMS.

Identifiants

pubmed: 38896845
doi: 10.1097/SAP.0000000000003981
pii: 00000637-990000000-00477
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

Déclaration de conflit d'intérêts

Conflicts of interest and sources of funding: none declared.

Références

Wolfswinkel EM, Lemaine V, Weathers WM, et al. Hyperplastic breast anomalies in the female adolescent breast. Semin Plast Surg. 2013;27:49–55.
Sachs D, Szymanski KD. Breast reduction. In: StatPearls. Treasure Island, Florida: StatPearls Publishing; 2023.
Xue AS, Wolfswinkel EM, Weathers WM, et al. Breast reduction in adolescents: indication, timing, and a review of the literature. J Pediatr Adolesc Gynecol. 2013;26:228–233.
Patel K, Corcoran J. Breast reduction surgery in adolescents. Pediatr Ann. 2023;52:e31–e35.
Koltz PF, Sbitany H, Myers RP, et al. Reduction mammaplasty in the adolescent female: the URMC experience. Int J Surg. 2011;9:229–232.
Payne SH, Brown CA, Saad O, et al. Short-term satisfaction, psychosocial impact, and complication profile of reduction mammaplasty during adolescence. Aesthet Surg J. 2023;43:NP484–NP491.
Sharma KS, Lim P, Baines R, et al. Reduction mammaplasty in adolescents: a review of the indications, timing, and outcomes in a regional plastic surgery unit. Eur J Plast Surg. 2014;37:661–666.
Lee MC, Lehman JA Jr., Tantri MD, et al. Bilateral reduction mammoplasty in an adolescent population: adolescent bilateral reduction mammoplasty. J Craniofac Surg. 2003;14:691–695.
The Aesthetic Society. Aesthetic Plastic Surgery National Databank. https://cdn.theaestheticsociety.org/media/statistics/2019-TheAestheticSocietyStatistics.pdf
Kulkarni K, Egro FM, Kenny EM, et al. Reduction mammaplasty in adolescents: a comparison of wise and vertical incision patterns. Plast Reconstr Surg Glob Open. 2019;7:e2516.
Mehringer JE, Harrison JB, Quain KM, et al. Experience of chest dysphoria and masculinizing chest surgery in transmasculine youth. Pediatrics. 2021;147:e2020013300.
Tang A, Hojilla JC, Jackson JE, et al. Gender-affirming mastectomy trends and surgical outcomes in adolescents. Ann Plast Surg. 2022;88(4 Suppl):S325–s331.
Ascha M, Sasson DC, Sood R, et al. Top surgery and chest dysphoria among transmasculine and nonbinary adolescents and young adults. JAMA Pediatr. 2022;176:1115–1122.
Olson-Kennedy J, Warus J, Okonta V, et al. Chest reconstruction and chest dysphoria in transmasculine minors and young adults: comparisons of nonsurgical and postsurgical cohorts. JAMA Pediatr. 2018;172:431–436.
Naides AI, Schultz JJ, Shulzhenko NO, et al. Chest masculinization technique and outcomes in 72 double-incision chest-contouring procedures with free nipple grafting. Plast Reconstr Surg Glob Open. 2021;9:e3459.
Skorochod R, Rysin R, Wolf Y. Age-related outcomes of chest masculinization surgery: a single-surgeon retrospective cohort study. Plast Reconstr Surg Glob Open. 2023;11:e4799.
Hudson AS, Morzycki AD, Guilfoyle R. Reduction mammaplasty for macromastia in adolescents: a systematic review and pooled analysis. Plast Reconstr Surg. 2021;148:31–43.
Redfield E, Conron KJ, Tentindo W, Browning E. Prohibiting gender-affirming medical care for youth. Williams Institute. 2023. Available at: https://williamsinstitute.law.ucla.edu/publications/bans-trans-youth-health-care/. Accessed November 1, 2023.
Outlawing trans youth: state legislatures and the battle over gender-affirming healthcare for minors. Harv Law Rev. 2021;134:2163–2185. Available at: https://harvardlawreview.org/wp-content/uploads/2021/04/134-Harv.-L.-Rev.-2163.pdf. Accessed February 23, 2023.
American College of Surgeons. About ACS NSQIP. Available at: https://www.facs.org/quality-programs/data-and-registries/acs-nsqip/about-acs-nsqip/. Accessed March 26, 2023.
American College of Surgeons. User Guide for the 2021 ACS NSQIP Procedure Targeted Participant Use Data File (PUF). Available at: https://www.facs.org/media/tjcd1biq/nsqip_puf_userguide_2021_20221102120632.pdf. Accessed March 29, 2023. https://www.facs.org/media/tjcd1biq/nsqip_puf_userguide_2021_20221102120632.pdf.
IBM SPSS Statistics. IBM SPSS Statistics 29 Brief Guide. Available at: https://www.ibm.com/docs/en/SSLVMB_29.0.0/pdf/IBM_SPSS_Statistics_Brief_Guide.pdf. Accessed April 22, 2023.
Davis MJ, Roy MG, Monson LA. Analysis of adolescent patient satisfaction and well-being following reduction mammaplasty using the BREAST-Q survey. J Pediatr Surg. 2022;57:538–543.
Tapp M, Singh R, Ulm JP, et al. Association of increased body mass index and resection weights on the safety of reduction mammaplasty in the adolescent population. J Plast Reconstr Aesthet Surg. 2019;72:1219–1243.
Grimstad F, Kremen J, Boskey ER, et al. How should clinicians navigate decision making about genital reconstructive surgeries among intersex and transgender populations? AMA J Ethics. 2023;25:E437–E445. https://edhub.ama-assn.org/ama-journal-of-ethics/module/2805770#r25. Accessed February 1, 2023.
Barbee H, Hassan B, Liang F. Postoperative regret among transgender and gender-diverse recipients of gender-affirming surgery. JAMA Surg. 2024;159:125–126.

Auteurs

Bashar Hassan (B)

From the Center for Transgender and Gender Expansive Health, Johns Hopkins University, Baltimore, MD.

Ferris Zeitouni (F)

From the Center for Transgender and Gender Expansive Health, Johns Hopkins University, Baltimore, MD.

Mona Ascha (M)

From the Center for Transgender and Gender Expansive Health, Johns Hopkins University, Baltimore, MD.

Renata Sanders (R)

From the Center for Transgender and Gender Expansive Health, Johns Hopkins University, Baltimore, MD.

Errol Fields (E)

From the Center for Transgender and Gender Expansive Health, Johns Hopkins University, Baltimore, MD.

Fan Liang (F)

From the Center for Transgender and Gender Expansive Health, Johns Hopkins University, Baltimore, MD.

Classifications MeSH