Abstract
Purpose:
Many transmasculine patients undergo gender-affirming mastectomy and hysterectomy. Conflicting evidence exists whether these procedures may be safely combined. The purpose of this study is to compare post-operative complications between transmasculine patients who underwent mastectomy alone versus mastectomy in combination with hysterectomy.
Methods:
Retrospective chart review was performed on patients who underwent mastectomy between January 2020 and September 2022 (n=227). Patients were separated into two groups based on whether they had mastectomy alone (n=187) versus in combination with hysterectomy (n=40). Outcomes included operation time, length of inpatient hospital stay, chest wall complication, and revision rate and gynecologic complication rate. Independent t-tests, Pearson-chi square analyses, and Fischer's exact tests were used to compare outcomes between the groups.
Results:
Overall rate of chest wall complications was 8.8%. Combination of mastectomy with hysterectomy within the same day significantly increased operation time (311 vs. 166 min, p<0.001), admission time (0.23 vs. 0.02 days, p<0.001), and rate of chest wall complications (17.5% vs. 6.9%, odds ratio [OR]=2.84 95% confidence interval [CI]: 1.05–7.65), particularly infection (7.5% vs. 1.1%, OR=7.50 95% CI: 1.21–46.46). There was no difference in hematoma or seroma formation, dehiscence, partial or complete nipple loss, or revision rates between groups. Gynecologic complication rate was 2.5% (n=1).
Conclusion:
Combining mastectomy and hysterectomy is not a benign undertaking as it is associated with increased risk of post-operative chest wall infection. Multidisciplinary surgical teams treating transmasculine patients should choose a surgical plan that optimizes patient outcomes.
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