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Gender-Affirming Mastectomy in a Transgender Individual with Breast Cancer
Neel Bhagat BS, Lauren Lautenslager MD, Ivan Hadad MD
Indiana University
2022-01-14
Presenter: Neel D Bhagat
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. All work on this project represents the original work of the resident or medical student
Director Name: William Wooden
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background
Gender-affirming mastectomy (GAM), in contrast to simple mastectomy (SM), utilizes preservation of subcutaneous and breast tissue in order to produce a cosmetically favorable result for transgender patients, however this procedure does not remove all future malignancy risk. Herein we present a case report of a transmale patient who was evaluated for GAM and subsequently found to have a malignant breast mass, necessitating multi-disciplinary intervention and coordination between breast and plastic surgery teams.
Case Description
N.T. is a 47 year-old African American transgender male who was found to have a 3 cm breast mass on routine pre-operative mammographic screening prior to GAM. Pathology confirmed grade IDC and further genetic testing showed the patient was BRCA2 positive. The breast and plastic surgery teams coordinated the GAM in order to best address the mass while achieving cosmetic goals. This case was complicated by positive nipple margins on intra-operative cold specimen, which necessitated deviation from the initial plan to perform bilateral nipple grafts, and instead utilized excess areolar tissue from the left nipple to reconstruct the contralateral right nipple. Graft survival and overall repair quality at 6 weeks was satisfactory to both patient and provider.
Discussion
This case highlights several of the challenges encountered when considering or performing GAMs in transmale patients with underlying breast cancer. Surgical considerations for these patients differs from cisgender individuals undergoing mastectomy for oncologic breast findings. Further research is needed to better determine the ideal operative practice and ideal follow-up screening for these patients.
