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Outcomes of Combining Mastectomy and Hysterectomy for Transmasculine Patients
Keeley D Newsom, Mary M Holohan, Megan Eigsti, Payal Patel, Hannah Locke, MD, Ivan Hadad, MD
Indiana University School of Medicine
2023-01-30
Presenter: Maggie Holohan
Affidavit:
Keeley D Newsom, Mary M Holohan, Megan Eigsti, Payal Patel, Hannah Locke, MD, Ivan Hadad, MD
Director Name: William Wooden
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Purpose: To treat gender dysphoria, many transmasculine patients undergo gender-affirming mastectomy and hysterectomy. Conflicting evidence exists as to whether these procedures may be safely combined and performed within the same session. The purpose of this study is to compare postoperative 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 complications was 8.8%. Combination of mastectomy with hysterectomy within the same day significantly increased operation time (311 vs 166 minutes, 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%, OR = 2.84 95% 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, nipple loss, or revision rates between groups. Gynecologic complication rate was 2.5% (n = 1).
Conclusion: Combining mastectomy and hysterectomy into a single-stage operation is not a benign undertaking as it increases the risk of postoperative chest wall infection. Multidisciplinary surgical teams treating transmasculine patients should choose a plan that optimizes patient outcomes.
