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Reevaluating BMI as a Barrier to Gender-Affirming Mastectomy: A Retrospective Analysis of Transmasculine Patients
Elad Fraiman BA MPH, Kyle Barclay, Vikas Kotha MD, Raymond Isakov MD
Cleveland Clinic
2025-01-10
Presenter: Elad Fraiman
Affidavit:
Elad Fraiman
Director Name: Raymond Isakov
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Aesthetics
Introduction
Many plastic surgeons are concerned about performing gender affirming double-incision mastectomy (GAM) in patients with a high BMI due to the potentially increased risk of anesthesia and surgical complications. While complications in reduction mammoplasty are often related to the size of the resection rather than purely being related to BMI, the two are often linked. This concept may be applied to GAM; therefore, we aim to address the paucity of data by comparing GAM outcomes across different BMI ranges in this population.
Methods
A retrospective review of over 600 GAM cases performed by a single surgeon between 2016 and 2024 was conducted. Patients were categorized into BMI ranges: <19.9, 20–24.9, 25–29.9, 30–34.9, 35–39.9, and >40. Surgical outcomes were compared across groups.
Results
There were no significant differences in the total or specific complication rates between BMI categories. The most common complication among all BMI groups were hematoma and seroma, a majority of which were evacuated nonoperatively or managed with close follow up. Free nipple grafting was not affected by patient's BMI with extremely high nipple graft take among different BMI groups.
Conclusion
The early data suggest that the postoperative complication profile is like that of normal BMI and overweight BMI patients. Despite the anecdotal evidence that these patients may attain inferior aesthetic outcomes compared to lower BMI patients, they can expect comparable complication rates and are often quite happy with their results.
