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A Meta-analysis Evaluating the Impact of Testosterone Supplementation on the Complications of Gender Affirming Mastectomy
Diwakar Phuyal, MBBS, Sara Yacoub, BA MPH, Zoe Beraldo, BA, Antonio Rampazzo, MD, PhD, Bahar Bassiri Gharb, MD, PhD
Cleveland Clinic Foundation
2025-01-10
Presenter: Diwakar Phuyal
Affidavit:
Yes
Director Name: Raymond Isakov
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Aesthetics
Introduction:
Patients undergoing gender-affirming chest masculinization are often on testosterone therapy (TT). This meta-analysis investigated the impact of perioperative TT on surgical complications.
Method:
A meta-analysis was conducted using Ovid MEDLINE, Embase, and Cochrane databases. Studies reporting perioperative hormone management and surgical outcomes were included, excluding case reports. Data included patient demographics, TT status, procedure types, postoperative complications, and levels of evidence (LOE).
Results:
Fifteen studies met inclusion criteria (8 LOE III and 7 LOE IV). Among three thousand thirty-six TT and seven hundred twenty-six non-TT (NTT) patients, acute complications (hematoma, seroma, infection, wound dehiscence, NAC necrosis) occurred in 11.08% (TT) and 9.8% (NTT) (p=0.29). Overall, TT patients had 1.88 times higher odds of hematoma (7.79% vs 2.9%), while seroma rates were significantly lower (1.55% TT vs 4.29% NTT; p=0.028). Infection (1.35% TT vs 1% NTT) and wound dehiscence (1% TT vs 1.45% NTT) showed no significant differences (p=0.32 and p=0.94). VTE rates were also similar (0.14% TT vs 0% NTT; p=0.88).
Stopping testosterone perioperatively did not reduce hematoma risk (8% stopped vs 8.73% continued; p=0.63). Hematoma rates did not differ based on cessation duration (2–6 weeks preoperatively; p=0.60). More patients in TT group underwent limited-incision mastectomy (20.62% vs 10.3%; p<0.001). However, within the TT group, hematoma rate was comparable between limited incision vs double incision (16% vs 11.8%, p=0.204).
However, when hormone therapy was not considered, the limited incision technique had higher hematoma risk than double-incision mastectomy (11.96% vs 6.5%; p<0.001).
Conclusion:
Testosterone might increase hematoma risk, but perioperative cessation does not mitigate this risk.
