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Nonbinary Patients Seeking Gender-Affirming Top Surgery: Wait Time and Outcomes
Christina R. Kuhrau, BA; Ermina Lee, BS; Kiersten C. Woodyard De Brito, MD MPH; Douglas Dembinski, MD; Sarah Pickle, MD; Ryan Gobble, MD
University of Cincinnati
2025-01-10
Presenter: Christina Kuhrau
Affidavit:
Christina Kuhrau
Director Name: Dr. Ann Schwentker
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
PURPOSE: This retrospective review of nonbinary individuals examines time to top surgery and outcomes at a Midwestern academic institution.
METHODS: Patients presenting for top surgery consultation between 2014-2024 were included. Demographics, insurance, gender-affirming hormone therapy (GAHT) use, surgical wait time, and complication data were analyzed using Stata. Comparisons were performed between surgical patients identifying as nonbinary (NB) and transgender men (TM), with chi-square analyses for categorical and t-tests for continuous variables. P-values <0.05 were significant.
RESULTS: Among 130 patients, 27 were NB, with 74% progressing to surgery after approximately 204 days. GAHT and private insurance led to non-statistically significant wait time increases of about 50 days. NB patients had more tissue resected (p<0.01), infections (p=0.01), and no-nipple surgeries (p<0.01). They were less likely to use GAHT (p<0.01), have public insurance (p=0.01), and face insurance denials (p=0.01). All 27 presented with a qualified mental health professional (QMHP).
CONCLUSIONS: One fifth of patients seeking top surgery identified as NB, with a mean wait time of seven months. They more often presented with a QMHP and private insurance, and all were approved despite less frequent GAHT use. NB patients favored a no-nipple result and had more tissue resected, indicating varying preferences and possibly greater breast volume without testosterone. A growing understanding of gender incongruence has likely shifted pre-certification requirements allowing NB access to top surgery.
