<< Back to the abstract archive
Hypertrophic Scarring Following Gender-Affirming Mastectomy: Incidence and Risk Factors
Matthew A DePamphilis, Katya Remy, Josip Plascevic, Ian L. Valerio, William G Austen Jr, Katherine H Carruthers
Massachusetts General Hospital
2025-01-16
Presenter: Matthew A. DePamphilis
Affidavit:
NA
Director Name: NA
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background
Rates of gender-affirming mastectomy (GAM) have increased by 200% in recent years. However, the procedure involves long horizontal chest incisions which may be prone to hypertrophic scarring (HS). HS can cause significant morbidity, yet few studies have investigated their occurrence. This study evaluated the incidence and risk factors of HS following GAM.
Methods
A retrospective study was conducted of patients who underwent double-incision GAM from 2020-2024. Data included demographics, comorbidities, androgen therapy, postoperative complications, HS occurrence, corticosteroid injections, and scar revision. Multivariable regression was performed.
Results
241 patients were included. HS occurred in 16.6%, with 8.3% receiving corticosteroid injections and 0.8% undergoing scar revision. Race other than White was significantly associated with higher rates of HS (32.4% vs. 13.4%, p=0.004; OR 4.0, 95% CI 1.7-9.4, p=0.001), corticosteroid injections (19.4% vs. 6.1%, p=0.007) and scar revision (5.6% vs. 0.0%, p=0.023). Preoperative androgen use (67.2% of patients; mean testosterone level 485.4±302.1 ng/dL vs. 35.1±17.4 ng/dL in non-users, p<0.0001) was significantly associated with higher rates of HS (20.4% vs. 8.9%, p=0.024; OR 3.4, 95% CI 1.3-8.4, p=0.001). Age, BMI, comorbidities, smoking, previous breast surgery, mastectomy weight, and other postoperative complications were not significantly associated with HS. Average follow-up was 5.3±4.5 months.
Conclusion
HS occurred in 16.6% of GAM patients, with race and androgen therapy identified as significant risk factors. Patients should be counseled regarding their individual risk profile. Future research should investigate perioperative androgen management or testosterone thresholds for optimal balance between scarring outcomes and patient goals.
