Breast Reduction Epidemiology and Complications in Nonbinary, Transgender, and Cisgender Adults

Introduction: Research in gender-affirming chest surgery has primarily compared cisgender versus transgender and gender-diverse (TGD) people, without specifically addressing nonbinary people. This study will assess surgical complications between cisgender, transgender, and nonbinary adults undergoing breast reductions. Methods: The National Surgical Quality Improvement Program databases from 2015 to 2021 were used to identify TGD patients who underwent breast reduction (Current Procedural Terminology code: 19318) and cisgender patients who underwent this procedure for cosmesis or cancer prophylaxis. Analysis of variance tests, chi-squared tests, unpaired t-tests, and regression models compared complications among cisgender, transgender, and nonbinary patients. Results: A total of 1222 patients met the inclusion criteria: 380 (31.1%) were cisgender, 769 (62.9%) were transgender, and 73 (6.0%) were nonbinary. The proportion of TGD patients grew significantly relative to cisgender patients over the study period (P < 0.001). The overall all-cause complication rate was 3.4%, with 4.2% of cisgender, 1.4% of nonbinary, and 3.1% of transgender patients experiencing surgical complications. After adjusting for confounding variables, no statistically significant difference was observed in all-cause complication rates between the cohorts. In the sample, 19 transgender patients (2.5%) underwent reoperation. Transgender patients had a lower likelihood of wound complications (odds ratio: 0.172; 95% confidence interval: 0.035-0.849; P = 0.031) compared to cisgender patients and nonbinary patients. None of the patients experienced a severe systemic complication. Conclusions: The findings emphasize the growing demand and safety of gender-affirming breast reductions. They underscore the importance of continued research and tailored approaches to delivering care to nonbinary and transgender patients, addressing their diverse needs and improving access to gender-affirming surgeries.