Female-to-Male Chest Reconstruction A Review of Technique and Outcomes

Purpose: Female-to-male transgender individuals frequently seek out chest wall masculinization as part of their gender transition and to aid with treating gender dysphoria. Critical evaluation of techniques, complications, and outcomes is important particularly as the surgery becomes more commonly performed. Methods: A retrospective review was performed of all patients undergoing female-to-male chest wall reconstruction by the senior author from 2008 to 2015. Charts were reviewed to evaluate patient demographics, intraoperative details, and postoperative outcomes. Complications were stratified into major and minor complications based on the need to return to the operating room. Inframammary fold techniques and periareolar techniques cohorts were compared for major complications, minor complications, and need for revision surgeries. Results: Over 8 years, 130 patients were identified. One hundred ten patients underwent inframammary fold techniques, and 20 patients underwent periareolar incisions. Early postoperative complications occurred in 25% of patients. Hematoma was the most common complications, occurring in 14% of patients. Major complications occurred in 8% of patients. Minor complications occurred in 16% of patients, with respiratory problems found to be a significant risk factor. On long-term follow up, 9% of patients had a revision procedure performed. Patients with prior breast surgery were more likely to require revisions (P = 0.009). Of patients requiring revision, 38% had a periareolar incision, compared with only 13% of patients who did not (P = 0.03). For unplanned revisions, there was no difference in periareolar and inframammary techniques. Conclusions: Our patient cohort demonstrates that female-to-male patients who undergo chest wall contouring through a transverse inframammary fold incision with either composite or standard free nipple grafting have decreased rates of revision surgery and trend toward having lower complication rates as compared with periareolar and limited scar techniques. To best manage expectations, patients undergoing a periareolar or other limited incision technique are counseled regarding an increased risk of hematoma and an increased likelihood of revisions.