AI Article Synopsis
- Gender-affirming mastectomy has grown in popularity among transgender and nonbinary patients, yet there exists controversy regarding the management of testosterone therapy prior to surgery.
- This study retrospectively analyzed 490 patients who underwent top surgery and compared complication rates between those who discontinued testosterone and those who continued it, finding no significant difference in postoperative complications across the groups.
- The findings indicate that it may not be necessary to routinely stop testosterone therapy before surgery, underscoring the need for further research on this topic.
Article Abstract
Background: Gender-affirming mastectomy, or "top surgery," has become one of the most frequently performed procedures for transgender and nonbinary patients. However, management of perioperative testosterone therapy remains controversial. Despite a lack of supporting evidence, many surgeons require cessation of testosterone before top surgery. This is the first study to compare complication rates in patients undergoing gender-affirming mastectomy with and without discontinuation of perioperative testosterone.
Methods: This retrospective review included patients undergoing top surgery by the senior author between 2017 and 2020. Reflecting a change in the senior author's practice, before May of 2019, all patients were required to discontinue testosterone before surgery; all patients treated after this point continued their testosterone regimens throughout the perioperative period. Patients were stratified according to testosterone regimen and perioperative hormone management, with demographic characteristics and postoperative outcomes compared among groups.
Results: A total of 490 patients undergoing gender-affirming mastectomy during the study period were included. Testosterone was held perioperatively in 175 patients and continued in 211 patients; 104 patients never received testosterone therapy. Demographic characteristics were similar among groups and there was no difference in rates of hematoma (2.9% versus 2.8% versus 2.9%, respectively; P = 0.99), seroma (1.1% versus 0% versus 1%, respectively; P = 0.31), venous thromboembolism (0% versus 0.5% versus 0%, respectively; P = 0.99), or overall complications (6.9% versus 4.3% versus 5.8%, respectively; P = 0.54).
Conclusions: Our results demonstrate no difference in postoperative complication rates among groups. Whereas further investigation is warranted, our data suggest that routine cessation of testosterone in the perioperative period is not necessary for patients undergoing gender-affirming mastectomy.
Clinical Question/level Of Evidence: Therapeutic, III.
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| http://dx.doi.org/10.1097/PRS.0000000000009858 | DOI Listing |
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