34238 Laser revision of periareolar scarring following masculinizing chest surgery: A case report

Abstract

Background: Masculinizing chest surgery (top surgery) involves the removal of breast tissue and nipple repositioning/reshaping to achieve a masculine chest appearance in transmasculine and transgender men. Keyhole mastectomy (KM) involves breast tissue removal via periareolar incision, which avoids the linear scarring seen with double-incision mastectomies (DM). Patients prefer the KM to the DM for this cosmetic advantage. However, outcomes are consistently poorer for the KM and literature regarding revision of post-KM scarring is limited to invasive surgical approaches. No studies examining laser revision have been published. Herein, we describe a case of laser revision for periareolar scarring following KM. Case: A 15-year-old transgender male presented 10 months following KM with hypertrophic, erythematous, and hyperpigmented periareolar scars bilaterally. Postsurgical complications included abscess formation requiring surgical revision. He had been using chest compression (ACE wrap) and silicone gel sheets to minimize scarring, but desired improved skin texture and decreased erythema to facilitate tattoo camouflage. The left areola was treated with 5 pulsed dye laser (PDL) (595 nm) and 5 CO2 laser (10,600 nm) sessions while the right was treated with 3 PDL sessions and a single CO2 session. Treatments were spaced 6-8 weeks apart. The patient reported improvement in skin texture and decreased erythema after 3 treatments with continued benefit after subsequent treatments without adverse events. Discussion: Laser therapy has been successfully used in the revision of postsurgical and burn scars. Our novel case highlights that laser therapy may be an effective option for treating periareolar scarring and dyspigmentation following KM.