A Drain-free Technique for Female-to-Male Gender Affirmation Chest Surgery Decreases Morbidity: Outcomes From 306 Consecutive Masculoplasties.

Abstract

One of the most common surgical procedures for gender affirmation surgery of the chest is mastectomy. The aims of this article are to review the outcomes of a single surgeon's experience with a drainless technique, which we named "masculoplasty" and compare morbidity in this group to previously published outcomes where drains were used. A retrospective chart review was undertaken of all patients presenting to a single surgeon for gender-affirming chest surgery. A literature review was completed, compiling data from previously published studies of mastectomy with free nipple graft for the transgender patient. Outcomes of this drain-free group were compared with historical data, where drains were known to have been used. One hundred fifty-three patients underwent 306 masculoplasties in a university teaching hospital. The mean age of patients was 30 years (17-66 years). Sixty-five (42%) had 1 or more chronic medical comorbidities with 17 diabetic patients (11%). The mean body mass index was 32 kg/m (18-57 kg/m), and 83 (54%) were obese. Forty-two (27%) of the patients had a history of smoking. Mean operative time was 136 minutes (74-266 minutes).Hematoma occurred in 1 patient (0.3%). Infections occurred in 7 masculoplasties (2%) with wound dehiscence in 3 (1%). Two masculoplasties (0.7%) had partial nipple necrosis. Two patients (0.7%) developed a symptomatic pneumothorax. There were 0 seromas, and no procedures were performed to drain fluid. Eight masculoplasties (3%) underwent secondary corrections. Median follow-up was 9 months.Outcomes from this drain-free technique were compared with previously published outcomes of mastectomy where drains were known to be used. When compared with previously published series (n = 1334), the drain-free group had statistically significantly lower rates of hematoma (1/306 vs 39/1334, P = 0.0036) and acute reoperation (1/306 vs 42/1334, P = 0.0024). There was a shorter length of hospital stay in the drain-free group with a statistically significantly lower revision rate (8/306 vs 116/1334, P = 0.0001). Gender affirmation chest surgery can be safely offered using a drain-free or "masculoplasty" technique. Compared with historical data, the use of progressive tension sutures decreases the incidence of hematoma, the need for acute reoperation, and other complications.