Complications following Breast Augmentation in Transgender Female: A Systemic Review and Meta-analysis

Abstract

PURPOSE: Gender confirming surgery (GCS) improves quality of life and alleviates psychological distress in transgender and gender diverse individuals[1]. For a transgender female, breast augmentation with implants is a frequently sought-after procedure, as breast growth from hormone therapy alone is often inadequate[2]. Peri-operative complications such as infection, implant malposition, hematoma, and capsular contracture are well-described in the literature in treatment of hypomastia for cis-gender females, however their description in the transgender female community has been less elucidated and limited to case series. In this study, we performed a meta-analysis of the published literature to evaluate peri-operative complications following breast augmentation in transgender females to evaluate its safety and efficacy in relative to the similar procedure in cis-gender females. METHOD: PubMed and the Cochrane Library and other resources were queried for studies published up to Jan 2022. The following keywords were used: ‘transgender’, ‘transfeminine’, ‘implant’, ‘augmentation’, ‘breast’, and ‘chest’. Primary outcomes of interest were complications (i.e. capsular contracture, hematoma or seroma, infection, implant asymmetry/malposition, hemorrhage, skin or systemic complications), patient satisfaction, and reoperation rates. Quantitative analyses were performed with STATA 16 statistical software (STATA Corp., College Station, TX, USA). Rates were pooled with the -metaprop function and reported in 95% confidence intervals. Breast implant surgery complications were compared between cis-gender and trans-gender patients. A chi-square test was performed to analyze the incidence of complications between cis-gender vs trans-gender female breast augmentation. RESULTS: A total 1864 patients from 14 studies were included for analysis in the transgender female group. Studies were conducted in various regions including the USA, Netherlands, Switzerland, and France. In the transgender female group, pooled rate of capsular contracture from 7 studies was 3.62% ((95% CI, 0.0038-0.0908); hematoma/seroma from nine studies was 0.63% ((95% CI: 0.0014-0.0134); infection incidence from eight studies was 0.08% (95% CI, 0.0000-0.0054); pooled rates of implant asymmetry/malposition from five studies was 4.51% (95% CI, 0.0089-0.1010. A comparison between cis-gender vs trans-gender females was performed via chi-square test by comparison of our pooled data with previously published data from cis-gender breast augmentation meta-analyses[3,4]. There was no statistical difference between rates of capsular contracture (p=0.41) and infection (p=0.71) between the two groups, while there were higher rates of hematoma/seroma (p=0.0095) and implant asymmetry/malposition (p=0.004) in the transgender female group. CONCLUSION: Breast augmentation surgery has similar published rates of post-operative infection and capsular contracture between cisgender and transgender females but has higher rates of hematoma/seroma and malposition in the transgender group. This could be explained by contributing factors such as patient’s chest size, differences in musculature and soft tissue envelope, and native nipple-areola complex position. Relative to the published literature on cis-gender breast augmentation, there is a relative paucity, smaller sample size and inconsistent reporting in the transgender female group, which is a limitation of the study. Lack of reporting of complications relative to surgical approach (i.e subglandular vs submuscular implant positioning) is another limitation of the published literature in the transgender female group and an area of further study. REFERENCES: 1. White Hughto JM, Reisner SL. A Systematic Review of the Effects of Hormone Therapy on Psychological Functioning and Quality of Life in Transgender Individuals. Transgend Health. Jan 2016;1(1):21-31. doi:10.1089/trgh.2015.0008 2. Surgeons ASoP. 2020 Plastic Surgery Statistics Report. 2020:26. 3. Li S, Mu D, Liu C, et al. Complications Following Subpectoral Versus Prepectoral Breast Augmentation: A Meta-analysis. Aesthetic Plast Surg. Aug 2019;43(4):890-898. doi:10.1007/s00266-019-01404-7 4. Shen Z, Chen X, Sun J, et al. A comparative assessment of three planes of implant placement in breast augmentation: A Bayesian analysis. J Plast Reconstr Aesthet Surg. Dec 2019;72(12):1986-1995. doi:10.1016/j.bjps.2019.09.010