van de Grift Tim C, Elfering Lian, Bouman Mark-Bram, Buncamper Marlon E, Mullender Margriet G
Amsterdam, The Netherlands.
From the Department of Plastic, Reconstructive, and Hand Surgery and the Department of Medical Psychology, Center of Expertise on Gender Dysphoria, VU University Medical Center.
Plast Reconstr Surg. 2017 Sep;140(3):415e-424e. doi: 10.1097/PRS.0000000000003607.
Although transgender surgery constitutes a growing field within plastic surgery, prospective studies on masculinizing mastectomies are lacking. The objectives of the present study were to prospectively follow a cohort of transmen undergoing mastectomy to assess technical and self-reported outcomes and to evaluate surgical decision-making.
Fifty-four transmen were recruited during a 10-month period at the Department of Plastic Surgery of the Centre of Expertise on Gender Dysphoria. Preoperative assessment included standardized chest examination. Six months postoperatively, participants rated their satisfaction with surgery, and 12-month postoperative surgical outcomes were reviewed independently. Surgical decision-making was evaluated by comparing indications and outcomes per technique, and assessing the clinical validity of the most-used decision aid (using the Cohen's kappa statistic).
One periareolar mastectomy, 26 concentric circular mastectomies, and 22 inframammary skin resections with free nipple graft were performed in the authors' cohort. Five participants were still to be operated on. Concentric circular mastectomy was performed in smaller or medium-size breasts with low ptosis grade and good elasticity, whereas the inframammary skin resection group showed a wider range of physical characteristics. Despite being performed in better quality breasts, concentric circular mastectomy was associated with more secondary corrections (38.5 percent), dehiscence, seroma, and lower postoperative satisfaction compared with inframammary skin resections. Clinical decision-making was generally in line with the published decision aid.
Compared with inframammary skin resections, concentric circular mastectomy-despite being performed in favorable breast types-appears to produce poorer technical and self-reported outcomes. Surgical indications and preoperative counseling regarding secondary corrections may therefore be subject to improvement.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
尽管变性手术在整形外科领域不断发展，但针对男性化乳房切除术的前瞻性研究仍很缺乏。本研究的目的是对一组接受乳房切除术的男变女者进行前瞻性随访，以评估技术和自我报告的结果，并评估手术决策过程。
在性别焦虑症专业中心的整形外科，于10个月内招募了54名男变女者。术前评估包括标准化的胸部检查。术后6个月，参与者对手术满意度进行评分，并独立回顾术后12个月的手术结果。通过比较每种技术的适应症和结果，并评估最常用决策辅助工具的临床有效性（使用科恩kappa统计量）来评估手术决策。
在作者的队列中，进行了1例乳晕周围乳房切除术、26例同心圆乳房切除术和22例带游离乳头移植的乳房下皮肤切除术。5名参与者仍有待手术。同心圆乳房切除术适用于乳房较小或中等大小、下垂程度低且弹性良好的患者，而乳房下皮肤切除术组的身体特征范围更广。尽管同心圆乳房切除术适用于质量更好的乳房，但与乳房下皮肤切除术相比，其二次矫正（38.5%）、裂开、血清肿更多，术后满意度更低。临床决策总体上与已发表的决策辅助工具一致。
与乳房下皮肤切除术相比，同心圆乳房切除术——尽管适用于乳房条件较好的类型——似乎产生的技术和自我报告结果较差。因此，手术适应症和关于二次矫正的术前咨询可能有待改进。
临床问题/证据水平：治疗性，IV级。
