Elfering Lian, van de Grift Tim C, Bouman Mark-Bram, van Mello Norah M, Groenman Freek A, Huirne Judith A, Budiman Ivo Y W, Goijen Linde D J, van Loenen Dorothea K G, Mullender Margriet G
Department of Plastic Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands.
Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.
Int J Transgend Health. 2020 Apr 25;21(2):138-146. doi: 10.1080/26895269.2020.1751014. eCollection 2020.
Masculinizing mastectomy is the most requested gender affirming surgery (GAS) in trans men, followed by genital GAS. Mastectomy and total laparoscopic hysterectomy, with or without bilateral salpingo-oophorectomy (TLH ± BSO), can both be performed in one single operation session. However, data on complication rates of the combined procedure is scarce and no consensus exists on the preferred order of procedures. To compare safety outcomes between mastectomy performed in a single procedure with those when performed in a combined procedure and assess whether the order of procedures matters when they are combined. A retrospective chart review was performed of trans men who underwent masculinizing mastectomy with or without TLH ± BSO in a combined session. The effects of the surgical procedure on complication and reoperation rate of the chest were assessed using logistic regression. In total, 480 trans men were included in the study. Of these, 212 patients underwent the combined procedure. The gynecological procedure was performed first in 152 (71.7%) patients. In the total sample, postoperative hematoma of the chest occurred in 11.3%; 16% in the combined versus 7.5% in the single mastectomy group (p = 0.001). Reoperations due to hematoma of the chest were performed in 7.5% of all patients; 10.8% in the combined versus 4.9% in the single mastectomy group (p = 0.017). The order of procedures in the combined group had no significant effect on postoperative hematoma of the chest (p = 0.856), and reoperations (p = 0.689). Combining masculinizing mastectomy with TLH ± BSO in one session was associated with significantly more hematoma and reoperations compared with separately performing mastectomy. This increased risk of complications after a combined procedure should be considered when deciding on surgical options. The order of procedures in a combined procedure did not have an effect on safety outcomes.
男性化乳房切除术是跨性别男性中最常要求的性别确认手术（GAS），其次是生殖器GAS。乳房切除术和全腹腔镜子宫切除术，无论是否进行双侧输卵管卵巢切除术（TLH±BSO），都可以在一次手术中完成。然而，关于联合手术并发症发生率的数据很少，并且对于手术的首选顺序也没有达成共识。为了比较单次手术中进行的乳房切除术与联合手术中进行的乳房切除术之间的安全结果，并评估联合手术时手术顺序是否重要。对在联合手术中接受或未接受TLH±BSO的男性化乳房切除术的跨性别男性进行了回顾性病历审查。使用逻辑回归评估手术程序对胸部并发症和再次手术率的影响。该研究共纳入了480名跨性别男性。其中，212例患者接受了联合手术。152例（71.7%）患者首先进行了妇科手术。在总样本中，胸部术后血肿发生率为11.3%；联合手术组为16%，单纯乳房切除术组为7.5%（p = 0.001）。所有患者中有7.5%因胸部血肿进行了再次手术；联合手术组为10.8%，单纯乳房切除术组为4.9%（p = 0.017）。联合组的手术顺序对胸部术后血肿（p = 0.856）和再次手术（p = 0.689）没有显著影响。与单独进行乳房切除术相比，在一次手术中将男性化乳房切除术与TLH±BSO联合进行会导致明显更多的血肿和再次手术。在决定手术方案时，应考虑联合手术后并发症风险增加的情况。联合手术中的手术顺序对安全结果没有影响。
