双切口游离乳头皮瓣移植术治疗女性男变男性别重置术后的手术和患者报告结局：肥胖有影响吗？

Surgical and patient-reported outcomes following double incision and free nipple grafting for female to male gender affirmation: does obesity make a difference?

机构信息

Department of Surgery, Division of Plastics and Reconstructive Surgery, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Unit S6, Ottawa, ON, Canada.

Clinical Epidemiology Program, Ottawa Hospital Research Institute, ON, Ottawa, Canada; Faculty of Medicine, University of Ottawa, ON, Ottawa, Canada.

出版信息

J Plast Reconstr Aesthet Surg. 2021 Aug;74(8):1743-1751. doi: 10.1016/j.bjps.2020.12.004. Epub 2020 Dec 10.

DOI:10.1016/j.bjps.2020.12.004

PMID:33341390

Abstract

BACKGROUND

The efficacy of chest wall contouring in alleviating symptoms of gender dysphoria in transmale and nonbinary patients is well established. As the popularity and indications for these procedures continue to increase, more surgeons are performing these surgeries on obese patients. The aim of this study was to investigate the association of obesity on postoperative and patient-reported outcomes.

METHODS

A retrospective chart review was performed for 97 consecutive masculinizing mastectomies by a single surgeon using the double incision and free nipple graft technique (DIFNG). Surgical outcomes were collected using electronic records and patient-reported outcomes using BODY-Q questionnaires.

RESULTS

DIFNG mastectomies were performed in 97 patients from 2016 to 2019, of which 43(44%) were obese and 54(56%) were non-obese. The average follow-up time was 62(12 - 112) months in obese patients and 61(10 - 127) months in non-obese patients. There was no difference in minor and major complication rates between non-obese and obese patients [minor: 4(7%) vs 5(12%), p = 0.19) and major: 0(0%) vs 1(2%), p = 0.46]. BODY-Q data was available for 33(77%) of obese and 43(80%) of non-obese patients. There was no difference in scores for each module of the BODY-Q between obese and non-obese patients (p>0.05).

CONCLUSION

Chest wall contouring using the DIFNG technique continues to be safe and effective for the management of gender dysphoria in transmale and nonbinary patients. Considering that obese patients have comparable surgical and patient-reported outcomes as non-obese patients, it is our practice to routinely offer the DIFNG technique to healthy obese patients with BMI's between 30 and 40.

摘要

背景

胸部轮廓成形术缓解跨性别男性和非二元性别患者性别焦虑症状的疗效已得到充分证实。随着这些手术的普及和适应证不断增加，越来越多的外科医生开始为肥胖患者施行这些手术。本研究旨在探讨肥胖对术后和患者报告结果的影响。

方法

对一位外科医生采用双切口游离乳头皮瓣技术（DIFNG）施行的 97 例连续男性乳房切除术进行回顾性图表分析。使用电子病历收集手术结果，使用 BODY-Q 问卷收集患者报告结果。

结果

2016 年至 2019 年，97 例患者接受了 DIFNG 乳房切除术，其中 43 例（44%）为肥胖患者，54 例（56%）为非肥胖患者。肥胖患者的平均随访时间为 62（12-112）个月，非肥胖患者为 61（10-127）个月。肥胖和非肥胖患者的轻微和主要并发症发生率无差异[轻微：4（7%）比 5（12%），p=0.19]和主要：0（0%）比 1（2%），p=0.46]。33 例（77%）肥胖患者和 43 例（80%）非肥胖患者可提供 BODY-Q 数据。肥胖和非肥胖患者的 BODY-Q 每个模块评分无差异（p>0.05）。