From the Department of Surgery, University of California San Francisco-East Bay, Oakland.
Department of Plastic Surgery, Kaiser Permanente Northern California, Richmond, CA.
Ann Plast Surg. 2021 Jul 1;87(1):24-30. doi: 10.1097/SAP.0000000000002712.
Obesity can often be a barrier to gender-affirming top surgery in transmasculine patients because of concern for increased surgical site complications.
All adult patients (N = 948) within an integrated health care system who underwent gender-affirming mastectomy from 2013 to 2018 were retrospectively reviewed to evaluate the relationship between obesity and surgical site complications or revisions.
One third of patients (n = 295) had obese body mass index (BMI), and those patients were further stratified into obesity class I (BMI of 30-34.9 kg/m2, 9.4%), class II (BMI of 35-39.9 kg/m2, 8.9%), and class III (BMI of ≥40 kg/m2, 2.9%). A majority of patients across BMI categories underwent double incision surgery. There were no significant differences in complications or revisions between patients with obesity versus those with normal BMI, when BMI was treated as a categorical or continuous variable and when evaluating only patients who underwent double incision surgery.
Obesity alone should not be considered a contraindication for gender-affirming mastectomy. Attention should be given to several modifiable risk factors identified in this study, including lesser incision surgical techniques, tobacco use, and testosterone use. Further research is needed to understand risks associated with the highest BMI (≥40 kg/m2) patients and to assess patient satisfaction with surgical outcome.
肥胖症通常会成为跨性别男性患者进行性别肯定性乳房切除术的障碍，因为担心手术部位并发症增加。
回顾性分析了 2013 年至 2018 年间在一个综合性医疗保健系统中接受性别肯定性乳房切除术的所有成年患者（N=948），以评估肥胖症与手术部位并发症或修复之间的关系。
三分之一的患者（n=295）存在肥胖体重指数（BMI），这些患者进一步分为肥胖症 I 级（BMI 为 30-34.9kg/m2，9.4%）、II 级（BMI 为 35-39.9kg/m2，8.9%）和 III 级（BMI 为≥40kg/m2，2.9%）。大多数 BMI 类别患者均接受双切口手术。当 BMI 被视为分类或连续变量，以及仅评估接受双切口手术的患者时，肥胖症患者与 BMI 正常的患者之间在并发症或修复方面无显著差异。
肥胖症本身不应被视为性别肯定性乳房切除术的禁忌症。应关注本研究中确定的几个可改变的危险因素，包括切口较小的手术技术、吸烟和使用睾酮。需要进一步研究以了解与最高 BMI（≥40kg/m2）患者相关的风险，并评估患者对手术结果的满意度。
