From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco, CA.
Ann Plast Surg. 2021 Oct 1;87(4):402-408. doi: 10.1097/SAP.0000000000002729.
Hormone therapy with exogenous estrogen and/or spironolactone is commonly used in transfemales to induce breast development. However, inherent differences in adult male and female anatomy create persistent deformities and inadequate gender congruency despite glandular breast development. This includes nipple characteristics, position of inframammary fold, and the distribution of breast tissue. Accordingly, the Tanner stages do not accurately reflect these persistent deformities because they relate to breast development in transwomen. Herein, we describe a classification system for breast development in transwomen treated with hormone therapy.
Ninety-nine transfemale patients who underwent breast augmentation from 2014 to 2018 were retrospectively reviewed and categorized using a novel scheme, the Breast Response to Estrogenic Stimulation in Transwomen (BREST) scale. Preoperative demographics, anatomic measurements, surgical technique, and postoperative results were also compared among BREST types.
Most patients were rated as BREST type II (25%) or type IV (37%). The BREST scale exhibited moderate interrater reliability (κ = 0.58) between 3 plastic surgeons. Objective breast measurements such as sternal notch-to-nipple distance and nipple-to-inframammary fold distance correlated with the BREST scale. Multivariate logistical regression identified the nipple-to-inframammary fold distance and different between the bust and chest circumference as the strongest predictors of BREST type (odds ratio, 2.57 and 1.96, respectively). Body mass index was not a predictor of BREST type after controlling for confound variables on multivariate analysis.
The BREST scale uniquely captures the differences in breast phenotypes in transgender women according to hormone therapy response. Although some subjectivity exists with moderate interrater reliability, the BREST scale correlates with objective breast measurements. The BREST scale provides a transwoman-specific metric allowing for a common language in assessment of transgender breast development and optimal communication among providers, different specialties, and insurance companies.
外源性雌激素和/或螺内酯激素疗法常用于跨性别女性以诱导乳房发育。然而，成年男性和女性解剖结构的固有差异导致尽管出现了腺体性乳房发育，但仍存在持续的畸形和不充分的性别一致性。这包括乳头特征、乳晕下皱襞位置和乳房组织分布。因此，Tanner 分期不能准确反映这些持续的畸形，因为它们与跨性别女性的乳房发育有关。在此，我们描述了一种用于接受激素治疗的跨性别女性乳房发育的分类系统。
回顾性分析了 2014 年至 2018 年期间接受乳房隆乳术的 99 例跨性别女性患者，并使用一种新的方案（跨性别女性雌激素刺激乳房反应分类系统，BREST）进行分类。还比较了 BREST 类型之间的术前人口统计学数据、解剖学测量、手术技术和术后结果。
大多数患者被评为 BREST 类型 II（25%）或 IV（37%）。三位整形外科医生之间 BREST 量表的评分具有中度的组内一致性（κ=0.58）。胸骨切迹至乳头距离和乳头至乳晕下皱襞距离等客观乳房测量值与 BREST 量表相关。多元逻辑回归确定了乳头至乳晕下皱襞距离和胸围与胸周周长之间的差异是 BREST 类型的最强预测因素（比值比分别为 2.57 和 1.96）。在多元分析中控制了混杂变量后，体重指数不是 BREST 类型的预测因素。
BREST 量表根据激素治疗反应独特地捕捉了跨性别女性乳房表型的差异。尽管存在中度组内一致性的主观性，但 BREST 量表与客观乳房测量值相关。BREST 量表提供了一种特定于跨性别女性的指标，允许在评估跨性别女性乳房发育和提供者、不同专业和保险公司之间进行有效的沟通中使用通用语言。
