Georgetown University School of Medicine, Washington, District of Columbia, USA.
Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.
Breast J. 2021 Apr;27(4):352-358. doi: 10.1111/tbj.14178. Epub 2021 Feb 12.
Transfeminine patients facing barriers to gender confirming surgery sometimes pursue illicit feminization procedures such as "street" hormones and silicone injections. These procedures often yield complications and disfigurement, making surgeons and insurance companies wary of secondary breast reconstruction. This clinical series assesses illicit treatment among our transfeminine breast surgery patients and describes the presentation, surgical approaches, and outcomes of each patient. A retrospective review of transfeminine patients who underwent chest feminization surgery with a single provider between March 2018 and March 2020 identified patients with a history of illicit hormones or silicone injections. Demographics, comorbidities, preoperative diagnoses and symptoms, surgical details, and postoperative outcomes were collected. Patients were contacted for a follow-up survey concerning outcomes and satisfaction. Of the 41 transfeminine patients reviewed, eight (19.5%) had previous illicit treatment. Seven (17.1%) used non-prescribed hormones, and three (7.3%) received silicone breast injections. Two patients presented with symptoms from silicone injections; the remaining were asymptomatic. Six patients underwent subglandular breast augmentation, one had a reduction mammoplasty, and one underwent an implant exchange. Only one patient had postoperative complications that healed without surgical intervention. This series emphasizes the need to assess the prevalence of silicone injections and illicit hormone use among transgender chest feminization patients. The use of these substances was relatively high in our population compared to national averages; however, there is a low risk of postoperative complications. Providers may perform breast surgery in patients with a history of illicit augmentation practices after careful evaluation and surgical planning.
跨性别女性患者在寻求性别肯定手术时可能会遇到障碍，有时会选择非法的女性化程序，如“街头”荷尔蒙和硅胶注射。这些程序通常会导致并发症和毁容，使外科医生和保险公司对二次乳房重建持谨慎态度。本临床系列评估了我们的跨性别乳房手术患者中非法治疗的情况，并描述了每位患者的临床表现、手术方法和结果。对 2018 年 3 月至 2020 年 3 月期间由单一提供者进行胸部女性化手术的跨性别女性患者进行回顾性研究，确定了有非法荷尔蒙或硅胶注射史的患者。收集了患者的人口统计学、合并症、术前诊断和症状、手术细节以及术后结果。联系患者进行随访调查，了解结局和满意度。在 41 名接受过跨性别女性胸部整形手术的患者中，有 8 名（19.5%）曾接受过非法治疗。7 名（17.1%）使用非处方荷尔蒙，3 名（7.3%）接受过硅胶乳房注射。2 名患者因硅胶注射出现症状，其余患者无症状。6 名患者接受了胸大肌下乳房增大术，1 名接受了乳房缩小成形术，1 名接受了乳房假体置换术。只有 1 名患者术后出现并发症，但无需手术干预即可愈合。本系列强调需要评估跨性别女性胸部女性化患者中硅胶注射和非法荷尔蒙使用的流行率。与全国平均水平相比，我们人群中这些物质的使用相对较高；然而，术后并发症的风险较低。在仔细评估和手术计划后，提供者可以为有非法隆胸史的患者进行乳房手术。
