From the University of California Riverside, School of Medicine, Riverside, CA.
University of California Irvine, School of Medicine, Irvine, CA.
Ann Plast Surg. 2024 Sep 1;93(3):308-311. doi: 10.1097/SAP.0000000000004037.
Gender-affirming mastectomy can improve mental health and gender expression. However, there is no consensus on routine drain usage in gender-affirming surgeries. The purpose of this study is to compare gender-affirming mastectomies with and without drains and review complications.
An institutional review board-approved, retrospective review was performed to identify patients between 2017-2021 who had double-incision mastectomy, with or without nipple graft, and separated into drain and no-drain cohorts. Patient demographics, outcomes, and postoperative complications were analyzed, including unplanned return to the operating room, seromas, hematomas, postoperative infection, and postoperative antibiotic use. Univariate and multivariate analysis was performed.
There were 359 patients that had a gender-affirming mastectomy surgery between 2017 and 2021. The mean age was 26.1 years old, and mean body mass index was 27.4. There were 144 patients (40.1%) who had a drain, and 215 patients (59.9%) without a drain. For postoperative complications of all patients, there were 12 (3.3%) unplanned returns to the operating room, 18 seromas (5.0%), 26 hematomas (7.2%), 50 (13.9%) postoperative antibiotic use, and 4 postoperative infections (1.1%). There were no significant differences found between drain use for all postoperative complications, but no-drain use was significantly associated with less prescribed postoperative antibiotics compared to drain use (3.7% and 29.0%, respectively; P < 0.001).
Gender-affirming mastectomy surgeries are safe and effective treatment options. No-drain placement was not associated with increased postoperative complications. Surgeons may consider not prescribing routine postoperative antibiotics if using drains, and avoiding drains for gender-affirming mastectomies may be considered in selected individuals based on clinical judgment.
性别肯定乳房切除术可以改善心理健康和性别表达。然而，在性别肯定手术中是否常规使用引流管尚未达成共识。本研究的目的是比较有引流管和无引流管的性别肯定乳房切除术，并回顾其并发症。
进行了一项机构审查委员会批准的回顾性研究，以确定 2017 年至 2021 年间接受双切口乳房切除术（带或不带乳头移植物）的患者，并将其分为引流组和非引流组。分析了患者的人口统计学特征、结果和术后并发症，包括非计划返回手术室、血清肿、血肿、术后感染和术后抗生素使用。进行了单变量和多变量分析。
2017 年至 2021 年间，共有 359 例患者接受了性别肯定乳房切除术。平均年龄为 26.1 岁，平均体重指数为 27.4。144 例（40.1%）患者使用引流管，215 例（59.9%）患者未使用引流管。对于所有患者的术后并发症，有 12 例（3.3%）非计划返回手术室，18 例血清肿（5.0%），26 例血肿（7.2%），50 例（13.9%）术后使用抗生素，4 例术后感染（1.1%）。在所有术后并发症中，使用引流管与不使用引流管之间没有显著差异，但与使用引流管相比，不使用引流管与术后抗生素使用显著减少相关（分别为 3.7%和 29.0%；P < 0.001）。
性别肯定乳房切除术是安全有效的治疗选择。不放置引流管与术后并发症增加无关。如果使用引流管，外科医生可能会考虑不常规开具术后抗生素，并且根据临床判断，在某些患者中可能会考虑避免在性别肯定乳房切除术中使用引流管。
