Wolf Yoram, Skorochod Ron
Unit of Plastic and Reconstructive Surgery, Hillel Yaffe Medical Center, Hadera 38100, Israel.
Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa 320002, Israel.
J Clin Med. 2025 Jul 1;14(13):4656. doi: 10.3390/jcm14134656.
Gender-affirming mastectomies are a pivotal step in the gender-affirmation process. These procedures represent the concordance between an individual's appearance, as seen by the environment, and his/her perception of themselves. Hematomas are a growing concern in gender-affirming mastectomies, as they carry the risk for reoperation, increased length of hospital stay, and sub-par aesthetic outcomes. Recognition of factors contributing to the development of hematomas in gender-affirming mastectomies can improve surgical outcomes and patient satisfaction. In this study, we hope to shed light on variables potentially contributing to the development of post-operative hematomas in our experience with 267 gender-affirming mastectomies. Medical records of 267 consecutive gender-affirming mastectomies performed by the senior author were included in this study. Relevant demographic, clinical, and surgical characteristics were collected from patients' medical files. The patients were stratified based on whether they developed post-operative hematomas. Univariate and multivariate analyses were performed to determine the impact of various factors on the risk of the development of post-operative hematomas. The study groups were found to be similar in most baseline demographic and surgical characteristics. Statistically significant differences were seen regarding mean BMI, use of combined TRT and estrogen blockers, surgical technique, previous reduction mammaplasty, and intra-operative tissue resection weight (-value = 0.007, 0.03, <0.001, 0.02, <0.001). Multivariate logistic regression was performed to predict post-operative hematomas. The covariates in question were statistically significant variables that differed between the groups. Previous reduction mammaplasty was found to be a statistically significant independent predictor of post-operative hematomas, with an OR of 41.55 (95% CI 4.2-408.3), and the "free NAC" surgical technique was found to decrease the incidence of post-operative hematomas, with an OR of 0.015 (95% CI 0.003-0.064). A history of reduction mammaplasty is a substantial risk factor for the development of post-operative hematomas in gender-affirming mastectomies. Of the various surgical techniques, the use of the "free NAC" technique can, to some degree, reduce the risk of hematoma development.
性别肯定性乳房切除术是性别肯定过程中的关键一步。这些手术体现了个体在他人眼中的外貌与其自我认知之间的一致性。血肿在性别肯定性乳房切除术中日益受到关注，因为它们存在再次手术、住院时间延长以及美学效果不佳的风险。认识到导致性别肯定性乳房切除术中血肿形成的因素，有助于改善手术效果和患者满意度。在本研究中，我们希望通过对267例性别肯定性乳房切除术的经验，揭示可能导致术后血肿形成的变量。本研究纳入了由资深作者连续实施的267例性别肯定性乳房切除术的病历。从患者的医疗档案中收集了相关的人口统计学、临床和手术特征。根据患者是否发生术后血肿进行分层。进行单因素和多因素分析，以确定各种因素对术后血肿发生风险的影响。研究组在大多数基线人口统计学和手术特征方面相似。在平均BMI、联合使用睾酮替代疗法（TRT）和雌激素阻滞剂、手术技术、既往缩乳术以及术中组织切除重量方面观察到统计学上的显著差异（P值 = 0.007、0.03、<0.001、0.02、<0.001）。进行多因素逻辑回归以预测术后血肿。所讨论的协变量是两组之间存在差异的具有统计学意义的变量。既往缩乳术被发现是术后血肿的统计学上显著的独立预测因素，比值比（OR）为41.55（95%置信区间4.2 - 408.3），而“游离乳头乳晕复合体（NAC）”手术技术被发现可降低术后血肿的发生率，OR为0.015（95%置信区间0.003 - 0.064）。既往缩乳术病史是性别肯定性乳房切除术中术后血肿形成的一个重要风险因素。在各种手术技术中，使用“游离NAC”技术在一定程度上可以降低血肿形成的风险。
