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California Society of Plastic Surgeons

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Gender-Affirming Mastectomy Trends and Outcomes in Adolescents
Annie Tang MD1, J Carlo Hojilla PhD2,3, Jordan Jackson MD1, Kara A Rothenberg MD1, Rebecca C Gologorsky MD1, Douglas A. Stram3, Colin Mooney MD1, Stephanie L.Hernandez MA LMFT4, Karen M Yokoo MD5 1Department of Surgery, University of California San Francisco East Bay, Oakland, CA 2Weill Institute for Neurosciences, Department of Psychiatry, University of California, San Francisco, CA 3Division of Research, Kaiser Permanente Northern California, Oakland, CA 4Multispecialty Transition Department, Kaiser Permamente Northern California, Oakland, CA 5Department of Plastic Surgery, Kaiser Permanente Northern California, Richmond, CA

Background: Although there are over 150,000 adolescents in the US who identify as transgender, research on outcomes following gender-affirming surgery for adolescents is limited. We aimed to evaluate trends and outcomes of gender-affirming mastectomy in adolescents.

Methods: Gender-affirming mastectomy referrals and operations performed between 2013-2020 in patients <18 years at referral were obtained from an integrated healthcare system. Demographic information, clinical characteristics (comorbidities, mental health history, testosterone use), surgical technique, and documented regret of patients who underwent surgery were reviewed. Patients with and without complications were analyzed to evaluate for differences in demographic or clinical characteristics.

Results: Surgical referrals for adolescents increased from 4 in 2013 to 93 in 2019. The incidence of gender-affirming mastectomy increased 13-fold (4.4 to 45.4 per 100,000 person-years). Of the 209 patients who completed surgery, the median age at surgery was 16 years (range 13-18). For patients with greater than 1-year follow-up (n=137), the overall prevalence of complications was 18% (n=25), which include aesthetic revision (9.5%), hematoma (3.6%), infection (2.9%), hypertrophic scars requiring steroid injection (2.9%), and seroma (0.7%). Only 1 patient (0.49%) had documented regret. There were no differences in patient demographics and clinical characteristics between those with and without complications (p>0.05).

Conclusion: There is an upward trend in gender-affirming mastectomy referrals and operations in adolescents. Gender-affirming mastectomy has a low prevalence of complications and regret in this population. As the largest case series to date, this study provides better guidance for providers treating adolescents who are seeking care for their gender dysphoria.

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