Subcutaneous mastectomy in female-to-male transsexuals – optimizing perioperative and operative management in 8 years clinical experience

Publication date: Available online 29 September 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): A. Wolter, T. Scholz, N. Pluto, J. Diedrichson, A. Arens-Landwehr, J. Liebau
IntroductionThe incidence of complications, especially acute hematoma requiring surgical revision in female-to-male transsexuals (FTMTS), is consistently highly documented in literature with up to 33 %. Since 2008 we perform subcutaneous mastectomies in FTMTS with an annually increasing number of cases. Due to an initially high hematoma revision rate in the previously published cohort (2008-2013), we implemented peri- and postoperative preventive measures and compared the results with recent patient cohort (2014-2016).Patients and methodsThe records of 356 patients (712 mastectomies) were retrospectively reviewed. We compared the first cohort (peri- and postoperative standard procedure and implementation of a care path in our institution, C1, 01/2008 - 12/2013, 346 mastectomies) with the recent cohort (C2, 01/2014 - 01/2016, 366 mastectomies) and introduced in C2 the following preventive measures: perioperative administration of tranexamic acid, intraoperative elevation of blood pressure to at least 120 mmHg before wound closure, bedrest and consequent wearing of compression bandage without removal 12 hours postoperatively. Comparison of complication rate, patient satisfaction and secondary revision rate were obtained in both cohorts.ResultsThe mean operation time could be reduced from 103.6 minutes to 72.5 minutes (p<0,05). The overall complication rate could be diminished from 11.8 % to 5.5 % (p<0,05), the acute hematoma revision rate from 9.2 % to 4.1 % (p<0,05). Secondary revisions were similar in both patient cohorts. Patient satisfaction rate was ameliorated from 88 % to 93.5 % „very satisfied" to „satisfied" patients.ConclusionHematoma is the most common reason for reoperation in FTMTS patients. By implementation of peri- and postoperative preventive measures and additional application of an institutional care path we could achieve a significant reduction of complications, particularly of the hematoma evacuation rate. During 8 years clinical and operative treatment in FTMTS we could furthermore achieve a decrease in operative time and an ameliorated patient satisfaction with the aesthetic results.