A. Miller1,2, M. J. Escobar-Domingo3, B. T. Lee3, O. Ganor4, S. J. Lin3, S. Hu5, A. L. Pusic1,5, M. N. Kaur1,5 1Harvard Medical School, Boston, MA, USA 2Harvard Kennedy School, Cambridge, MA, USA 3Beth Israel Deaconess Medical Center, Division Of Plastic And Reconstructive Surgery, Department Of Surgery, Boston, MA, USA 4Boston Children’s Hospital, Department Of Plastic And Oral Surgery, Boston, MA, USA 5Brigham And Women’s Hospital, Patient-Reported Outcomes, Value And Experience (PROVE) Center, Department Of Surgery, Boston, MA, USA
Introduction: Nonbinary people are increasingly accessing breast reduction procedures, and their desired chest appearance can differ from that of transgender or cisgender individuals. Research in gender-affirming chest surgery research has primarily compared cisgender versus transgender and gender-diverse (TGD) people, without specifically addressing nonbinary people. This study will assess surgical and post-operative complications between cisgender, transgender, and nonbinary adults undergoing breast reduction procedures.
Methods: The ACS-NSQIP database was used to identify TGD patients who underwent breast reduction between 2018 and 2021 (Current Procedural Terminology code: 19318). TGD patients were identified using International Classes of Diseases, Tenth Revision (ICD-10) codes F64, F64.0, F64.1, F64.2, F64.8, F64.9, F65.1, and Z87.890. Cisgender patients who underwent breast reduction for cosmetic (ICD-10 codes: Z41, Z41.0, and Z41.1) or cancer prophylaxis purposes (ICD-10 codes: Z14.8, Z15.0, Z15.01, Z15.09, Z15.89, Z40, Z40.0, Z40.00, Z40.01, and Z80.3) were also identified. Baseline characteristics and surgery-related complications among cisgender, transgender, and nonbinary patients were assessed using analysis of variance tests, Fisher’s exact test, unpaired t-tests, and regression models.
Results: A total of 978 patients met inclusion criteria: 279 (28.5%) were cisgender, 627 (64.1%) were transgender, and 72 (7.4%) were nonbinary. The three cohorts differed in age, race, ethnicity, and tobacco history. The all-cause complication rates were 3.2% in cisgender patients, 1.4% in nonbinary patients, and 0.6% in transgender patients. After adjusting for confounding variables, including age, BMI, ethnicity, smoke, diabetes, or any bleeding disorders, transgender patients had a lower likelihood of wound complications (OR: 0.12; 95% CI: 0.02-0.76; p=0.02) or all-cause complications (OR: 0.23; 95% CI: 0.02-0.97; p=0.045) compared to cisgender patients. No significant differences in wound or all-cause complications were identified between nonbinary and cisgender patients.
Conclusion: Our findings suggest that cisgender patients may have a higher likelihood of post-surgical complications compared to transgender patients and an equivocal risk compared to nonbinary patients. However, the overall rates of complications following breast reductions were low across all genders, which might limit the clinical significance of these results. Ultimately, this study underscores the importance of further research to better characterize the safety profiles of breast reduction among different genders.
