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New Algorithm for Chest-wall Surgery and Quality of Life Assessment in Female-to-male Reassignment Patients
Vittorio Ramella1, Giovanni Papa1, Chiara Stocco1
1Department of Medical, Surgical and Health Sciences, Plastic and Reconstructive Surgery Unit, University of Trieste, Trieste, Italy.
Plastic and Reconstructive Surgery. Global Open
|November 2, 2020
Summary
A new algorithm aids in selecting the best chest-wall contouring surgery for female-to-male patients, improving satisfaction and aesthetic outcomes. This simplifies top surgery decisions and enhances patient quality of life.
Area of Science:
- Plastic Surgery
- Gender Affirming Surgery
- Surgical Outcomes Research
Background:
- Chest-wall contouring surgery is a primary step in female-to-male (FtM) gender reassignment surgery (GRS), aiming for a masculine chest appearance.
- Current practice lacks a standardized algorithm for surgical technique selection and objective tools for post-operative evaluation of patient satisfaction and quality of life.
Purpose of the Study:
- To introduce and evaluate a simplified algorithm for selecting appropriate surgical techniques in FtM chest-wall contouring.
- To assess patient satisfaction and quality of life following these procedures using a novel questionnaire.
Main Methods:
- A single-center clinical trial analyzed 184 subcutaneous mastectomies in 92 FtM GRS patients (2003-2019).
- Patient selection for semicircular or double-incision with free nipple grafting techniques was based on breast size, ptosis, and skin elasticity.
- Outcomes, complications, and patient-reported satisfaction/quality of life were assessed using 5-point Likert scale questionnaires.
Main Results:
- The study included 92 female-to-male patients undergoing 184 chest-wall contouring procedures.
- The overall reoperation rate was 11.9%.
- Patients reported high satisfaction and good aesthetic results, with an average score of 4.4/5.
Conclusions:
- The proposed algorithm effectively guides the selection of optimal surgical techniques for top surgery in FtM GRS.
- Patient-reported outcomes, assessed via a dedicated Health-Related Quality of Life questionnaire, validate the algorithm's utility.
- Further research is recommended to validate the proposed selection and evaluation tools.
