Need for Routine Screening Prior to Female-to-Male Gender-Affirming Chest Surgery

Recognition of gender diverse individuals and their unique health care needs is increasing. Population-based studies demonstrate numbers of individuals identifying as transgender and gender non-binary is growing, particularly in younger generations. Since the end of Medicare coverage exclusion for gender-affirming surgeries (GASs) and expansion in third-party coverage, patients seeking GAS have increased dramatically.Gender-affirming chest surgery (GACS) is performed at nearly twice the rate of genital surgery. The average age of patients seeking GAS is 29.8 years. With expansion in GAS availability, more individuals at or near screening age present for chest surgery. Without pre-operative imaging, breast tissue abnormalities may not be discovered until surgical pathology. We present a patient with Paget's disease of the breast (PDB) discovered after female-to-male gender-affirming chest surgery (FTM GACS) without pre-operative imaging. This case highlights the importance of routine breast surveillance prior to FTM GACS.