A New Algorithm for Masculine Chest-Wall Contouring in 560 Trans-AFAB (Assigned Female at Birth) Patients: Clinical...

Area of Science:

• Plastic Surgery
• Gender Affirming Care
• Surgical Algorithms

Background:

• Preoperative planning is critical for chest-wall contouring surgery in transgender AFAB patients.
• Selecting the appropriate surgical technique can be complex due to numerous variables.
• A novel, simplified preoperative algorithm was developed and applied to a cohort of 560 patients.

Purpose of the Study:

• To evaluate the efficacy of a new preoperative algorithm for chest-wall contouring in transgender AFAB patients.
• To assess surgical outcomes, complications, and patient satisfaction using the new algorithm.
• To determine the optimal surgical technique based on the algorithm's landmark guidance.

Main Methods:

• A cohort of 560 transgender AFAB patients underwent top surgery between 2016 and 2024 utilizing the new algorithm.
• The algorithm uses the inferior border of the pectoralis major muscle to guide the choice between Periareolar (PA), Hemi-periareolar (HP), or Double Incision with free nipple graft (DI) techniques.
• Outcomes analyzed included complications, need for revision, scar quality (Vancouver Scar Scale), and patient-reported outcomes (TRANS-Q questionnaire).

Main Results:

• The Double Incision (DI) technique was most frequently used (82.4%), followed by Hemi-periareolar (HP) (11.4%) and Periareolar (PA) (6.2%).
• Hematoma occurred in 10.8% of patients, with only 1.7% requiring reoperation. Revision procedures were performed in 9% of cases.
• High patient satisfaction was reported, with the majority showing significant improvement post-surgery (p < 1.41 × 10^-16), and favorable scar quality (VSS score 1 in 38.4%).

Conclusions:

• The developed algorithm provides a simple yet effective method for guiding surgical technique selection in transgender AFAB chest-wall contouring.
• The algorithm contributes to maximizing aesthetic results and achieving high levels of patient satisfaction.
• The study demonstrates the algorithm's efficacy through positive surgical outcomes and patient-reported improvements.