Outcomes of Combining Mastectomy and Hysterectomy for Transmasculine Patients

Many transmasculine patients undergo gender-affirming mastectomy and hysterectomy. Conflicting evidence exists whether these procedures may be safely combined. The purpose of this study is to compare post-operative complications between transmasculine patients who underwent mastectomy alone versus mastectomy in combination with hysterectomy.

Retrospective chart review was performed on patients who underwent mastectomy between January 2020 and September 2022 (n=227). Patients were separated into two groups based on whether they had mastectomy alone (n=187) versus in combination with hysterectomy (n=40). Outcomes included operation time, length of inpatient hospital stay, chest wall complication, and revision rate and gynecologic complication rate. Independent t-tests, Pearson-chi square analyses, and Fischer's exact tests were used to compare outcomes between the groups.

Overall rate of chest wall complications was 8.8%. Combination of mastectomy with hysterectomy within the same day significantly increased operation time (311 vs. 166 min, p<0.001), admission time (0.23 vs. 0.02 days, p<0.001), and rate of chest wall complications (17.5% vs. 6.9%, odds ratio [OR]=2.84 95% confidence interval [CI]: 1.05-7.65), particularly infection (7.5% vs. 1.1%, OR=7.50 95% CI: 1.21-46.46). There was no difference in hematoma or seroma formation, dehiscence, partial or complete nipple loss, or revision rates between groups. Gynecologic complication rate was 2.5% (n=1).

Combining mastectomy and hysterectomy is not a benign undertaking as it is associated with increased risk of post-operative chest wall infection. Multidisciplinary surgical teams treating transmasculine patients should choose a surgical plan that optimizes patient outcomes.