Treatment of Keloids from Gender-Affirming Mastectomy: A Case Report

A transgender (trans) man is a trans person who was assigned female sex at birth. Some trans men undergo gender-affirming surgical procedures, particularly mastectomy. We present a case of keloid formation after gender-affirming mastectomy that highlights the importance of choosing the most appropriate mastectomy technique in patients at risk of keloid and the most effective therapeutic strategies for anterior-chest keloids. A 40-year-old Japanese trans man developed keloids along inverted-T mastectomy-induced anterior-chest scars. The keloids were completely excised, and the defects were closed by primarily using a layered technique. Starting the next day, the wounds were treated with radiotherapy over 3 consecutive days. The wounds/scars were carefully monitored and treated with continuous taping fixation for 1 year. There was no recurrence, and aesthetic outcomes at 18 months were good. To prevent keloids after gender-affirming mastectomy, surgeons must estimate individual risk of keloid formation. If the patient is young, of Asian or African descent, or has a personal or family history of keloids, surgical methods that leave long lateral scars on the anterior chest (e.g., the inverted T procedure) should be avoided. Tensionless or tension-reducing surgical techniques should also be used, along with postoperative radiotherapy, long-term taping or compression, close follow-up to detect early signs of keloid formation, and referral to a plastic surgery department if any scar induration or elevation is observed. Surgeons performing gender-affirming mastectomy can potentially reduce the risk of keloid formation by carefully considering these factors.