Mastectomy in transgender patients: The experience of a Portuguese reference center

Gender-affirming mastectomy represents a fundamental procedure in the transition process for transgender patients, substantially contributing to psychosocial well-being. This study presents the 13-year experience of the only reference center in Portugal and aims to analyze surgical techniques, outcomes, complications and patient-reported satisfaction following chest wall masculinization. A retrospective review was conducted of all trans men who underwent gender-affirming mastectomy between October 2011 and December 2024. Surgical techniques were selected based on breast size, ptosis and skin elasticity. Demographics, operative details, complications, and revision procedures were recorded, and postoperative satisfaction was assessed. A total of 87 patients underwent chest wall masculinization surgeries, including 174 mastectomies. Inframammary mastectomies with nipple-areolar complex grafts were performed in 55%, concentric periareolar in 34%, and hemiperiareolar in 9.2% of cases. Mean body mass index was higher in the inframammary group (25.8 vs. 22.8 kg/m²; p < 0.001). The overall complication rate was low. Hematoma occurred in 13%, hypertrophic scarring in 11% (significantly associated with inframammary technique; p < 0.05), and no infections were recorded. Secondary revision surgery was required in 8.0% of patients. Among survey respondents (47%), the mean satisfaction score was 8.5/10, with no reports of regret. Gender-affirming mastectomy is a safe and effective procedure that provides significant aesthetic and psychosocial outcomes. Individualized surgical technique selection based on anatomical features yields high patient satisfaction and low complication rates.