Preoperative breast cancer screening before chest masculinization surgery

Area of Science:

• Oncology
• Radiology
• Gender-affirming care

Background:

• Standardized preoperative breast imaging guidelines are lacking before gender-affirming chest masculinization surgery (GACMS).
• Inconsistent practices may lead to missed diagnoses and impact surgical planning.
• Limited data exists on the efficacy of preoperative imaging for GACMS.

Purpose of the Study:

• To characterize patterns, indications, and outcomes of preoperative breast imaging before GACMS.
• To assess the impact of preoperative imaging on cancer detection and surgical decision-making.
• To evaluate the effect of preoperative imaging on the timing of GACMS.

Main Methods:

• Retrospective review of adult patients undergoing GACMS (January 2017-September 2024).
• Descriptive statistics analyzed imaging frequency, indications, modalities, and outcomes.
• Surgical management alterations and an institutional screening algorithm were described.

Main Results:

• Preoperative breast imaging was performed in 11.1% of 368 patients.
• Malignancy was detected in 2 patients (4.9% of imaged), influencing surgical planning.
• Overall perioperative breast cancer diagnoses were 0.8% (3 patients); time to surgery did not differ significantly between imaged and non-imaged groups.

Conclusions:

• Preoperative breast imaging before GACMS identified malignancies, significantly altering surgical plans and preventing postoperative procedures.
• A decision-making algorithm can standardize and guide preoperative breast imaging practices for GACMS.
• Standardized imaging protocols are crucial for optimizing surgical outcomes and patient safety in gender-affirming care.