Oncoplastic chest masculinization using lateral thoracic adipofascial flaps after risk-reducing mastectomy

The high-risk transgender man with a pathogenic variant in a cancer predisposition gene presents a clinical dilemma wherein the requisite oncologic mastectomy creates an inherent dichotomy with the aesthetic goals of chest masculinization. A standard gender-affirming mastectomy leaves residual glandular tissue, necessitating burdensome surveillance. Conversely, a complete oncologic mastectomy, particularly in obese patients, frequently yields a contour deformity characterized by anterior chest hollowing and exacerbated lateral chest rolls. We present novel use of a single-stage technique that repurposes the tissue that would otherwise form a "dog ear" deformity as a robust, pedicled adipofascial flap for immediate autologous reconstruction. This approach synergistically resolves the dichotomy between oncologic safety and aesthetic outcomes by simultaneously achieving complete resection, obliterating the mastectomy defect, and eliminating lateral chest rolls.