Perioperative blood pressure and hematoma risk after gender-affirming mastectomy

Hematoma formation is a common complication following gender-affirming mastectomy, yet the contribution of perioperative hemodynamics to hematoma risk in this population remains unclear.

A retrospective cohort study was performed of transgender patients undergoing bilateral gender-affirming mastectomy by a single surgeon from 2016 to 2023. Hematoma was defined as a postoperative collection requiring surgical evacuation. MAP was calculated at baseline, preoperatively, intraoperatively, and within one hour postoperatively. Group comparisons and multivariable logistic regression were used to assess predictors of hematoma formation.

Among 216 patients, 8 (3.7%) developed hematomas requiring evacuation. Patients who developed hematoma had significantly lower intraoperative MAP than those without hematoma (73.5 ± 7.2 vs. 83.9 ± 8.6 mmHg, p = 0.004). In addition, the increase in MAP from the intraoperative to postoperative period was significantly greater in the hematoma group (25.6 ± 15.0 vs. 5.85 ± 12.6 mmHg, p = 0.007). On multivariable logistic regression, the intraoperative-to-postoperative MAP increase was a strong independent predictor of hematoma formation (OR 1.14 per mmHg increase, p < 0.001).

Optimizing perioperative hemodynamic stability may be an important modifiable factor in reducing hematoma formation and improving outcomes after gender-affirming top surgery.