Case 28 Gender Transition (Male-to-Female)



Angie M. Paik and Daniel Kwan

Case 28 Gender Transition (Male-to-Female)

Case 28 (a-c) A 22-year-old asserted female, natal male, presents to discuss top surgery for gender confirmation. She has been taking hormone replacement for over a year.



28.1 Description




  • Some breast development noted, well-defined lateral pectoral border, no significant volume discrepancy, laterally positioned nipple-areolar complexes (NACs), and pink scars overlying sternum and left shoulder



  • Tuberous breast deformity with herniation of breast tissue into the NAC, constricted base, and deficient lower pole



28.2 Work-Up



28.2.1 History




  • Duration of social transition as female



  • Use and duration of feminizing hormone therapy and stability of breast development



  • Use of padded brassiere or volume-enhancing prosthetic



  • History of hypertrophic scarring or keloids



  • Weight stability



  • Medical comorbidities



  • Psychiatric history and any established relationship with a mental health professional



  • History of smoking



  • Family history or personal history of breast cancer



28.2.2 Physical Examination




  • Volume of native breast tissue



  • Breast measurements: Sternal notch to nipple distance, inframammary fold (IMF) toNAC distance, breast width, height, projection, soft tissue pinch, and NAC dimensions



  • Skin quality



  • Grade of breast ptosis



  • Masses, discharge, or lymphadenopathy



  • Chest wall contour



  • Skin rashes



28.2.3 Pertinent Imaging or Diagnostic Studies




  • Breast imaging if any abnormality is noticed on examination



28.3 Consultations




  • Mental health professional:Should be involved throughout the preoperative and postoperative process



  • Endocrinologist or primary physician:Coordinating hormone therapy and follow-up



28.4 Patient Counseling




  • Effects of feminization hormone therapy on the chest




    • Mammogenesis (similar to pubertal development) to varying degrees



  • Inherent differences between the male and female chest relevant to top surgery




    • Male chest is wider with more pectoral muscle development and stronger pectoral fascia



    • Male areolae are smaller and more laterally positioned



    • The male chest has a shorter distance between nipple and inframammary crease



  • Goals of surgery: Achieve a more feminine profile, cleavage, and desired breast volume



  • Smoking cessation encouraged

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Jul 17, 2021 | Posted by in General Surgery | Comments Off on Case 28 Gender Transition (Male-to-Female)

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