Abstract：
BACKGROUND: The increasing demand for gender-affirming surgery (GAS) in transgender and gender-diverse healthcare highlights the importance of breast augmentation surgery (BAS) for transfeminine patients. Despite its significance, there is a lack of research on postoperative outcomes of BAS.
METHODS: We analyzed the multi-institutional American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) (2008-2021) database to identify female transgender individuals (TGIs) who underwent BAS surgery, both isolated and combined with concurrent GAS procedures. We evaluated 30-day outcomes, including the incidence of mortality, reoperation, readmission as well as surgical and medical complication occurrence.
RESULTS: Of 1699 female TGIs, 92% underwent isolated BAS and 7.7% underwent combined BAS. The mean age and body mass index (BMI) were 36 ± 12 years and 27 ± 6.6 kg/m2, respectively. Isolated BAS showed a 2.8% complication rate, while combined BAS had a higher rate with 9.1%. Specifically, all complications occurred in patients undergoing BAS with concurrent genitourinary surgery (n = 85; 14%), whereas no adverse events were recorded after combined BAS and facial feminization (n = 19) or chondrolaryngoplasty (n = 19). In patients seeking combined BAS, advanced age (p = 0.05) and nicotine abuse (p = 0.004) were identified as risk factors predisposing to adverse events, whereas American Society of Anesthesiology class 1 was found to be protective (p = 0.02).
CONCLUSIONS: Isolated BAS in TGIs demonstrates a positive safety profile. Combined surgeries, particularly with genitourinary procedures, pose higher risks. Identifying risk factors such as smoking and advanced age is crucial for patient selection and surgical planning. These findings can aid in refining patient eligibility and inform surgical decision-making for BAS.
METHODS: We analyzed the multi-institutional American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) (2008-2021) database to identify female transgender individuals (TGIs) who underwent BAS surgery, both isolated and combined with concurrent GAS procedures. We evaluated 30-day outcomes, including the incidence of mortality, reoperation, readmission as well as surgical and medical complication occurrence.
RESULTS: Of 1699 female TGIs, 92% underwent isolated BAS and 7.7% underwent combined BAS. The mean age and body mass index (BMI) were 36 ± 12 years and 27 ± 6.6 kg/m2, respectively. Isolated BAS showed a 2.8% complication rate, while combined BAS had a higher rate with 9.1%. Specifically, all complications occurred in patients undergoing BAS with concurrent genitourinary surgery (n = 85; 14%), whereas no adverse events were recorded after combined BAS and facial feminization (n = 19) or chondrolaryngoplasty (n = 19). In patients seeking combined BAS, advanced age (p = 0.05) and nicotine abuse (p = 0.004) were identified as risk factors predisposing to adverse events, whereas American Society of Anesthesiology class 1 was found to be protective (p = 0.02).
CONCLUSIONS: Isolated BAS in TGIs demonstrates a positive safety profile. Combined surgeries, particularly with genitourinary procedures, pose higher risks. Identifying risk factors such as smoking and advanced age is crucial for patient selection and surgical planning. These findings can aid in refining patient eligibility and inform surgical decision-making for BAS.
摘要：
背景：在跨性别和性别多样化的医疗保健中，对性别确认手术（GAS）的需求不断增加，突显了隆胸手术（BAS）对经女性患者的重要性。尽管意义重大,缺乏对BAS术后结局的研究。
方法：我们分析了多机构的美国外科医生学院（ACS）国家外科质量改进计划（NSQIP）（2008-2021）数据库，以识别接受BAS手术的女性跨性别个体（TGI）。既孤立又结合并发GAS程序。我们评估了30天的结果，包括死亡率，再操作,再入院以及手术和医疗并发症的发生。
结果：1699名女性TGI，92%接受孤立BAS，7.7%接受联合BAS。平均年龄和体重指数（BMI）分别为36±12岁和27±6.6kg/m2。孤立的BAS显示2.8%的并发症率，而合并BAS的发生率更高，为9.1%。具体来说,所有并发症均发生在接受BAS并同时进行泌尿生殖系统手术的患者中（n=85;14％），而BAS联合面部女性化(n=19)或软骨喉成形术(n=19)后无不良事件发生.在寻求联合BAS的患者中，高龄（p=0.05）和尼古丁滥用（p=0.004）被确定为诱发不良事件的危险因素，而美国麻醉学会1级被发现是保护性的(p=0.02)。
结论：TGI中分离的BAS显示出积极的安全性。联合手术，特别是泌尿生殖系统，构成更高的风险。确定吸烟和高龄等风险因素对于患者选择和手术计划至关重要。这些发现可以帮助提高患者的资格，并为BAS的手术决策提供信息。
方法：我们分析了多机构的美国外科医生学院（ACS）国家外科质量改进计划（NSQIP）（2008-2021）数据库，以识别接受BAS手术的女性跨性别个体（TGI）。既孤立又结合并发GAS程序。我们评估了30天的结果，包括死亡率，再操作,再入院以及手术和医疗并发症的发生。
结果：1699名女性TGI，92%接受孤立BAS，7.7%接受联合BAS。平均年龄和体重指数（BMI）分别为36±12岁和27±6.6kg/m2。孤立的BAS显示2.8%的并发症率，而合并BAS的发生率更高，为9.1%。具体来说,所有并发症均发生在接受BAS并同时进行泌尿生殖系统手术的患者中（n=85;14％），而BAS联合面部女性化(n=19)或软骨喉成形术(n=19)后无不良事件发生.在寻求联合BAS的患者中，高龄（p=0.05）和尼古丁滥用（p=0.004）被确定为诱发不良事件的危险因素，而美国麻醉学会1级被发现是保护性的(p=0.02)。
结论：TGI中分离的BAS显示出积极的安全性。联合手术，特别是泌尿生殖系统，构成更高的风险。确定吸烟和高龄等风险因素对于患者选择和手术计划至关重要。这些发现可以帮助提高患者的资格，并为BAS的手术决策提供信息。
