PDF(Pubmed)
Abstract：
UNASSIGNED: Gender-affirming mastectomy (GAM), in contrast to simple mastectomy (SM), utilizes preservation of subcutaneous and breast tissue to produce a cosmetically favorable result for transgender patients, however does not remove all future malignancy risk. Here we present a case report of a transmale patient who was evaluated for GAM and subsequently found to have a malignant breast mass, necessitating multi-disciplinary intervention and coordination between breast and plastic surgery teams. This patient\'s unique and rare presentation with breast cancer prior to GAM emphasized the paucity of previously detailed cases in the literature and demonstrated the likely degree of variability in decision-making for treatment of these patients without universal guidelines for management.
UNASSIGNED: The patient is a 47-year-old African American transgender male who was found to have a 3-cm breast mass on routine pre-operative mammographic screening prior to GAM. Pathology confirmed grade II invasive ductal carcinoma (IDC) and further genetic testing showed the patient was BRCA2 positive. The breast and plastic surgery teams coordinated the GAM to best address the mass while achieving cosmetic goals. This case was complicated by positive nipple margins on intra-operative cold specimen, which necessitated deviation from the initial plan to perform bilateral nipple grafts, and instead utilized excess areolar tissue from the left nipple to reconstruct the contralateral right nipple. Graft survival and overall repair quality at 6 weeks was satisfactory to both patient and provider.
UNASSIGNED: This case highlights several of the challenges encountered when considering or performing GAMs in transmale patients with underlying breast cancer. Surgical considerations for these patients differ from cisgender individuals undergoing mastectomy for oncologic breast findings. Further research is needed to better determine the ideal operative practice and ideal follow-up screening for these patients.
UNASSIGNED: The patient is a 47-year-old African American transgender male who was found to have a 3-cm breast mass on routine pre-operative mammographic screening prior to GAM. Pathology confirmed grade II invasive ductal carcinoma (IDC) and further genetic testing showed the patient was BRCA2 positive. The breast and plastic surgery teams coordinated the GAM to best address the mass while achieving cosmetic goals. This case was complicated by positive nipple margins on intra-operative cold specimen, which necessitated deviation from the initial plan to perform bilateral nipple grafts, and instead utilized excess areolar tissue from the left nipple to reconstruct the contralateral right nipple. Graft survival and overall repair quality at 6 weeks was satisfactory to both patient and provider.
UNASSIGNED: This case highlights several of the challenges encountered when considering or performing GAMs in transmale patients with underlying breast cancer. Surgical considerations for these patients differ from cisgender individuals undergoing mastectomy for oncologic breast findings. Further research is needed to better determine the ideal operative practice and ideal follow-up screening for these patients.
摘要：
■性别确认乳房切除术（GAM），与单纯乳房切除术(SM)相比，利用皮下和乳房组织的保存为变性患者产生美容上有利的结果，然而，并不能消除所有未来的恶性肿瘤风险。在这里，我们提供了一个跨男性患者的病例报告，该患者接受了GAM评估，随后发现患有恶性乳腺肿块。需要乳房和整形外科团队之间的多学科干预和协调。该患者在GAM之前的独特且罕见的乳腺癌表现强调了文献中先前详细病例的缺乏，并证明了在没有通用治疗指南的情况下，这些患者的治疗决策可能存在差异程度。
患者是一名47岁的非裔美国跨性别男性，在GAM之前的常规术前乳房X线检查中发现乳房肿块3厘米。病理证实为II级浸润性导管癌（IDC），进一步的基因检测显示患者为BRCA2阳性。乳房和整形外科团队协调GAM，以最好地解决肿块，同时实现美容目标。该病例因术中冷标本乳头边缘阳性而并发，这就需要偏离进行双侧乳头移植的最初计划，取而代之的是利用左侧乳头多余的乳晕组织来重建对侧右侧乳头。患者和提供者在6周时的移植物存活和总体修复质量均令人满意。
■该案例突出了在考虑或进行GAM治疗患有潜在乳腺癌的跨男性患者时遇到的一些挑战。这些患者的手术考虑与因肿瘤乳房发现而接受乳房切除术的顺式个体不同。需要进一步的研究来更好地确定这些患者的理想手术方法和理想的随访筛查。
患者是一名47岁的非裔美国跨性别男性，在GAM之前的常规术前乳房X线检查中发现乳房肿块3厘米。病理证实为II级浸润性导管癌（IDC），进一步的基因检测显示患者为BRCA2阳性。乳房和整形外科团队协调GAM，以最好地解决肿块，同时实现美容目标。该病例因术中冷标本乳头边缘阳性而并发，这就需要偏离进行双侧乳头移植的最初计划，取而代之的是利用左侧乳头多余的乳晕组织来重建对侧右侧乳头。患者和提供者在6周时的移植物存活和总体修复质量均令人满意。
■该案例突出了在考虑或进行GAM治疗患有潜在乳腺癌的跨男性患者时遇到的一些挑战。这些患者的手术考虑与因肿瘤乳房发现而接受乳房切除术的顺式个体不同。需要进一步的研究来更好地确定这些患者的理想手术方法和理想的随访筛查。
