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.
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。