Keywords: Top Surgery, Breast Sensation, Gender Health

Background: 

Mastectomy for chest masculinization is an important gender-affirming surgery for transgender female-to-male (FtM) and non-binary patients. The goals of this procedure include the removal of breast tissue and excess skin, repositioning and reshaping of the nipple-areolar complex (NAC), and minimization of scarring. Breast sensation in untreated FtM individuals has been shown to heighten gender dysphoria and discomfort, however little is known about how FtM top surgery affects breast/chest sensation. Currently, there are no prospective studies investigating this topic. Therefore, the aim of this study is to provide longitudinal data comparing breast and nipple sensation after top surgery using objective and subjective scores.

Objective: 

The aim of this study is to assess how gender-affirming mastectomy affects how patients experience breast/chest and nipple sensation or lack thereof. We will compare the outcomes from the subjective measurement (BREAST-Q breast sensation survey) to the outcomes by objective measurements (monofilament sensory test).

Methods: 

Patients over the age of 18 who are seeking gender-affirming FtM top surgery are eligible for study participation. The goal population size is 20 subjects. Patient information will be obtained via electronic chart review including demographic data, medical history, and operative variables such as amount of tissue removed, mastectomy method, and complications. Data will be collected at three timepoints: baseline (consult or pre-operation visit), 3 months post-operation, and 1 year post-operation. At each visit, the subjects will complete a BREAST-Q survey to subjectively assess their breast sensation and a monofilament test will be performed to assess sensation in different breast quadrants and the areolar region. Data analysis will involved a multivariate analysis of survey answers and monofilament sensation scores over time.

Results: 

Ten female-at-birth patients (median age = 25.5 years, median BMI = 24.8) have been enrolled in this study to date. Four patients report their ethnicity as Hispanic or Latino. Five patients report their race as White/Caucasian, three report Asian American or Pacific Islander, and two declined to answer. All ten subjects have completed their baseline survey and monofilament sensation testing and are awaiting their mastectomy. All subjects report complete feeling to light and deep touch of the breasts, and on average report no breast tenderness. Bilaterally, the minimum monofilament size required for sensation was on average 0.58g, 0.62g, 1.08g, and 0.74g for the superolateral, superomedial, inferolateral, and inferomedial quadrants, respectively. The areolar region required on average a heavier monofilament for sensation than any of the quadrants. 

Conclusions: 

At this point in the study, there is no longitudinal data and thus no conclusions can be made about the effects of gender-affirming mastectomy on breast sensation.