Transgender Top Surgery & the hybrid nipple flap: A retrospective review of data on surgical outcomes and patient-reported satisfaction at NYU Langone Medical Center, Hansjörg Wyss Department of Plastic Surgery

Top surgery is the most frequently performed transition-related procedure sought by trans men, initiated by patients who wish to align their physical body (chest wall) with a preferred gender identity. Technical goals of this... [ view full abstract ]

Top surgery is the most frequently performed transition-related procedure sought by trans men, initiated by patients who wish to align their physical body (chest wall) with a preferred gender identity. Technical goals of this procedure include the removal of breast tissue and excess skin, proper repositioning and reshaping of the nipple-areola complex (NAC), and the minimization of chest wall scars.

Despite the immense practical importance of top surgery for trans men in daily life, literature on long term patient satisfaction with surgical outcomes is scarce. In particular, the degree to which top surgery—independent of other gender confirming surgeries (GCS)—improves quality of life (QOL) for trans men is not well documented in the medical literature. As a result, patients considering this surgery and the medical personnel tasked with guiding them often have minimal reliable information to share regarding post-op patient reported satisfaction and QOL associated with different surgical techniques, and funding for this procedure is too often disputed.

In this presentation, the author recounts her groups’ recent experience with their preferred surgical technique— referred to as the Hybrid Nipple Flap—and reviews retrospective patient data on associated primary and... [ view full abstract ]

In this presentation, the author recounts her groups’ recent experience with their preferred surgical technique— referred to as the Hybrid Nipple Flap—and reviews retrospective patient data on associated primary and secondary outcome metrics, in terms of both surgical results and post-operative patient satisfaction (patient-reported survey data).

A retrospective chart review was undertaken of 50 top surgery cases overseen by a single surgeon (Alexes Hazen MD) during a twelve month period at NYU Langone Medical Center (March 2015-March 2016, Hansjörg Wyss Department of... [ view full abstract ]

A retrospective chart review was undertaken of 50 top surgery cases overseen by a single surgeon (Alexes Hazen MD) during a twelve month period at NYU Langone Medical Center (March 2015-March 2016, Hansjörg Wyss Department of Plastic Surgery, New York, NY). The electronic medical records of individual subjects were reviewed for data on patient characteristics, surgical technique, and postoperative results.

In addition, an original survey—designed to gauge post-op quality of life and satisfaction with top surgery outcomes —was distributed to 250 of Dr. Hazen’s former patients via email and US Mail as part of an ancillary research study. Completion of the survey was completely voluntary, subjects did not receive compensation for participating, and responses were anonymous. All survey participants were at least three months post-operative.

In our chart review, data from fifty electronic medical charts was retrospectively analyzed for demographics (patient age, sex, medical history, hormone therapy regimen, length of hospital stay), pre and post op photographs... [ view full abstract ]

In our chart review, data from fifty electronic medical charts was retrospectively analyzed for demographics (patient age, sex, medical history, hormone therapy regimen, length of hospital stay), pre and post op photographs (if available), complications (hematoma, infection, seroma, fistula, or partial necrosis of nipple-areola complex), characteristics of operation (description of reconstruction/technique, operative time), and need for subsequent interventions, aesthetic corrections, or re-operation.

In our survey study, qualitative data on patient attitudes and experiences undergoing top surgery was collected in the following domains: 1) patient-reported satisfaction with the functional and aesthetic outcomes of their top surgery; 2) barriers encountered (if any) in the surgical decision making process; 3) pre and post op Quality of Life; and 4) long term satisfaction with decision to have top surgery.

In transgender men, the Hybrid Nipple Flap technique is a reliable, reproducible, and effective top surgery technique. The majority of patients who responded to our survey reported a general sense of satisfaction with surgical... [ view full abstract ]

In transgender men, the Hybrid Nipple Flap technique is a reliable, reproducible, and effective top surgery technique. The majority of patients who responded to our survey reported a general sense of satisfaction with surgical outcome (aesthetic and functional), coupled with notable improvements in post-operative quality of life, sexual satisfaction, and mental health (to varying degrees).

As funding for bilateral mastectomy and associated chest re-contouring for trans men is continually disputed throughout the United States and elsewhere, our findings contribute to a much-needed body of evidence that top... [ view full abstract ]

As funding for bilateral mastectomy and associated chest re-contouring for trans men is continually disputed throughout the United States and elsewhere, our findings contribute to a much-needed body of evidence that top surgery improves the daily lives and functioning of trans men to a marked extent.