Simplified Drainless Outpatient Female-to-Male Gender-Affirming Bilateral Mastectomy

PurposeFemale-to-male gender-affirming top surgery is growing in demand. We ventured to further improve double-incision free nipple graft bilateral mastectomy by utilizing a streamlined method of eliminating dead space and abandoning the practice of postoperative drain placement. MethodsPatients with gender dysphoria and who underwent streamlined gender-affirming top surgery without drain placement were retrospectively reviewed from August 2017 to June 2020. A literature review was conducted to identify comparative studies with historical complication data. Patient outcomes were analyzed against this aggregated data. ResultsOne-hundred and seven patients underwent 214 simplified double incision free nipple graft bilateral mastectomies in an outpatient surgery center. Mean patient age was 27.2 {+/-} 10.4 years. The overall complication rate was 13.1 percent. Hematoma occurred in 2 patients (1.9%). Seroma occurred in 10 patients (9.3%). Wound dehiscence occurred in 2 patients (1.9%). Elective revision rate was 3/107 (2.8%). One patient had acute reoperation due to major hematoma (0.9%). Compared with eleven studies of pooled historical outcomes of patients with drain placement, analysis revealed the drainless group had significantly higher rates of seroma (p = 0.003353), but significantly lower rates of revision (p = 1.37x10-12). Aggregation of our data with two past drainless studies was compared to the eleven drain inclusive studies, revealing significantly lower rates of hematoma (p = 0.001069), nipple areola complex necrosis (p = 0.01034), and revision (p = 2.20x10-16). ConclusionSimplified, drainless, outpatient double incision free nipple graft bilateral mastectomy can be performed with comparable outcomes to historical data.