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Introduction <p>The preoperative plan is crucial in chest-wall contouring surgery. Choosing the right surgical technique may be challenging, especially when there are many variables to consider.</p> <p>Therefore, the senior author (GLR) described a novel and simpler preoperative algorithm which we used in our group of 560 trans-AFAB patients.</p> Methods <p>From 2016 to 2024, 560 consecutive trans-AFAB patients underwent top surgery with the new algorithm that uses the inferior border of pectoralis major muscle as a landmark to decide between three techniques: (1) Periareolar incision (PA), when the NAC is on the landmark, (2) hemi-periareolar incision (HP), when the NAC is above the landmark, and (3) double-incision technique with free nipple graft (DI) when the NAC is below the landmark.</p> <p>Complications, need for a touch-up, scar quality (through the Vancouver Scar Scale) and patient-reported outcomes (through TRANS-Q questionnaire) were analyzed.</p> Results <p>The most used technique was DI (82.4%) followed by HP (11.4%) and PA (6.2%).</p> <p>Hematoma occurred in 10.8% of the patients but only 1.7% needed a reintervention in the operating room.</p> <p>We performed a touch-up procedure in 9% of the patients. The most prevalent VSS score was 1 registered in 38.4% of patients.</p> <p>The TRANS-Q questionnaire revealed that the large majority of patients showed an improvement after surgery (<i>p</i> value: 1.41 × 10<sup>-16</sup>).</p> Conclusion <p>This simple but effective new algorithm can support surgical choices and maximize the aesthetic outcomes in trans-AFAB patients’ chest-wall contouring.</p> <p>High patient satisfaction and good surgical outcomes evidence the efficacy of this algorithm.</p> Level of Evidence V <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>

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A New Algorithm for Masculine Chest-Wall Contouring in 560 Trans-AFAB (Assigned Female at Birth) Patients: Clinical Outcomes and Patient-Reported Satisfaction Using the TRANS-Q Questionnaire

  • 期刊论文

  • 发表日期：

    2025年5月28日

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  • Giulia Lo Russo,
  • Leonardo Scortecci,
  • Francesca Ruccia,
  • Ankur Khajuria,
  • Leonardo Gada

摘要

Introduction

The preoperative plan is crucial in chest-wall contouring surgery. Choosing the right surgical technique may be challenging, especially when there are many variables to consider.

Therefore, the senior author (GLR) described a novel and simpler preoperative algorithm which we used in our group of 560 trans-AFAB patients.

Methods

From 2016 to 2024, 560 consecutive trans-AFAB patients underwent top surgery with the new algorithm that uses the inferior border of pectoralis major muscle as a landmark to decide between three techniques: (1) Periareolar incision (PA), when the NAC is on the landmark, (2) hemi-periareolar incision (HP), when the NAC is above the landmark, and (3) double-incision technique with free nipple graft (DI) when the NAC is below the landmark.

Complications, need for a touch-up, scar quality (through the Vancouver Scar Scale) and patient-reported outcomes (through TRANS-Q questionnaire) were analyzed.

Results

The most used technique was DI (82.4%) followed by HP (11.4%) and PA (6.2%).

Hematoma occurred in 10.8% of the patients but only 1.7% needed a reintervention in the operating room.

We performed a touch-up procedure in 9% of the patients. The most prevalent VSS score was 1 registered in 38.4% of patients.

The TRANS-Q questionnaire revealed that the large majority of patients showed an improvement after surgery (p value: 1.41 × 10-16).

Conclusion

This simple but effective new algorithm can support surgical choices and maximize the aesthetic outcomes in trans-AFAB patients’ chest-wall contouring.

High patient satisfaction and good surgical outcomes evidence the efficacy of this algorithm.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.