Subcutaneous mastectomy in female-to-male transsexuals: Optimizing perioperative and operative management in 8 years clinical experience

The incidence of complications, especially acute hematoma requiring surgical revision in female-to-male transsexuals (FTMTS), is consistently highly documented in literature with up to 33%. Since 2008 we perform subcutaneous mastectomies in FTMTS with an annually increasing number of cases. Due to an initially high hematoma revision rate in the previously published cohort (2008–2013), we implemented peri- and postoperative preventive measures and compared the results with the recent patient cohort (2014–2016). The records of 356 patients (712 mastectomies) were retrospectively reviewed. We compared the first cohort (C1, 01/2008 - 12/2013, 346 mastectomies; peri- and postoperative standard procedure and implementation of an algorithmic care path in our institution) with the recent cohort (C2, 01/2014 - 01/2016, 366 mastectomies) and introduced in C2 the following preventive measures: perioperative administration of tranexamic acid, intraoperative elevation of blood pressure to at least 120 mmHg before wound closure, bedrest and consequent wearing of compression bandage without removal 12 hours postoperatively. Comparison of complication rate, patient satisfaction and secondary revision rate was obtained in both cohorts. The mean operation time could be reduced from 103.6 minutes to 72.5 minutes (p