Age and surgical outcomes in gender-affirming mastectomy. A 12-year institutional review

Abstract

Background: Gender-affirming mastectomy is the most frequently performed surgical procedure among the transmasculine population. This study evaluates surgical outcomes over a 12-year study period and examines associations between changing patient demographics and surgical results. Methods: A retrospective chart review of all gender-affirming mastectomies between January 2011 and December 2022 was performed. Postoperative outcomes included complications and revision rates over time. Multivariable logistic regression models were performed to assess the association between patient age and postoperative complications and revision surgery, adjusting for clinically relevant confounders. Results: A total of 258 patients were included, with a median age of 24 years (range 16–61 y). During the study period, surgical volume increased, accompanied by a notable trend toward younger patients. Overall complication and revision rates were 15.1% and 22.8%, respectively, and both declined significantly over time. Despite these concurrent trends, we did not observe a significant association between patient age and postoperative complications or revision surgery. After multivariable adjustment, year of surgery remained the only variable independently associated with a reduced risk of postoperative complications (odds ratio 0.89, P = 0.040) and revision surgery (odds ratio 0.88, P = 0.009). Conclusions: In this single-institution cohort, we did not observe a significant association between patient age and postoperative complications or revision surgery following gender-affirming mastectomy. Improvements in surgical outcomes were related to year of surgery, likely a reflection of cumulative procedural refinement and evolving patient selection based on increasing institutional experience in gender-affirming care over time.