Purpose: Gender-affirming mastectomy (top surgery) treats gender dysphoria and provides a gender congruent chest for transgender male and non-binary patients. Close-suction drains are commonly utilized to mitigate seromas. However, drains may increase scarring, pain, and number of clinic visits. This study aims to evaluate clinical outcomes and adverse events in patients undergoing drainless top surgery.
Methods: An IRB approved retrospective chart review was performed on a series of 20 patients who underwent bilateral drainless top surgery between 2021 and 2022. In the surgical approach, quilting sutures were used to anchor the mastectomy flaps and eliminate the dead space. Age, BMI, smoking status, diabetes, mastectomy specimen weights and post operative pain measurement were curated. Two sample t-test and Fishers exact test was used to assess significance in risk factors and adverse events.
Results: The follow up period ranged from 3 - 12 months. Among this cohort there was one major complication (pulmonary embolism requiring anticoagulation therapy) and two minor complications (surgical site cellulitis resolved with antibiotics, small self-resolved hematoma. There were no seromas or reoperations. The average BMI and age of these patients were 31.59 ± 5.30 and 25.45 ± 5.74 years old, respectively. There was no significant difference in demographic data, medical comorbidities or mastectomy weight in patients who had major or minor complications versus those who did not (p>0.05).
Conclusion: Gender affirming top surgery is not without risk. However, our results showed no increased risks of complications in a drainless approach compared to published studies utilizing drains. Further, a drainless approach may decrease postoperative pain and increase patient satisfaction.