PURPOSE: The majority of patients undergoing gender-affirming surgery pursue top surgery. Within this population, the development of cardiac arrhythmias has been reported in the literature. At our institution, there has been a noticeable occurrence of acute intraoperative bradycardia in gender-affirming mastectomy patients. This study aimed to describe the frequency of acute intraoperative bradycardia in patients undergoing gender-affirming mastectomies and identify potential risk factors that contribute to its occurrence.
METHODS: A retrospective review was performed for all patients who underwent gender-affirming mastectomy at a single institution. Demographic, comorbidity, and intraoperative data were collected. Patients were separated into those who did and did not develop acute intraoperative bradycardia. The definition of intraoperative bradycardia was any patient whose heart rate dropped below 60 beats per minute. Logistic regression was performed to determine which variables were predictive of intraoperative bradycardia.
RESULTS: 337 patients underwent gender-affirming mastectomy between January 2018 and 2023. Of these patients, 144 (42.7%) experienced acute intraoperative bradycardia, with 97 (67.4%) requiring anesthetic intervention and 5 (3.5%) requiring halting of surgery. Two patients (1.4%) needed compressions for asystole. Fluoxetine (OR: 2.63, p= 0.002) and harvest of a nipple graft (OR: 2.77, p= 0.018) were associated with a significantly increased risk of developing intraoperative bradycardia.
CONCLUSION: Acute intraoperative bradycardia may be a unique phenomenon in patients undergoing gender-affirming mastectomies due to variables specific to this patient population and top surgery. A future study comparing patients undergoing gender-affirming top surgery to those undergoing elective breast surgeries is forthcoming to assess further contributing risk factors.