A single link to the first track to allow the export script to build the search page
  • Friday, June 17, 2016
  • 0706-000726 THE BARRIERS TO, AND EXPERIENCE WITH BREAST SURGERY (MASTECTOMY) IN THE GENDER MANAGEMENT CLINIC IN SAN DIEGO CALIFORNIA, FOR TRANSGENDER PATIENTS UNDER AGE 21

    June 19, 2016 10:09 AM - June 19, 2016 10:21 AM

    Garden Room

    • Maja Marinkovic, MD ;
    • Ron Newfield, MD

    Purpose

    For many transgender men, having a bilateral mastectomy and chest reconstruction is a very important step in the transitioning process. Guidelines from WPATH and Endocrine Society suggest age 16 years as an acceptable age for this type of surgical intervention.  In clinical practice, however, the decision depends on factors such as: patients’ desires, insurance coverage and availability of local surgical experts, to name a few. We present data about mastectomies in trans youth from our Gender Management clinic in San Diego.

    Materials and Methods

    This is a longitudinal, prospective, observational study. Data was collected from patients who attended the Gender Management clinic (GeM) from 10/2011 to 12/2015. All subjects in this study were consented and assented into an IRB approved clinical database.

    Results

    Out of more than 120 patients referred to our clinic, 94 were consented into an IRB approved endocrine database and most are followed prospectively. Among consented patients 59 were affirmed males, presenting to the clinic at an average age of 15.2 (range 5.1 to 19 years). Nine patients had a bilateral mastectomy at an average age of 17.1 years (range 13.5-19.7 years); two patients were under 16 years of age. Only four out of nine patients had the procedure covered by the insurance. Interestingly, our two youngest patients who had procedures performed without our referral at 13.5 and 14.7 years, both had their procedures paid by the insurance. All but one patient were on testosterone treatment and generally testosterone was not held prior to the procedure as per surgeons’ decision. Only three patients had the procedure done locally, while others sought care out of town, state and even in Mexico. All patients were satisfied with the surgical outcome. Many more of our patients wish to get breast/chest surgery but the lack of insurance coverage makes it cost prohibitive. 

    Conclusion

    A bilateral mastectomy is an important part of transitioning for many transmen. The patients’ age at the time of this surgical procedure varies greatly even within one center. Insurance coverage is unfortunately not always available and therefore many of our patients are unable to get necessary treatment unless they opt to pay out of pocket.




    Category: Pediatrics and Adolescent Health