Masculinizing chest surgery outcomes by body mass index and American Society of Anesthesiologists class in ambulatory care.

Abstract

Masculinizing chest surgery improves quality of life, though access is often restricted based on body mass index. Centers of excellence in gender-affirming surgery have begun developing perioperative practices to increase safety among high-risk patients. We aimed to compare postoperative complications among patients receiving masculinizing chest surgery based on body mass index (BMI) and American Society of Anesthesiologists (ASA) class, and to suggest a perioperative protocol to manage these patients in ambulatory facilities. We conducted a retrospective chart review of patients receiving masculinizing chest surgeries (full mastectomies and breast reductions) between August 2021 and October 2024 from one surgeon at an ambulatory facility with a center of excellence in gender-affirming surgery. Patients without postoperative follow-up or height/weight data (2/532) were excluded. Perioperative management and postoperative complications occurring by one-year postoperatively were compared based on body mass index, per the World Health Organization categories, and American Society of Anesthesiologists classes via the Chi-squared test and a multivariable logistic regression. In total, 530 individuals aged 15-66 years with body mass index ranging 16.1-58.7 kg/m² were included. Notably, 22% of participants experienced a complication ranging from Grades I to IIIb on the Clavien-Dindo scale. There were no significant differences in Grades I, II, IIIa, or IIIb complications between the BMI or ASA groups. After adjusting for age and smoking, compared to participants with BMI <25.0 kg/m², no BMI group had higher odds of experiencing postoperative complications. Compared to patients in ASA Class I, controlling for age, participants in ASA II and III/IV did not have higher odds of experiencing postoperative complications. There was no difference in the rate or odds of postoperative complications after masculinizing chest surgery based on body mass index or American Society of Anesthesiologists class, suggesting appropriate perioperative protocols may allow patients at higher-risk to access this procedure in ambulatory facilities.