SP51. Hypertrophic Scarring Following Gender Affirming Chest Masculinization Surgery: Risk Factors and Clinical Impact on the Patient

PURPOSE: Hypertrophic scarring is a significant complication of gender-affirming chest masculinization surgery (GACMS), impacting both aesthetic outcomes and patient well-being. These raised, thickened scars can lead to functional limitations and emotional distress, diminishing satisfaction with the surgery and undermining its affirming nature. Scar management often involves ongoing follow-up, including corticosteroid injections or, in more severe cases, revisional surgery—prolonging recovery, increasing healthcare costs, and adding emotional and physical burdens. Although risk factors for hypertrophic scarring, such as elevated BMI, smoking, age, are well-documented in other surgical fields, there is limited research specific to GACMS. This study aims to identify patient-specific and procedural risk factors for hypertrophic scarring and its clinical impact in this unique context, with the goal of optimizing postoperative outcomes and quality of life for transgender and gender-diverse individuals undergoing chest masculinization. METHODS: A retrospective chart review was conducted at a single institution, examining all patients who underwent GACMS between February 2020 and July 2023. Patient data were collected from electronic medical records, including demographic information, relevant comorbidities, type of chest masculinization procedure performed, and postoperative complications. Specific focus was placed on the incidence of hypertrophic scarring, along with scar management techniques, and revision rates.Data was analyzed using IBM’s SPSS software. Independent t-tests were performed to assess the association between potential risk factors and the development of hypertrophic scarring. A multivariate logistic regression analysis was conducted to identify hypertrophic scarring’s impact on unplanned revision surgery. Statistical significance was set at p < 0.05 for all analyses. RESULTS: A total of 214 patients who underwent GACMS between February 2020 and July 2023 were included in the analysis. There were 66 cases of hypertrophic scarring or keloid formation. Among those with postoperative wound infections, 54.5% developed hypertrophic scarring, compared to 29.6% of patients who did not experience infections. Smokers had a hypertrophic scarring rate of 43.5%, while past or never smokers had a rate of 29.3%. However, these differences did not reach statistical significance (p=0.081, p=0.17). Similarly, current hormone replacement therapy (HRT) use was not found to be significantly associated with hypertrophic scarring (p=0.31). Patients who underwent the double incision technique had a significantly higher rate of hypertrophic scarring compared to those who had the periareolar technique (p=0.03). A total of 44 patients in the entire cohort underwent revision. Multivariate analysis, controlling for smoking status, age, and BMI, revealed that patients with hypertrophic scarring were 2.2 times more likely to undergo revision than those without hypertrophic scars (p=0.03). CONCLUSION: This study found that the double incision technique was significantly associated with an increased risk of hypertrophic scarring in gender-affirming chest masculinization surgery (GACMS), while comorbidities and demographic variables were not statistically significant factors. Patients with hypertrophic scarring were more than twice as likely to undergo revision. Based on the long-term impact hypertrophic scarring has shown to have in this study, further research is needed to confirm and better understand risk factors for hypertrophic scarring in this patient population.