Combining total laparoscopic hysterectomy and bilateral salpingo-oophorectomy with subcutaneous mastectomy in trans men: The effect on safety outcomes

Abstract

Background: Masculinizing mastectomy is the most requested gender affirming surgery (GAS) in trans men, followed by genital GAS. Mastectomy and total laparoscopic hysterectomy, with or without bilateral salpingo-oophorectomy (TLH?±?BSO), can both be performed in one single operation session. However, data on complication rates of the combined procedure is scarce and no consensus exists on the preferred order of procedures.

Aims: To compare safety outcomes between mastectomy performed in a single procedure with those when performed in a combined procedure and assess whether the order of procedures matters when they are combined.

Methods: A retrospective chart review was performed of trans men who underwent masculinizing mastectomy with or without TLH?±?BSO in a combined session. The effects of the surgical procedure on complication and reoperation rate of the chest were assessed using logistic regression.

Results: In total, 480 trans men were included in the study. Of these, 212 patients underwent the combined procedure. The gynecological procedure was performed first in 152 (71.7%) patients. In the total sample, postoperative hematoma of the chest occurred in 11.3%; 16% in the combined versus 7.5% in the single mastectomy group (p?=?0.001). Reoperations due to hematoma of the chest were performed in 7.5% of all patients; 10.8% in the combined versus 4.9% in the single mastectomy group (p?=?0.017). The order of procedures in the combined group had no significant effect on postoperative hematoma of the chest (p?=?0.856), and reoperations (p?=?0.689).

Conclusion: Combining masculinizing mastectomy with TLH?±?BSO in one session was associated with significantly more hematoma and reoperations compared with separately performing mastectomy. This increased risk of complications after a combined procedure should be considered when deciding on surgical options. The order of procedures in a combined procedure did not have an effect on safety outcomes.     

THE PAST,PRESENT, AND FUTURE ALL MATTER: HOW TIME PERSPECTIVE IS ASSOCIATED WITH OPTIMISM AND SENSATION SEEKING AMONG YOUNG ADULTS

We used a multidimensional model of time perspective to examine how feelings and thoughts about the past, present, and future were related to optimism and sensation seeking among young adults. The dimensions of time perspective assessed were time feelings, the positive and negative emotions one has about the past, present, and future; time frequency, the amount of thinking about each time period; and time orientation, the relative emphases toward the time periods. Optimism and sensation seeking were self-reported and participants included 463 young adults. Variable-based analyses indicated that reporting more positive and less negative feelings about the time periods or emphasizing the present and future simultaneously were associated with greater optimism. For sensation seeking, boredom susceptibility was especially associated with the time perspective dimensions. Person-centered analyses based on time feelings and time frequency yielded four profiles (i.e., Mindful, Discontent, Bleak, and Indifferent) that were associated with both optimism and sensation seeking.     

A CONSTRUCT MATURES: TIME PERSPECTIVE’S MULTIDIMENSIONAL,DEVELOPMENTAL, AND MODIFIABLE QUALITIES

Human development approaches to time perspective that are life-span and include multiple developmental periods are largely lacking in the literature even though the topic has received wide attention from many scholars. Extant studies have focused on specific age groups or have compared younger and older adults. This introduction addresses these issues and provides on overview of the multidimensional, developmental, and modifiable qualities of time perspective. The four contributions focus on distinct age groups including adolescents, young adults, middle-aged adults, and older adults. The papers comprised several conceptualizations of time perspective, diverse participants, and age-specific outcomes. Collectively, this work sets the stage for the next era of age-related research on time perspective.