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Vanessa Mroueh, MD
Pronouns
She/Her/Hers
Job Title
Post-doctoral Research Fellow
Academic Rank
Research Fellow
Department
Surgery
Authors
Vanessa Mroueh MD, Erik Reiche MD, Patrick R Keller MD, Visakha Suresh MD, Jessica Mroueh MD, Calvin Schuster BS, Vance Soares MSE, Devin Coon MD MSE
Principal Investigator
Devin O'Brien Coon
Research Category: Women's Health, Sex-Differences and Gender Biology
Tags
Intro: Chest masculinization surgery (CMS) is associated with hypertrophic scarring and can lead to reduced patient quality of life and need for revision surgery.
Specific Aims: Given our clinical observations and prior animal data suggesting that testosterone (T) negatively affects wound healing, we hypothesized that T is associated with worse clinical healing and scarring after CMS.
Methods: 152 patients who have undergone either double incision mastectomy +/- free-nipple graft (DIFNG) or keyhole/circumareolar mastectomy (KC) were enrolled in an IRB-approved prospective registry from 2017-2022. Data regarding patient demographics, exogenous hormone regimen (type, dose, preoperative T levels), scarring co-morbidities, procedural details and complications were collected. Scars were assessed by four blinded clinicians using Manchester Scar Scale and SCAR scale using photos taken at early, mid, and late timepoints (2-4 weeks; 5-12 weeks; >12 weeks). Scores on every scar were averaged for each scale and subscale. T-tests and Pearson correlations were used to look for association between scale/subscale mean scores and pre-op T levels/weekly T dose.
Results: 66% were of the white race, 90% identified themselves as male, 90% were on exogenous T. MSS contour and SCAR palpability were positively correlated with increasing weekly dose of T (r=0.2, p-value=0.034 and r=0.234, p-value=0.013 respectively). Patients who had high preop T level (>500) AND high weekly T dose (>50) had a higher mean score on SCAR palpability subscale (x̅ = 1) and SCAR overall impression subscale (x̅ = 0.458) compared to patients in the low preop T (<500) AND low weekly T dose (<50) group (x̅ = 0.469 and x̅= 0.188, respectively) with a p-value of 0.038 and 0.047, respectively.
Conclusion: T might be associated with hypertrophic scarring after CMS in transgender patients.
Intro: Chest masculinization or top surgery is associated with overgrowth scarring and can lead to reduced patient quality of life and need for revision surgery.
Specific Aims: Given our clinical observations and prior animal data suggesting that testosterone negatively affects wound healing, we hypothesized that testosterone is associated with worse clinical healing and scarring after top surgery.
Methods: 152 patients who have undergone top surgery from 2017-22 were enrolled in this study. Information about patient demographics, type and dose of testosterone used, preoperative testosterone levels, conditions that predispose to worse scarring, procedural details and complications were collected. Scars were assessed by four clinicians using two known scar assessment tools (MSS and SCAR scales) using photos taken at early, mid, and late postoperative timepoints. Scores on every scar were averaged for each scale and subscale and tested to look if high or low pre-operative testosterone levels/weekly testosterone dose led to different scores, which echo how the scars look.
Results: Most patients were of the white race, identified themselves as male, and were taking testosterone. Increasing dose of testosterone showed higher scores on MSS contour subscale that describes the contour of the scar, and SCAR palpability subscale that describe how visible the scar is. Patients who had high preoperative testosterone level AND high weekly testosterone dose had a higher score on SCAR palpability and SCAR overall impression compared to patients who had low preoperative testosterone AND low weekly testosterone dose.
Conclusion: Testosterone might be associated with worse scarring after top surgery in transgender patients.
