Background & Objectives:
Gender affirming chest surgery, (“Top surgery”) is an important component of transition for some members of the transgender population which can substantially improve gender incongruence and dysphoria. Publicly funded top surgery in the Northern region (Auckland, and Northland) is undertaken by the Plastic Surgery Department at Middlemore Hospital, Te Whatu Ora, Counties Manukau. The aim of this study is to evaluate the trend in top surgery in the department and its' impact on elective surgery resource.
Methods:
A retrospective review was undertaken over an 11-year period from the 1st January 2012 to 1st January 2023. Utilising local category surgery codes, 114 transgender cases referred to the Plastic Surgery Department at Middlemore Hospital for gender affirming chest surgery were identified. These cases were analysed to evaluate referral tends, patient demographics, service delivery, and health resource utilised. As well as post-operative complications.
Results:
Between 2011 and 2020 referrals to the Plastic Surgery Department at Middlemore Hospital for gender affirming chest surgery increased by 3.2 patients per year (P<0.01). Transmasculine patients comprised the vast majority of referrals (n=114, 95.6%). Median age at surgery was 26 years. The majority were European (n=77, 68%). Elapsed time from accepted referral to FSA, and FSA to primary surgery was 130.75 (95% CI; 116.50 – 145), and 234.90 (95% CI; 203.14 – 265.65) days respectively. Average number of procedures was 1.46 (95% CI; 1.31 - 1.60), and total operative time was 278 minutes (95% CI; 259.4 – 296.4) respectively per patient.
Conclusions:
The Plastic Surgery Department at Middlemore Hospital has experienced an increase in demand for top surgery amongst the transgender population. We expect this to continue to increase, in line with the increasing transgender population. This underscores the importance of developing a sustainable health-care delivery model to service this growing population group.