D99. The Effect of BMI on Postoperative Sensation Following Gender Affirming Mastectomy

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PURPOSE: Body mass index (BMI) as a threshold for surgical candidacy in gender affirming mastectomy is an evolving field of study. No study to date has examined the impact of BMI on restoration of sensation following reinnervation during this chest masculinization surgery. METHODS: A retrospective review was conducted on top surgery patients. Patients who received chest and/or the nipple areolar complex neurotization underwent pre and post operative sensation testing with Semmes-Weinstein monofilaments. Patients were grouped into normal or class 1-3 BMI (class I BMI 30.0-34.9, class II 35.0-39.9, class III >40.0). RESULTS: Of 61 patients, average BMI was 25.5±5.4 kg/m2 (range 18.8 to 49.8 kg/m2) and average age was 22±9.5 years. Obesity Class 1 patients(N=9) had worse sensation than patients with normal BMI (N=29) at 6 months at the inferior areola(p=0.01), and beyond 24 months at the medial breast(p=0.02). Obesity Class 3 patients (N=2)had worse sensation at 6 months at the inferior breast(p<0.01), and beyond 24 months at the nipple (p=0.01). There were no differences in total breast sensation for normal versus obese BMI groups at 6 months, 12-24 months, or beyond 24 months(p>0.05) when all tested sections were combined. Intraoperatively, BMI did not correlate with available nerves for reinnervation(R=0.169), and number of nerves used for reinnervation did not correlate with superior restoration of sensation (R=-0.143). CONCLUSION: Although BMI impacted initial restoration of sensation, it did not affect long-term results in the whole breast. Obesity status does not predict likelihood to restore sensation following reinnervation.

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