“Chest masculinization significantly reduces the risk of breast cancer. It is not a mastectomy. Some breast tissue (around 5%) is left behind. These patients can still develop breast cancer later on. Screening should continue, but it changes. Imaging is often not indicated. Rather, annual chest exams and self-chest exams are the norm.”
That is what I gave MDLinx on August 12, in a piece by Alpana Mohta, MD, about a multicenter cohort in JAMA Network Open. The study followed 112 transgender, nonbinary, and gender-diverse patients who developed breast cancer. Only 51.8 percent had a mammogram in the ten years before diagnosis. And 13.4 percent of those cancers were found by accident, sitting in tissue removed during chest masculinization surgery.
The line I keep coming back to is that barely half of them had ever had a mammogram.
Q: How do you frame breast cancer risk with patients considering chest masculinization?
“I tell my patients that although the risk of breast cancer decreases after chest masculinization, it does not go away 100 percent, because the surgery that we do is for aesthetics, and there is some breast tissue left behind.”
Q: How is the procedure different from an oncologic mastectomy?
“It’s not the same as a full mastectomy for oncologic reasons, but it is a mastectomy. We have to leave some breast tissue behind to avoid contour irregularities, and there’s often some axillary breast tissue that can be left behind.”
They are two operations on the same organ doing different jobs, because the cancer surgeon is chasing margins while I am building a chest my patient has to live in for the next fifty years, which means a thin layer stays behind and the armpit keeps its share as well.
Q: What screening do you recommend after surgery?
“After surgery, patients no longer need to have mammograms done every year. It’s more of a clinical self-exam and yearly exam procedure. Of course, on higher-risk patients, we may modify the screening for higher risk.”
“Higher-risk patients are those with a family history or positive genetic testing.”
A mammogram needs a breast to compress, and there is not enough left for the machine to do anything useful with. Which is why I want the genetic question answered before surgery, not after.
Q: When and how does this conversation happen in your practice?
“This is something that we bring up during consultation and in the post-op visits. We also send the tissue to pathology after the surgery, to make sure that there were no tumors or lesions, and to identify any findings that would indicate a higher risk for the patient.”
Every specimen goes, without exceptions, and that 13.4 percent is the reason why. Those cancers were found because somebody actually looked at the tissue, and in the other version of the story the specimen goes in the bin and the diagnosis waits a few years to introduce itself.
The same article cites a 2025 JAMA Oncology analysis: these patients were roughly 50 percent less likely to receive endocrine therapy and about 80 percent less likely to receive postmastectomy reconstruction than cisgender patients. No surgical technique fixes that one, and my own view is that a clinician who fumbles the terminology but keeps the patient in the room is doing better than one who says nothing at all.
If you have had the surgery, ask what your pathology showed. If you are planning it, ask whether your surgeon sends every specimen.
Ready to Talk?
If you want a straight conversation about chest masculinization, or about what your screening should look like now that you have had it, come see me. Office (915) 590-7900, text 1-866-814-0038, or book at https://www.agulloplasticsurgery.com/appointments/.
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