You may be considering FTM or FTN top surgery in order to effectively address your gender dysphoria.
Or, you might have already successfully undergone a gender affirming mastectomy and your life now has been positively transformed.
Either way, an important health consideration that you should be aware of going forward is if there is a possibility of developing breast cancer in the future despite the fact that you have had a mastectomy.
This may or may not have been discussed by your plastic surgeon. Perhaps, you heard something vaguely about this from someone else or came across this topic online.
So, is there a still risk of developing breast cancer after a gender affirming mastectomy?
If so, what is that risk?
Are transmen and gender nonbinary individuals frequently diagnosed with breast cancer?
Let’s look into this a little bit more.
Can you develop breast cancer despite having had a mastectomy?
Top surgery entails the removal of breast tissue – a procedure that is called a mastectomy. This is the same name of the procedure that is employed in the treatment of breast cancer. However, there are some significant differences.
With the mastectomy performed for the treatment of breast cancer, all breast tissue is removed, leaving skin that is generally thin and with contour irregularities which frequently creates varying degrees of chest wall concavities. This outcome is considered to be acceptable as its purpose is for the treatment of a cancer which can be life threatening.
In comparison, the mastectomy performed for gender dysphoria needs to be considered an aesthetic procedure in addition to a therapeutic one. This means that the chest wall has to look as natural as possible. Defects and deep indentations must be avoided. Consequently, a small amount of breast tissue may remain to allow for a natural, desirable chest wall contour.
It is this residual breast tissue that can be susceptible to malignant degeneration at a later time.
Is it common to develop breast cancer after top surgery?
It appears that the occurrence of breast cancer in individuals who have had either FTM or FTN top surgery is relatively rare and far less common than the rate seen in cisgender women. However, truly accurate numbers are not presently available for many reasons.
Rates that have been publicized are largely based on imperfect data culled from multiple retrospective published studies. This can offer generalities but not highly reliable numbers.
Intuitively, you would think that by removing virtually all of the breast tissue, the risk for developing breast cancer would be markedly reduced.
And you would be right.
In fact, this is the basis and logic of the procedure known as a prophylactic mastectomy where the breasts are removed in women who are at a very high risk of being diagnosed with breast cancer in the future. A study published years ago determined that this procedure reduces the risk of developing breast cancer in women who have a strong family history of this disease by 90% (1).
There is also evidence that taking testosterone may also reduce the risk of developing breast cancer. Studies have shown the positive effects of testosterone at the cellular level in breast tissues of transmen that appear to support this.
What is the actual risk of developing breast cancer after top surgery?
There is no highly accurate data detailing the risk of developing breast cancer after undergoing FTM or FTN top surgery. What information that is available is based on a combination of multiple previously published papers that have many uncontrolled variables and limited information.
These variables, however, are very important in order to obtain quality data.
Nevertheless, there are numbers that at least can provide us with some perspective of the risk and relative risk of developing breast cancer as compared to cisgender females and cisgender males.
Gooren et al (2) conducted a retrospective study evaluating the incidence of breast cancer occurring in transmen and transwomen who were receiving hormonal treatment for their gender identity. From what could be ascertained, few if any of these individuals had undergone gender affirming top surgery. The results of this study were published in the Journal of Sexual Medicine in 2013 (2).
Based on this information, it was determined that the incidence of developing breast cancer in these transmen was 5.9 per 100,000 person-years.
The comparative the risk for cisgender women was 154.7 per 100,000 person-years.
For cis-gender men, that risk was 1.1 per 100,000 person years.
Based on these numbers, the risk of developing breast cancer in transmen and gender nonbinary individuals is massively reduced. It is only a very small fraction of the risk facing cisgender women.
In fact, the risk is quite close to that of cisgender men.
It is also important to note that this study involves a cohort of transmen who have not had top surgery – a procedure that we know will reduce the risk of developing breast cancer.
Consequently, the actual risk for transmen will be even lower than the above cited number – approaching the rate experienced by cisgender men.
This is big!
What are some factors that can affect your risk of developing breast cancer?
Personal factors and other variables can affect your overall risk of developing breast cancer after top surgery. These can increase or decrease it from the already generally very low rate.
Some of the positive and negative influences on the risk of developing breast cancer after top surgery include:
• Age when you had top surgery
• Family history of breast cancer
• Genetic markers for breast cancer
• Whether or not you are taking testosterone
• If taking testosterone, for how long?
• Dosage of testosterone
• Whether or not you are taking estrogen suppressors and for how long
• Whether or not you had your ovaries removed (oophorectomy) and at what age
• Lifestyle factors
• Presence and amount of residual breast tissue
Key Takeaway Points on Having Breast Cancer after Top Surgery
Based on present and past information, the occurrence of breast cancer in transmen (and likely gender nonbinary individuals) is extremely low. In fact, it appear to be very close to the rate experienced by cisgender men.
Going forward, hopefully, we will not only be able to more accurately determine the rate of occurrence of breast cancer after FTM and FTN top surgery but also identify the important risk factors such as a family history of breast cancer.
This can better help in making surveillance recommendations to those transmen and gender nonbinary individuals who have had top surgery.
Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona
1. Hartmann LC, Schaid DJ, Woods JE, Crotty TP, Myers JL, Arnold P, et al. Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med 1999;340(2):77-84
2. Gooren BJ, van Trotsenburg MA, Giltay EJ, et al. Breast cancer development in transsexual subjects receiving cross-sex hormone treatment. J Sex Med 2013; 10: 3129-34