Early and Late Surgical Complications After Gender-affirming Mastectomy in Predominantly Young Adults: A Single-center Cohort Study.

BACKGROUND: Gender-affirming mastectomy (GAM) is generally associated with low morbidity and high patient satisfaction. Nevertheless, postoperative complications may occur, including seroma, hematoma, nipple necrosis, and hypertrophic scarring. This study reviews their incidence and management in a single-center cohort predominantly composed of young adult patients undergoing GAM. METHODS: Between May 2021 and June 2025, GAM was performed in 100 patients. Outcomes of patients with and without complications were compared to evaluate differences in surgical technique and treatment strategies. RESULTS: All patients were followed up for at least 6 months. Complications and sequelae occurred in 25 patients and were classified as early versus late and surgical versus aesthetic. Only 2% required immediate revision for postoperative hematoma. Seroma (9%) was the most frequent complication, whereas scar revision was the most common sequela. Overall, 99% did not require readmission, and most issues were managed on an outpatient basis; minor revisions were done under local anesthesia. One patient developed a major respiratory complication requiring transfer for supportive care. None reported postoperative regret during the scheduled follow-up visits at 3 and 12 months, and no patient underwent reversal surgery. CONCLUSIONS: GAM demonstrated a low complication rate, with most issues being minor, easily managed, and not requiring increased procedural costs. These findings provide practical guidance for clinicians caring for patients before and after surgery, underscoring the procedure's safety and range of potential complications.