Preoperative Breast Cancer Screening Before Chest Masculinization Surgery
PREOPERATIVE breast cancer screening before chest masculinization surgery helped identify malignancy and improve surgical planning.
New data suggest preoperative imaging can play an important role before chest masculinization surgery, particularly when risk factors or clinical concerns are present. In a retrospective review of 368 adults who underwent gender affirming chest masculinization surgery between January 2017 and September 2024, investigators examined how often imaging was recommended, why it was ordered, what it found, and whether it changed management.
Most patients were younger than 40 years of age, with a mean age of 27.2 years. Preoperative breast imaging was recommended in 11.7% of the cohort and ultimately performed in 11.1%. Screening mammography was the most commonly used modality, followed by diagnostic mammography, MRI, and ultrasound.
Breast Cancer Screening Findings and Surgical Planning
The main reasons for imaging were age, family history, physical examination findings, and BRCA2 mutation status. Irregular findings were reported in 17.1% of those who underwent imaging. Malignancy was confirmed in 2 patients, representing 4.9% of the imaged group and 0.5% of the full cohort.
An additional patient who did not undergo preoperative imaging was later found to have invasive ductal carcinoma on postoperative pathology. Altogether, 3 perioperative breast cancer diagnoses were identified, corresponding to 0.8% of the total study population.
These findings had direct implications for care. Detecting malignancy before surgery changed operative planning and helped avoid the need for additional postoperative procedures. Notably, preoperative imaging did not appear to delay access to surgery. Median time to surgery was 3.1 months among patients who underwent imaging versus 3.7 months among those who did not, with no significant difference.
Toward Standardized Preoperative Imaging
The authors argued that the absence of standardized preoperative breast imaging guidance before chest masculinization surgery has contributed to inconsistent, surgeon dependent practice. Their findings suggest that a more structured decision making approach could improve consistency, support risk based screening, and better align surgical planning with oncologic findings.
Overall, the study supports the use of a preoperative screening algorithm to guide imaging decisions before chest masculinization surgery, helping clinicians identify malignancy without introducing meaningful delays to care.
Reference
Schuster CR et al. Preoperative breast cancer screening before chest masculinization surgery. Breast Cancer Research and Treatment. 2026;217(2):27.
Featured Image: Drazen on Adobe Stock.
