September 04, 2026 | Uncategorized
“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 told MDLinx in August. A patient had asked me last year whether he still needed a mammogram. He had finished his chest masculinization surgery and somebody had told him the question was behind him now. It was not.
MDLinx had called about a JAMA Network Open cohort of 112 transgender, nonbinary, and gender-diverse patients with breast cancer. Only 51.8 percent had a mammogram in the ten years before diagnosis. In 13.4 percent, the cancer was found by accident, in tissue removed during chest masculinization.
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.”
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.”
A cancer operation is planned around margins. I am planning around contour and nipple position, so a thin layer stays on purpose.
The same article cites a 2025 JAMA Oncology analysis: these patients were about 50 percent less likely to get endocrine therapy and roughly 80 percent less likely to get postmastectomy reconstruction. No technique of mine fixes that.
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 it to tell anybody much. I want the genetic question answered before I operate, not after.
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, on every case. That 13.4 percent exists because somebody put the tissue in a jar and walked it down the hall. If you have had the surgery, ask what your pathology report said. If you are planning it, ask whether your surgeon sends everything he removes.
Ready to Talk?
If you are considering chest masculinization, or you have had it and want a clear plan for what your screening should look like now, come talk to me. Call the office at (915) 590-7900, text 1-866-814-0038, or book a consultation at https://www.agulloplasticsurgery.com/appointments/.
#StayBeautiful
@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
