Breast Cancer Screening Considerations for Transgender Patients Undergoing Chest Surgery: Evidence Review and Suggested Approaches

Summary: This article reviews current practices and challenges in breast cancer screening for transgender individuals undergoing gender-affirming chest surgery, highlighting the unique role of plastic surgeons in long-term oncological care. As masculinizing mastectomies become more common, concerns persist regarding residual breast tissue and cancer risk. Although surgery substantially reduces risk—comparable to the protective effect of reduction mammaplasty in cisgender women—it does not eliminate risk entirely, as 1%–2% of breast tissue typically remains. Patient-driven aesthetic decisions may further influence oncological risk and complicate imaging, underscoring the importance of patient education and ongoing surveillance. The effects of exogenous hormones on breast cancer risk remain incompletely defined. Feminizing hormone therapy, family history, and obesity are established risk factors in cisgender women, but their independent contribution to risk in transgender women remains under investigation. Patients with genetic predisposition or strong family history should be referred to breast oncology specialists for individualized risk assessment. Systemic barriers—including delayed initiation of imaging, limited primary care–based risk assessment, and inconsistent insurance coverage—position plastic surgeons to address critical gaps in care. Recommended practices include annual clinical chest examinations for transgender men following mastectomy, continuation of age-appropriate screening for transgender women on long-term estrogen therapy, and routine documentation of counseling and referrals to ensure continuity of care. By integrating epidemiological data, practice surveys, and surgical considerations, this article provides a distinct specialty perspective and calls for interdisciplinary collaboration to establish evidence-based screening protocols for this growing patient population.