D101. An Analysis Of Gender-affirming Breast Augmentation Access and Outcomes: A Comparative Study between a Safety Net Hospital and an Academic Medical Center

PURPOSE: We compared patients undergoing gender-affirming breast augmentation at San Francisco General Hospital (SFGH), a safety net county hospital, and the University of California, San Francisco (UCSF), an academic medical center. METHODS: We reviewed patients who underwent primary gender-affirming breast augmentation at SFGH from August 2019 to June 2023 (n = 73) and at UCSF from March 2015 to June 2023 (n = 122). Pearson's chi-squared, Fisher's exact, and Student's t-tests were used to assess differences in sociodemographic characteristics, surgical access, and outcomes between SFGH and UCSF patients. RESULTS: SFGH patients were more likely to be unstably housed (p = 0.000), Spanish-speaking (p = 0.001), and to have HIV infection and obesity (both p's < 0.05). SFGH patients used hormones for longer (p = 0.000) but had shorter referral-to-surgery intervals (p = 0.024). Surgical complications were uncommon (6.7%). SFGH patients had more surgical site infections (p = 0.028). Aesthetic complications occurred in 27.2% of patients, the most common being implant asymmetry (15.9%). UCSF patients had longer follow-up periods (p = 0.001). CONCLUSION: Given their lengthier pre-surgical hormone treatment duration, SFGH patients might experience greater barriers that delay their eligibility for surgery. Nevertheless, established patient navigation services at the county may explain their shorter referral-to-surgery intervals. More work is needed to improve follow-up among underserved patients and to discern additional factors influencing outcomes of this procedure.