Post-mastectomy ultrasound is a crucial diagnostic tool in post-mastectomy care of transgender men, revealing important information about fluid collection, tissue healing, and the integrity of chest wall structures. By identifying possible complications, they support early interventions and optimal patient outcomes. They also provide a comfortable and effective alternative to mammography for long-term monitoring.
However, to provide optimal care, clinicians must work collaboratively with each other and each patient. Only then can they meet the unique needs of this patient population while guarding against potential implicit biases.
Assessing Complications
Post-mastectomy ultrasound can provide a detailed view of the post-surgical area, revealing important information about potential complications, including:
- Seromas: Seromas are most common post-mastectomy complication. These abnormal accumulations of fluid can increase the risk of infection and slow healing. Ultrasound scans can detect and measure seromas, and guide fluid aspiration if needed.
- Wound infection: Postoperative infections include cellulitis and abscesses, which ultrasound can detect, allowing for treatment before the infection spreads.
- Hematomas: A hematoma is a collection of blood at the surgical site. Small hematomas usually resolve on their own, but large or rapidly developing hematomas can cause pain, swelling, and skin discoloration. Ultrasound scans can detect and evaluate hematomas, and guide surgical intervention if necessary.
- Pain: Pain can have a variety of causes. For example, post-mastectomy pain syndrome, characterized by chronic neuropathic pain, can be caused by neuromas. These are abnormal nerve growths in the area where scar tissue and nerves intersect. Ultrasound can be used for neuroma evaluation. In addition, an ultrasound-guided nerve block can confirm the diagnosis and alleviate certain types of pain by injecting local anesthetic around the affected nerves.
By identifying these complications early, healthcare providers can initiate appropriate treatment strategies, thereby preventing further complications and promoting faster recovery. However, to make a correct evaluation, radiologists need to understand the ways hormone and surgical treatments affect imaging appearance and influence the risk for breast diseases.
Ultrasound Supports Long-Term Monitoring
Ultrasound can support monitoring well after recovery. Mammography compresses tissues, making a traditional mammogram uncomfortable for transgender men following a mastectomy. Ultrasound provides a potential alternative for breast cancer screening. However, transgender men who've had a mastectomy are at very low risk of breast cancer. In fact, there's little reliable evidence to guide the screening of trans men who have undergone a mastectomy.
Nevertheless, it's worth noting that sexual and gender minority patients with breast cancer may experience diagnosis and treatment delays. They also had a higher chance of cancer recurrence than non-LGBTQ+ patients, according to a 2022 study
Take a Collaborative Approach to Post-Mastectomy Care
A multidisciplinary approach is essential in post-mastectomy care and is especially critical for transgender men. They need a team of engaged and informed clinicians who understand their needs and provide quality care.
This requires active collaboration among surgeons, radiologists, primary care providers, and—most importantly—the patient. Direct and clear communication between the radiologist and mammography technician is essential for the technologist to understand the patient's surgical history and the exact area of concern. This not only facilitates obtaining diagnostically useful images, but also supports patient-centered care.
Make sure patients know what to expect. Open communication is essential to ensure personalized care planning. This collaborative approach ensures that the patient's medical and personal concerns are addressed, leading to improved patient satisfaction and better health outcomes.
It is also important to acknowledge that transgender patients frequently face discomfort or bias in radiology encounters. Nearly 71% of transgender and nonbinary patients reported at least one negative imaging encounter, according to one survey. This is much higher than the rate of negative general health encounters (33%), illustrating the need for greater sensitivity and education on the part of healthcare professionals. It also illustrates the need for psychological support for the patients. Care teams can connect patients with counseling or support groups for transgender men.
Post-Mastectomy Ultrasound and Patient-Centered Care
Post-mastectomy ultrasound provides a non-invasive method to monitor recovery, detect complications, and support the long-term health of transgender male patients. The use of these scans, coupled with a sensitive and multidisciplinary approach to care, can improve the patient's outcomes and their experience of care.
