Systematic Review of Complication Rates of Gender-affirming Breast Augmentation and Its Closest Analogue: Tuberous Breast Augmentation.

Background: Gender-affirming breast augmentation (GABA) with implants is most commonly compared with cosmetic breast augmentation. A better comparator is tuberous breast augmentation (TBA). Anatomically, both feature relative medial pole deficiency, constricted breast footprints, and parenchymal herniation through the areola. Technically, both often require radial scoring and inframammary fold lowering. This review summarized techniques and outcomes of GABA and TBA. Methods: A systematic review was performed in 3 databases: PubMed/MEDLINE, Scopus, and the Cochrane Database of Controlled Trials from 2000 to 2024. In total, 1319 articles were identified, of which 29 met inclusion criteria: outcomes-based primary literature detailing GABA and/or TBA. Meta-analysis was performed, but due to the noncomparative nature of the included studies, no comparative statistics were performed. Results: In total, the GABA cohort included 3234 breasts in 1617 patients from 13 studies, and the TBA cohort featured 1093 breasts in 583 patients from 16 studies. Cohort characteristics were similar between groups. Surgical characteristics included primarily prepectoral augmentation via inframammary fold incision in the GABA cohort and dual-plane augmentation via periareolar incision in the TBA cohort. In both the GABA and TBA cohorts, rates of common complications, including explantation, infection, hematoma, and seroma, were all below 1%. The rate of reoperation was 4.5% in the GABA cohort and 11.9% in the TBA. Conclusions: This systematic review found low rates of complications in GABA and confirmed that GABA uses standard surgical techniques, which are routinely used in other breast procedures. Our findings demonstrate a similar complication profile between GABA and TBA.