Background/Objectives: Assigned female at birth (AFAB) individuals who identify as transgender or gender-diverse (TGD) with concurrent breast cancer or high-risk genetic mutations represent a unique population, requiring consideration of oncologic and aesthetic goals. These patients sought chest masculinization with oncologic gender-affirming mastectomy (OGAM) or non-binary reconstruction to alleviate gender dysphoria and treat their breast cancer. There is limited literature on surgical techniques in this patient population. Methods: A retrospective chart review of AFAB TGD adults (>18 years of age) who underwent OGAM or non-binary reconstruction at the University of Washington between 2019 and 2023 was conducted. All patients had a consultation with a plastic surgeon for reconstruction and a minimum of one year follow-up. Demographic data, oncologic status, post-operative complications, and revision surgical history were collected. Results: Eight AFAB TGD individuals met the inclusion criteria. The mean age at the time of mastectomy was 35.13 years (SD = 8.04), and the mean BMI was 29.88 (SD = 6.40). Indications for mastectomy included a breast cancer diagnosis (N = 4) or a strong family history of breast cancer or genetic predisposition (N = 4). Two (25%) patients underwent nipple-sparing mastectomies (NSM), two patients (25%) underwent skin-sparing mastectomy with Goldilocks reconstruction, and four patients (50%) underwent simple mastectomy (oncologic gender-affirming mastectomy), flat closure with free nipple graft (FNG). Two patients had staged nipple mastectomy with secondary nipple reduction and fat grafting. Six patients had immediate reconstruction, four (50%) patients underwent immediate double-incision OGAM with FNG, and two (25%) patients underwent Goldilocks procedures—one with and one without FNG. One patient (12.5%) experienced a surgical site infection, and three patients (37.5%) underwent revision surgery. No patients had positive margins following their mastectomy. Conclusions: This case series highlights the importance of a multidisciplinary and highly personalized approach for AFAB and TGD individuals undergoing oncologic gender-affirming mastectomy or non-binary reconstruction. We reviewed reconstructive options performed at our institution, demonstrating safe oncologic and reconstructive techniques that emphasized collaboration between breast and plastic surgeons.

Background: A cleft palate is a common birth defect that can occur in isolation or in combination with other congenital anomalies. Children with medical complexity (CMC) represent a subgroup of patients with increased health care needs. This study aimed to investigate the association with cleft palate and CMC to guide early screening and treatment plan. Methods: A retrospective review of the Pediatric Health Information System (PHIS) database was conducted from 2015 to 2023 for inpatient encounters of patients with cleft palate. Patient demographics, associated anomalies, complex chronic conditions (CCCs), and surgical outcomes were extracted and analyzed. Statistical analyses were performed to compare categorical and continuous variables between CMC and non-CMC. Results: A total of 2313 pediatric patients with cleft palate were identified, with 318 CMC (13.7%) and 1995 non-CMC (86.3%). CMC were more likely to have public insurance ( P =0.005), resided in a low overall child opportunity level (COI) neighborhood ( P =0.024), and had a higher cost of hospitalization and longer length of stay ( P <0.001). They also had a higher proportion of all CCCs and syndromic cleft palate and were more likely to have associated ear anomaly, comorbid conditions, surgical complications, and all-cause readmissions. Conclusion: This study demonstrated that medical complexity in patients with cleft palate is associated with higher health care utilization and worse clinical outcomes. These findings emphasize the need for early recognition and involvement of multidisciplinary care across multiple domains to support a patient-specific intervention that may improve resource allocation and long-term clinical outcomes.

Effective soft tissue coverage is essential for minimizing complications in large cranial defects. This case report describes the successful application of a chimeric serratus anterior fascia–latissimus dorsi (SAFLD) flap for single-stage coverage of a large cranial defect. This technique is compared to the current literature. A 69-year-old female with a history of glioblastoma and a rapidly growing scalp squamous cell carcinoma underwent en bloc resection and single-stage reconstruction. After cranioplasty, a large defect was covered with an SAFLD flap, ensuring multilayered vascularized soft tissue coverage. Recovery was uneventful, and a 1-year follow-up demonstrated good cranial morphology. This case demonstrates the successful application of a chimeric free flap for dual-layer coverage in cranial reconstruction, potentially reducing complications associated with single-stage repairs and improving patient outcomes. A literature review demonstrating various case applications of this flap is also presented.