영구적 손실: 성전환을 되돌린 여성이 유방절제술 후 모유 수유 불가능에 애도

가슴 남성화 유방절제술과 성전환 되돌림 후 모유 수유에 대한 슬픔

Authors: Karleen D. Gribble, Susan Bewley, Hannah G. Dahlen
Journal: Frontiers in Global Women's Health
Year: 2023
Source: www.frontiersin.org/articles/10.3389/fgwh.2023.1073053/full

Summary

This paper tells the story of one woman who had her breasts removed as part of a gender transition, later stopped transitioning, and then grieved deeply when she could not breastfeed her baby. The authors point out that the main transgender health guidelines (WPATH, AusPATH and PATHA) do not tell surgeons to discuss breastfeeding before this surgery. They also describe how midwives and doctors who did not understand detransition made her pregnancy and early motherhood harder. They call for honest talks about breastfeeding before surgery, better training for maternity staff, emotional support and access to donor milk. It is a vivid and useful warning, but it is one person's account, told from memory and not checked against her surgical or clinic records, so it cannot tell us how common this experience is.

Key findings

엘리자베스는 성별 정체성 장애로 진단받아 18세에 테스토스테론을 처방받았습니다. 20세에 양쪽 유방을 제거했고 젖꼭지는 다시 이식했습니다. 이것이 모유 수유에 어떤 영향을 줄지에 대한 이야기는 기억나지 않습니다.
수술은 두껍고 아픈 흉터와, 아프고 새는 젖꼭지를 남겼습니다. 트랜스젠더 친구들에게 거부당한 것, 테스토스테론으로 인한 질 건조와 얇아짐과 함께 위기로 이어졌고 24세에 전환을 멈췄습니다.
엘리자베스는 그때라면 모유 수유 이야기를 아마 거절했을 거라고 말했습니다. 지금은 그것을 회피로 보며, 성별 고통이 논의를 닫아 버리는 ‘으뜸패’로 쓰였다고 봅니다.
30세에 임신한 그녀는 모유 수유를 할 수 없다는 것에 슬퍼했습니다. 조산사는 ‘그냥 분유를 먹이라’고 했고 의사는 계속 그녀를 남성이라고 불렀습니다. 혼란은 아동 보호 신고로 이어졌고, 모유 은행은 친절하게 기증 모유를 주었습니다.
저자들은 국제 및 호주 트랜스젠더 건강 지침(WPATH, AusPATH, PATHA)이 이 수술 전에 모유 수유에 대해 이야기하라고 권하지 않는다고 지적합니다. 젖꼭지 이식은 거의 확실히 모유 수유를 불가능하게 만든다고 주장합니다.
사람들이 얼마나 자주 디트랜지션하는지, 그리고 특히 10대에서 유방 제거의 이점에 관한 연구는 부실하다고 주장합니다. 사람들을 짧은 기간만 추적하고 많은 사람이 연구에서 이탈하기 때문입니다.
수술 전 솔직한 모유 수유 상담, 디트랜지션한 여성에 관한 산부인과 직원 교육, 모유 수유 상실의 슬픔에 대한 정서적 지원, 기증 모유 이용을 권고합니다.

Abstract

An increasing number of young females are undergoing chest masculinisation mastectomy to affirm a gender identity and/or to relieve gender dysphoria. Some desist in their transgender identification and/or become reconciled with their sex, and then revert (or detransition). To the best of our knowledge, this report presents the first published case of a woman who had chest masculinisation surgery to affirm a gender identity as a trans man, but who later detransitioned, became pregnant and grieved her inability to breastfeed. She described a lack of understanding by maternity health providers of her experience and the importance she placed on breastfeeding. Subsequent poor maternity care contributed to her distress. The absence of breast function as a consideration in transgender surgical literature is highlighted. That breastfeeding is missing in counselling and consent guidelines for chest masculinisation mastectomy is also described as is the poor quality of existing research on detransition rates and benefit or otherwise of chest masculinising mastectomy. Recommendations are made for improving maternity care for detransitioned women. Increasing numbers of chest masculinisation mastectomies will likely be followed by more new mothers without functioning breasts who will require honest, knowledgeable, and compassionate care.

Conclusion

Until recently, it would be extremely unusual for a new mother to have had a mastectomy. With increasing numbers of female adolescents and young adults obtaining chest masculinisation mastectomies, more new mothers will present without functioning breasts. Some will retain a transgender identification and others will have detransitioned. Each requires an individualised approach to provide them and their infants with honest, knowledgeable, and compassionate care.

Methodological limitations

Only one person: The report describes one woman's experience. As the authors say, we don't know how typical it is of detransitioned women, and it cannot show how often breastfeeding grief or poor maternity care happen.
Told from memory years later: The account comes from one three-hour interview a decade or more after surgery. Her memory that breastfeeding was never discussed, and her views on what her doctors thought, cannot be checked.
Key records missing: Elizabeth provided pregnancy records, a milk bank referral and photos of her scars. Her surgery, consent and gender clinic records were not reported, so what she was told before surgery is known only from her memory.
How she was found isn't explained: The report does not say how the authors came across Elizabeth. She describes being a 'trans activist' and later 'persona non grata', so she may have been found through detransition networks.
Story written with her: The case was written 'in consultation with Elizabeth' and she approved the final paper. This respects her, but it means the authors were less independent in how they told the story.
Authors have stated views: The authors have written before about sex-based language in maternity care and about regret after gender surgery (three of the cited papers are their own), and they frame the case as 'unanticipated harm'. They declare no financial conflicts, but readers should know their positions.
Staff side not heard: The midwife, doctor and surgeon were not asked for their views. Explanations for how they acted, for example that they were following transgender care training, rest on the patient's interpretation.
Breastfeeding claims borrowed from other surgery: The authors admit there is no research on how different breast removal methods for transition affect breastfeeding, so they rely on breast reduction studies. The case is strong for grafted nipples, but less certain for other methods.
Evidence judged unevenly: The report sharply criticises studies that find low regret for short follow-up and dropouts, but cites surveys of self-selected detransitioners (such as Littman 2021) without the same criticism.
Some details changed: The authors say 'some details have been changed to preserve anonymity'. This is reasonable, but readers can't know which details are exact.

detrans.ai

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