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

• Elizabeth被诊断为性别认同障碍，18岁时被开具睾酮。20岁时她切除了双侧乳房，乳头被重新移植。她回忆不起有人谈过这会如何影响哺乳。
• 手术留下了厚重而疼痛的瘢痕，乳头疼痛并渗液。再加上被跨性别朋友拒绝，以及睾酮造成的阴道干燥和变薄，这引发了危机，她在24岁时停止了过渡。
• Elizabeth说，当时她很可能会拒绝关于哺乳的谈话。她现在认为那是一种回避，她的性别痛苦被当作一张“王牌”，终止了讨论。
• 30岁怀孕后，她为无法哺乳而悲痛。她的助产士让她“就用配方奶喂养”，一位医生则一直称她为男人。这种混乱导致了一份儿童保护报告，而一家母乳库好心地为她提供了捐赠母乳。
• 作者指出，国际和澳大利亚的跨性别健康指南（WPATH、AusPATH和PATHA）并不建议在这类手术前谈论哺乳。他们认为，乳头移植几乎肯定会使哺乳变得不可能。
• 他们认为，关于有多少人去过渡以及乳房切除的益处的研究（尤其是针对青少年）很薄弱：随访时间很短，而且许多人退出研究。
• 他们建议在手术前进行诚实的哺乳咨询，对产科人员进行关于去过渡女性的培训，为哺乳方面的悲伤提供情感支持，并提供捐赠母乳。

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.