General information about Screening and Surgeries
Cancer screening types
The goal of cancer screening is to find cancer early, when it is most treatable. Getting cancer screening on a regular basis is important for everyone, especially as you get older.
Again, we know the word “breast” is dysphoric for some people. We are calling it “chest cancer” and “chest screening.” It’s important to remember we are not including your risk of other chest cancers, like lung cancer, in this guidance. Your doctors are likely to call it “breast cancer” and “breast screening.”
There are a few different factors that impact what type of chest cancer screening you may need. How often you get screening and the type of screening you get depends on:
- Your age
- If you have a family history of cancer
- If you’ve had surgery to remove chest tissue
- If a genetic test shows a high risk of chest cancer
There are four common types of screening for chest cancer. Based on the above factors, any of these types of screening may be recommended to people, regardless of their sex and gender.
- Mammogram
- Mammograms are special x-rays of the chest. They take about 15 minutes. The chest is squeezed or “compressed” by the machine to ensure the images are clear. This is repeated for both sides of the chest. For people who have had top surgery, mammogram may or may not be possible.
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- Magnetic Resonance Imaging (MRI)
- An MRI uses magnets to visualize the chest. This can take about 30 minutes to an hour. During MRIs, you lie face down on a table which slides into a tube-like scanner. You would be asked to remove all metal and jewelry. You may have contrast dye injected into your vein through an IV to help the machine take better pictures.
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- Ultrasound
- An ultrasound uses sound waves to take pictures of the chest. A technician applies a gel to the chest and moves a probe over the area they are taking pictures of.
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- Clinical exam
- Clinical exams are typically performed at an annual check-up. A healthcare professional uses their hands to visually and physically check for lumps.
In addition to these four clinical screenings, you can also complete self exams. It is helpful to know what your body typically looks and feels like so you can share any changes with your clinician. In addition to checking for lumps, it is important to be familiar with what your nipples and scars feel like.
Some people may experience dysphoria with chest cancer screening. Talk to your healthcare provider about the logistics of the exam and what support you may need.
Surgery options for people with cancer risk
- Risk-reducing mastectomy + no reconstruction (a.k.a. “going flat”)
- If you have a genetic risk or a strong family history, a genetic counselor may advise you to think about risk-reducing mastectomy. One way to do this is to work with a surgical oncologist, just like a cisgender woman would do, but choose to have no reconstruction of breasts. Some people, including cisgender women, choose this option. This option is sometimes called “going flat” in the cancer community. However, your scars will be in a different place than in traditional top surgery, and your chest will be more concave — you won’t have tissue making masculine “pecs.”
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- Risk-reducing mastectomy + masculine reconstruction
- Another option is to work with a special team of a surgical oncologist and a plastic surgeon. These two people work together as a team to reduce your risk and affirm your gender. There are existing case studies with recommendations for this option in the medical literature. This option is similar to when cisgender women have a plastic surgeon create breasts after risk-reducing mastectomy. In this case, the surgeon helps reconstruct an area that looks like pectoral muscles. The chest may not look the same, and your scars may be less hidden than traditional top surgery. However, this option can give you a masculine shape while still removing all the at-risk tissue.
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- Traditional Top Surgery + Screening
- Choice of surgery type is a personal decision that only you should make. Some people will have a high risk but still decide to undergo top surgery. We want doctors to leave this decision to you after making sure you understand your risk. If your doctor does not agree, remind them that they do not make cisgender women get risk-reducing mastectomy, even if they have very high risk. Gender-affirming care is a separate healthcare need that should be fulfilled even when patients do not want to address their cancer risk with surgery. But, if you choose this option and do have a high cancer risk, be sure to talk to your doctor about your screening options.
- You might also want to talk to your surgeon about which gender-affirming top surgery technique will leave you with a masculine shape, but reduce your tissue the most. A surgeon might suggest you choose a specific technique to minimize leftover tissue, like double incision top surgery instead of keyhole surgery.