Transgender men who have not undergone bilateral mastectomy, or who have only undergone breast reduction, should undergo screening according to current guidelines for non-transgender women. No reliable evidence exists to guide the screening of transgender men who have undergone mastectomy. Since most or nearly all breast tissue may have been removed, mammography for the evaluation of a palpable lesion may not be technically feasible, and alternatives such as ultrasound or MRI may be necessary. The risk of breast cancer in residual breast tissues after mastectomy is unknown. It is important to obtain a clear surgical history, as some patients may have undergone only breast reduction. Some surgeons perform routine preoperative mammography. Some guidelines recommend annual chest wall exams in transgender men after mastectomy; however this is not based on evidence, and is in conflict with the move away from clinician exams in general for non-transgender women. Diagnostic physical exams may be appropriate in the case of new complaints.
Clinicians should engage in dialogue with transgender men who have undergone bilateral mastectomy about the unknown risks associated with residual breast tissue, as well as the possible technical limitations of mammography (Grading: X C S).