Gender-Affirming Chest Masculinization and Nipple–Areolar Complex Reconstruction: An All-Payer Claims Database Analysis

This study assessed trends and disparities in chest masculinization with and without nipple–areolar complex (NAC) reconstruction across insurance type, socioeconomic strata, geography, and time. Transgender and gender-diverse patients who underwent chest masculinization between 2016 and 2020 were identified using the Massachusetts All-Payer Claims Database. Demographics, comorbidities, and socioeconomic factors were compared between patients with and without NAC reconstruction. Among 912 patients, 638 (70.0%) underwent chest masculinization with NAC reconstruction, and 274 (30.0%) underwent chest masculinization without reconstruction. Patients undergoing NAC reconstruction were more likely to live in higher-income ZIP codes and Greater Boston. The relative proportion of chest masculinization with NAC reconstruction increased from 60.5% in 2016 to 81.0% in 2019, but declined in 2020. Publicly insured patients had lower insurer payments for NAC. This study found rising rates of chest masculinization with documented coding for NAC reconstruction, as well as socioeconomic and geographic disparities in access.