Breast Imaging of Transgender Individuals: A Review

Abstract

Purpose: This review will inform radiologists about the evidence base regarding radiographic imaging for transgender individuals and considerations for providing culturally sensitive care for this population.

Findings: Transgender individuals are increasingly referred for both screening and diagnostic breast imaging. It is important that the clinic environment is welcoming, the medical staff utilize accepted terminology and patients are able to designate their gender and personal history to ensure appropriate care. Hormone and surgical treatments used for transition by many transgender women and men may change the approach to imaging.

Summary: Although not yet evidence-based, screening mammography is currently suggested for transgender women with risk factors, including those receiving hormone treatment over 5 years. The risk for breast cancer in transgender individuals is still being defined.

Keywords: Breast; Mammography; Screening; Transgender; Transsexual.

Fig. 1

A 61-year-old transgender woman treated with estradiol and spironolactone for over 10 years. Standard CC and MLO views from her screening mammogram show normal heterogeneously dense breasts

Fig. 2

Histology from the breast of a 55-year-old transgender woman treated with cross-sex hormones since age 19. a Lobule formation (H and E stain at ×100 magnification). b Pseudolactational changes (H and E stain at ×200 magnification)

Fig. 3

A 57-year-old transgender woman treated with estrogen for 37 years. a Left breast mammogram shows extremely dense breast tissue containing a group of calcifications (circled). b Magnified view shows pleomorphic calcifications. c Histopathology from stereotactic biopsy shows tangential section of epithelial lined cystic ducts in fibrous stroma (H and E stain 400X). Findings are consistent with fibrocystic changes

Fig. 4

A 58-year-old transgender woman on hormone treatment complains of lumps in her breast. a CC and MLO mammography views show triangle-shaped skin markers over palpable masses. b Ultrasound shows benign duct ectasia which correlates with the palpable masses

Fig. 5

A 60-year-old transgender woman with free silicone injections feels a lump. a Mammogram shows multiple high-density masses which are silicone granulomas. The palpable granuloma is designated by blue arrow. b Ultrasound shows the palpable silicone granuloma is a circumscribed anechoic mass (arrow). c The silicone granuloma is a very high signal circumscribed mass on MRI T2 STIR sequence (arrow). d On a TI post-contrast sequence the silicone granuloma is a non-enhancing circumscribed mass (arrow)

Fig. 6

A 54-year-old transgender woman is referred for a screening mammography prior to nipple sparing mastectomy to remove painful masses caused by free silicone. a Tomosynthesis shows bilateral large dense masses which are inseparable from the pectoralis muscle (arrows). There are also innumerable small silicone granulomas. b Ultrasound shows an example of the indistinct hyperechoic “snow storm” appearance of free silicone at posterior depth in both breasts (arrows). c Post-contrast subtracted MRI image shows no suspicious enhancing mass

Fig. 7

Chest wall migration of mineral oil incidentally seen on a CT scan in a 41-year-old transgender woman with a history of breast augmentation with free mineral oil self-injections (arrows)