Warning: this article contains an image of the attempted surgery
An attempt by a New Zealand teenager to remove their own breasts following YouTube instructions has prompted calls for better access to gender affirming surgery.
The 18-year-old, referred to as Patient Z, arrived at a hospital emergency department after a botched attempt to complete a left mastectomy at home.
Details of the case were published in the New Zealand medical journal on Friday in an article written by three Wellington surgeons.
The teenager was awaiting female-to-male gender affirmation surgery at the time.
The article said he decided to attempt the surgery himself due to the wait times for a referral in the public system, an inability to afford private surgery and the "significant psychological stress of having breasts at an upcoming pool party."
"He had demonstrated premeditation by watching a ‘how to’ video on YouTube," said the doctors who wrote the case study.
Patient Z had also prepared 'appropriate equipment', marked the incision and considered how to numb the pain and stop the bleeding.
After spending several hours trying to remove his left breast, he became worried he would damage a nerve and went to hospital.
Surgeons then performed a double mastectomy.
"After discussing the risks, including irreversibility, poor cosmetic outcome/asymmetry and loss of both nipples, he proceeded to have a completion left mastectomy and symmetrising right mastectomy," the article said.
"He was reviewed by the acute mental health team and was deemed to have capacity to consent, with no active mood disorder, psychosis or suicidality."
Dr Rita Yang, the only surgeon who performs genital gender affirmation operations in New Zealand, told Newshub it was “extremely distressing” to hear about the case.
"It could have easily ended with this person dying," she said.
“All surgeries come with life-threatening risks even when performed by surgeons. I implore anyone who needs gender affirming surgery to never even consider this for the sake of their own life.”
Dr Yang said top surgery - the reshaping of the breasts to be more masculine – is complex and can take a specialist surgeon up to four hours to complete.
“It involves highly trained operating room staff, anaesthetists, nurses, and hospital-level wraparound care. There are few reconstructive surgeons in New Zealand qualified to perform this surgery and even then there are serious risks that must be mitigated," Yang told Newshub.
The patient Z case study was written by Wellington Hospital surgeons Dr Mairarangi Haimona, Dr Sue Hui Ong and Dr Scott Diamond. In the article, they call for better access to gender reassignment surgery.
"In Aotearoa New Zealand, there is an overwhelming unmet need for masculinising chest reconstruction for transgender men."
"A lack of access to gender-affirming surgery led to this act of desperation," they wrote.
A 2019 report from the 'Counting Ourselves' survey found only 13 percent of trans men who had chest reconstruction surgery had access through the public system
"This is a significant under-service and likely an under-representation of the unmet need due to poor documentation and lack of information of how to access services," said the doctors.
The lengthy assesment process for patients to qualify for gender affirmation surgery is highlighted as an issue in the medical journal article.
Some are left waiting as long as a decade for surgery, and many don't end up having it due to the cost.
"With increasing demand and associated psychological and possible physical harm it is crucial for public services to be more accessible to an under-served population, " the doctors said.
Patient Z "healed well" following the hospital surgery.
"He reported improvement in self-esteem and self-confidence and his ability to complete school work, and was looking forward to enrolling at university."
