Breast imaging in transgender women: a review


      Transgender women are increasingly evaluated in breast imaging centers. Radiologists should be familiar with a range of imaging findings related to feminizing hormone therapy and breast augmentations as well as benign and malignant lesions seen in this population. A growing body of literature has suggested that feminizing hormone therapy may increase the risk of breast cancer, prompting professional organizations to develop screening guidelines. The aim of this paper is to review common breast imaging findings in transgender women, recent data on the association between feminizing hormone therapy and breast cancer, and guidelines for breast cancer screening. Knowing these unique imaging features in transgender women is essential for providing competent care and reducing health care disparities.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • National LGBTQIA Health Education Center
        LGBTQIA Glossary of Terms for Health Care Teams.
        2020 (Published online August 30)
        • Gooren L.J.
        • van Trotsenburg M.A.A.
        • Giltay E.J.
        • van Diest P.J.
        Breast cancer development in transsexual subjects receiving cross-sex hormone treatment.
        J Sex Med. 2013; 10: 3129-3134
        • Brown G.R.
        • Jones K.T.
        Incidence of breast cancer in a cohort of 5,135 transgender veterans.
        Breast Cancer Res Treat. 2015; 149: 191-198
        • Wiepjes C.M.
        • Nota N.M.
        • De Blok C.J.M.
        • et al.
        Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands.
        BMJ. 2019; (Published online May 14): 11652
        • Society of Breast Imaging
        Society of Breast Imaging Position Statement on Diversity and Inclusion.
        (Accessed March 19, 2021)
        • Center of Excellence for Transgender Health, Department of Family and Community Medicine, University of California San Francisco
        Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People.
        (Published June)
        Date: 2016
        Date accessed: April 27, 2020
        • Makadon H.J.
        • Mayer K.H.
        • Potter J.
        • Goldhammer H.
        Fenway guide to lesbian, gay, bisexual, and transgender health.
        2nd ed. American College of Physicians, 2015
        • Hembree W.C.
        • Cohen-Kettenis P.
        • Delemarre-van de Waal H.A.
        • et al.
        Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline.
        J Clin Endocrinol Metab. 2009; 94: 3132-3154
        • Marshall W.A.
        • Tanner J.M.
        Variations in pattern of pubertal changes in girls.
        Arch Dis Child. 1969; 44: 291-303
        • Kanhai R.C.J.
        • Hage J.J.
        • van Diest P.J.
        • Bloemena E.
        • Mulder J.W.
        Short-term and long-term histologic effects of castration and estrogen treatment on breast tissue of 14 male-to-female transsexuals in comparison with two chemically castrated men.
        Am J Surg Pathol. 2000;24(1):74.;
        • Weyers S.
        • Villeirs G.
        • Vanherreweghe E.
        • et al.
        Mammography and breast sonography in transsexual women.
        Eur J Radiol. 2010; 74: 508-513
        • Kanhai R.C.J.
        • Hage J.J.
        • Bloemena E.
        • van Diest P.J.
        • Karim R.B.
        Mammary fibroadenoma in a male-to-female transsexual.
        Histopathology. 1999; 35: 183-185
        • Lemmo G.
        • Garcea N.
        • Corsello S.
        • et al.
        Breast fibroadenoma in a male-to-female transsexual patient after hormonal treatment.
        Eur J Surg Suppl Acta Chir Suppl. 2003; 588: 69-71
        • Faria L.L.
        • Brasil S.T.
        • Endo E.
        • Chala L.
        • Shimizu C.
        • Barros N.
        Breast fibroadenoma in transgender woman.
        Breast J. 2020; 26: 293-294
        • Richards S.M.
        • Pine-Twaddell E.D.
        • Ioffe O.B.
        • Bellavance E.C.
        A case of benign phyllodes tumor in a transgender woman receiving cross-sex hormones.
        Int J Surg Pathol. 2018; 26: 356-359
        • O’Bryan J.
        • Wolf-Gould C.
        • Matsuo Y.
        Mammary myofibroblastoma in a transgender patient on feminizing hormones: literature review and case report.
        Transgender Health. 2018; 3: 1-9
        • Walsh C.M.
        • Yang L.
        • Park J.M.
        • Askeland R.W.
        • Fajardo L.L.
        Angiolipoma of the breast in a transgender patient.
        Breast J. 2014; 20: 662-663
        • Tongson K.
        • Konovalova V.
        • Dhawan N.
        • Sharma S.
        • Bahl J.
        • Masri M.
        Breast cancer suspicion in a transgender male-to-female patient on hormone replacement therapy presenting with right breast mass: breast cancer risk assessment and presentation of a rare lesion.
        Case Rep Oncol Med. 2017; 2017: 1-4
        • Sapino A.
        • Bosco M.
        • Cassoni P.
        • et al.
        Estrogen receptor-ß is expressed in stromal cells of fibroadenoma and phyllodes tumors of the breast.
        Mod Pathol. 2006; 19: 599-606
        • Hartley R.L.
        • Stone J.P.
        • Temple-Oberle C.
        Breast cancer in transgender patients: a systematic review. part 1: male to female.
        Eur J Surg Oncol. 2018; 44: 1455-1462
        • Lienhoop T.
        • Smetko M.
        • Green L.
        Breast cancer in transgender women: a case report.
        Clin Imaging. 2020; 68: 20-23
        • Giordano S.H.
        • Buzdar A.U.
        • Hortobagyi G.N.
        Breast cancer in men.
        Ann Intern Med. 2002; 137: 678
        • Colditz G.A.
        • Hankinson S.E.
        • Hunter D.J.
        • et al.
        The use of estrogens and progestins and the risk of breast cancer in postmenopausal women.
        N Engl J Med. 1995; 332: 1589-1593
        • Chlebowski R.T.
        • Hendrix S.L.
        • Langer R.D.
        • et al.
        Influence of estrogen plus progestin on breast cancer and mammography in healthy postmenopausal women: the Women’s health initiative randomized trial.
        JAMA. 2003; 289: 3243
        • Brown Ann
        • Lourenco Ann P.
        • Niell Bethany L.
        • et al.
        ACR Appropriateness Criteria ® Transgender Breast Cancer Screening.
        J Am Coll Radiol. 2021; 17 (Accessed June 20, 2021.
        • Gethins M.
        Breast Cancer in Men.
        JNCI J Natl Cancer Inst. 2012; 104: 436-438
        • de Blok C.J.M.
        • Staphorsius A.S.
        • Wiepjes C.M.
        • Smit J.M.
        • Nanayakkara P.W.B.
        • den Heijer M.
        Frequency, determinants, and satisfaction of breast augmentation in trans women receiving hormone treatment.
        J Sex Med. 2020; 17: 342-348
        • Food and Drug Administration
        Breast Implants - Certain Labeling Recommendations to Improve Patient Communication - Guidance for Industry and Food and Drug Administration Staff.
        2021 (Accessed June 20, 2021.
        • Lourenco A.P.
        • Moy L.
        • Baron P.
        • et al.
        ACR appropriateness criteria ® breast implant evaluation.
        J Am Coll Radiol. 2018; 15: S13-S25
        • Leberfinger A.N.
        • Behar B.J.
        • Williams N.C.
        • et al.
        Breast implant-associated anaplastic large cell lymphoma: a systematic review.
        JAMA Surg. 2017; 152: 1161
        • Department of Surgery, The Mount Sinai Hospital, New York, NY, USA, Zaveri S, Yao A, Division of Plastic and Reconstructive Surgery, Department of Surgery, The Mount Sinai Hospital, New York, NY, USA, Schmidt H, Dubin Breast Center, Tisch Cancer Institute, The Mount Sinai Hospital, New York, NY, USA
        Breast implant-associated anaplastic large cell lymphoma following gender reassignment surgery: a review of presentation, management, and outcomes in the transgender patient population.
        Eur J Breast Health. 2020; 16: 162-166
        • Sonnenblick E.B.
        • Shah A.D.
        • Goldstein Z.
        • Reisman T.
        Breast imaging of transgender individuals: a review.
        Curr Radiol Rep. 2018; 6: 1
        • Peters W.
        • Fornasier V.
        Complications from injectable materials used for breast augmentation.
        Can J Plast Surg. 2009; 17: 89-96
        • James S.E.
        • Herman J.L.
        • Rankin S.
        • Keisling M.
        • Mottet L.
        • Anafi M.
        The Report of the 2015 U.S. Transgender Survey. National Center for Transgender Equality.
        • Stowell J.T.
        • Grimstad F.W.
        • Kirkpatrick D.L.
        • et al.
        Imaging findings in transgender patients after gender-affirming surgery.
        Radiographics. 2019; 39: 1368-1392
        • Bradford J.
        • Reisner S.L.
        • Honnold J.A.
        • Xavier J.
        Experiences of transgender-related discrimination and implications for health: results from the Virginia transgender health initiative study.
        Am J Public Health. 2013; 103: 1820-1829
        • Safer J.D.
        • Coleman E.
        • Feldman J.
        • et al.
        Barriers to healthcare for transgender individuals.
        Curr Opin Endocrinol Diabetes Obes. 2016; 23: 168-171
        • Bazzi A.R.
        • Whorms D.S.
        • King D.S.
        • Potter J.
        Adherence to mammography screening guidelines among transgender persons and sexual minority women.
        Am J Public Health. 2015; 105: 2356-2358