Efficacy and safety of 1064‐nm fractional picosecond laser for the treatment of postmastectomy scars in transgender men: A randomized controlled trial

Abstract Objectives Subcutaneous mastectomy is a crucial component of gender affirmation therapy for transgender men (TM), but the scars that result from this procedure can frequently impair their quality of life. This study aimed to assess the efficacy and safety of 1064‐nm fractional picosecond laser (FxPico) treatment for hypertrophic and atrophic postmastectomy scars in TM. Methods Twenty‐two patients with a total of 35 pairs of bilateral symmetric mastectomy scars were enrolled. One of each pair of symmetric scars was randomly assigned to receive four FxPico treatments at 4‐week intervals. All scars were evaluated using the modified Vancouver Scar Scale (mVSS) and three‐dimensional imaging for scar roughness, melanin index, and hemoglobin index before each treatment session and at 1, 3, and 6 months following the last treatment. Additionally, participant‐rated scar satisfaction (PSS) and scar improvement (Global Assessment Score, GAS), as well as adverse events were recorded. Results During the 6‐month follow‐up period after the end of laser treatment sessions, the treated scars showed significant reductions in the mVSS compared to the untreated controls ( p < 0.001), whereas the melanin index and hemoglobin index were not significantly different. Subgroup analysis of hypertrophic scars demonstrated statistically significant reductions in mVSS at 1 ( p = 0.003) and 3 months ( p = 0.041) after the end of laser treatments. PSS was significantly higher on the laser‐treated scars than the controls ( p = 0.008), and a participant‐rated GAS of 2.95 ± 0.65 was found. There were no serious adverse events reported. Conclusions 1064‐nm FxPico could be utilized to treat mastectomy scars among TM, particularly the hypertrophic type.