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Background: Shoulder reduction through clavicle reduction osteotomies can successfully reshape the outer appearance of the shoulders. It is most commonly requested in the transfemale patient where shoulder dysphoria can be significant. It has a high patient satisfaction rate andcomplication rates have been few. The need for secondary hardware removal has been limited to a handful of patients.

While the majority of shoulder reduction patients to date have been transgender there are cis-females who are also bothered by the appearance of their wider or more square shoulder shapes. These female patients may or may not have bideltoid measurements that are outside of the normal range. In performing clavicle reduction osteotomies on this female population the anatomic question is whether the shape of a genetic female clavicle poses different considerations for the surgery. The concept of the operation is the same but is the clavicle bone that is reduced any different.

There are established anatomic differences in the shape of the male vs female clavicle. Such differences are used in forensic identification. The male clavicle is longer, thicker and more curved while the female clavicle is a bit shorter and less curved. It also has less of a cross-sectional diameter.      

Case Study: This thin framed female desired to have less broad and square-shaped shoulders. Her bideltoid measurement was 44cms. Despite this upper end of normal width her shoulders did appear broad. 

Under general anesthesia bilateral clavicle osteotomies were performed and 2.5cms of bone length was removed on the right side and 2.75cm on the left side. (due to asymmetry) Noteworthy was how thin the clavicle was compared to the transfemale patient, averaging a 10mm diameter at the mid shaft area.

Due to the thin size of the clavicle a single 3.5mm fixation plate was applied with three bicortical screws per side. In bringing together the two ends of the cut bone together the discrepancy in the size of the clavicle ends can be seen.

Her postoperative visit a few days after the surgery showed the significant difference in the appearance of her shoulders in both the front and back views. It is important to note that she also had a vertical backlift which would have a synergistic effect with the shoulder reduction procedure.

The most noteworthy aspect of a cis-female shoulder reduction surgery is how much smaller the clavicle is. Due to concerns about devascularization of the bone ends only a single superior plate fixation plate was used. 

Case Highlights:

1) Shoulder reduction in cis-females can be just as effective at resolving shoulder dysphoria as in transfemale patients.

2) Cis-females have noticeable smaller clavicle size in thickness/diameter.

3) Because of the smaller clavicle thicknesses a single superior plate may be all the fixation that can be placed.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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