Gender Affirming Mastectomy Improves Quality of Life in Transmasculine Patients

Abstract

Objective: To determine the impact of gender-affirming mastectomy on depression, anxiety, and body image. Background: There are many cross-sectional and ad-hoc studies demonstrating the benefits of gender-affirming surgery. There are few prospective investigations of patient-reported outcomes in gender-affirming surgery using validated instruments. Methods: In this prospective study, patients presenting to the University of Michigan for gender-affirming Mastectomy were surveyed preoperatively and 6-months postoperatively. Primary outcomes were patient-reported measurements of anxiety measured by General Anxiety Disorder-7, depression measured by Patient Health Questionnaire-9, body image measured by BODY-Q and Body Image Quality of Life Index, psychosocial and sexual functioning measured by BREAST-Q, and satisfaction with decision measured by BREAST-Q. Linear regression analysis was used to control for presence of complication and existing history of mental health conditions. Results: A total of 70 patients completed the study. The average age of participants was 26.7. The mean Patient Health Questionnaire-9 score pre-operatively was 7.8 and postoperatively was 5.4 (P=0.001). The mean preoperative and postoperative General Anxiety Disorder-7 scores were 7.6 and 4.6, respectively (P < 0.001). There were significant improvements in both psychosocial (35 to 79.2, P < 0.001) and sexual (33.9 to 67.2, P < 0.001) functioning related to chest appearance as measured by the BREAST-Q and global psychosocial functioning (-15.6 to +32, P < 0.001) as measured by the Body Image Quality of Life Index. Satisfaction with chest contour (14.3 to 93.8, P < 0.001) and nipple appearance (29.3 to 85.9, P < 0.001) measured by the BODY-Q significantly improved. Patients had a mean satisfaction with outcome score of 93.1. Conclusions: Patients undergoing gender-affirming mastectomy in this single-center prospective study reported significant improvements in anxiety, depression, body image, psychosocial, and sexual functioning after this procedure. Patients were extremely satisfied with the decision to undergo this operation.

Effect of Gender-affirming Facial Feminization Surgery on Psychosocial Outcomes

“…Multivariable linear regression analyses were conducted for each of the PROMIS scores to assess the effects of the following independent variables: completion of FFS, completion of other gender-affirming surgeries, duration of hormone therapy for medical transition, presence of preexisting mental health diagnoses, socioeconomic disparities defined by the source of health insurance (private vs public), and patient-reported emotional support and companionship PROMIS scores. Independent variables selected for inclusion in the regression model was based on the potential effects of each variable on psychosocial functioning in transgender patients 27–31. All of the following assumptions were met for each model: linearity and homoscedasticity using a residual versus predicted values plot, collinearity using a variance inflation factor <2 for all predictors for each model, independence of residuals using a Durbin-Watson criteria of 1.5 to 2.5, and normality of residuals using a visual inspection of the P-P plot.…”

“…Independent variables selected for inclusion in the regression model was based on the potential effects of each variable on psychosocial functioning in transgender patients. [27][28][29][30][31] All of the following assumptions were met for each model: linearity and homoscedasticity using a residual versus predicted values plot, collinearity using a variance inflation factor <2 for all predictors for each model, independence of residuals using a Durbin-Watson criteria of 1.5 to 2.5, and normality of residuals using a visual inspection of the P-P plot. Statistical analyses were performed using SPSS, Version 27.0 (SPSS Inc., Chicago, IL) with a significance threshold of P value < 0.05.…”

Long-Term Regret and Satisfaction With Decision Following Gender-Affirming Mastectomy

“…Individual studies have also shown low rates of regret but have been limited by sample size and measurements that relied on chart review, ad hoc instruments, and use of changes in gender identity postoperatively as a proxy measure . While prospective studies have shown high short-term satisfaction with decision, follow-up time has remained limited, ranging from months to 1 year . The lack of data surrounding satisfaction with decision and decisional regret leaves clinicians unable to counsel patients on these important long-term outcome measures and legislators ill-equipped to draft evidence-based policy.…”

“…[4][5][6][7][8][9] While prospective studies have shown high short-term satisfaction with decision, follow-up time has remained limited, ranging from months to 1 year. 10,11 The lack of data surrounding satisfaction with decision and decisional regret leaves clinicians unable to counsel patients on these important long-term outcome measures and legislators ill-equipped to draft evidence-based policy.…”

Developing Gender-Affirming Surgery Curricula for Plastic Surgery Residency and Fellowship via Delphi Consensus

“…3,4 Gender-affirming surgery (GAS) helps alleviate gender dysphoria, improves quality of life, and reduces negative health outcomes. [5][6][7] Increased awareness as well as expansion of insurance coverage have led to an increase in the number of GAS surgeons and procedures. 8,9 GAS represents a constellation of procedures, and multiple surgical specialties are involved, including plastic and reconstructive surgery (PRS), otolaryngology, gynecology, and urology.Background: Gender-affirming surgery (GAS) is a rapidly growing field within plastic surgery, and residents and fellows must receive appropriate training.…”