Psychosocial Benefits of Gender Affirming Surgery

New survey data published in Plastic and Reconstructive Surgery, is the first of its kind to assess patient quality of life (QoL) after gender affirming surgery. 

Gender affirming surgery can help transgender patients that suffer from gender dysphoria feel more comfortable in their bodies and has been associated with decreased rates of mental health disorders and improved psychosocial function.¹ 

Currently, BREAST-Q is used as a patient-reported outcomes tool for cisgender females after breast reconstruction. Although this included improvement in QoL, it was specified for cisgender individuals. 

The study’s objective was to create a survey for transgender male patients (transmen) undergoing chest surgery and to test outcomes by administering the survey to patients before and after the procedure. 

There were 8 key domains identified when creating the survey: gender dysphoria, gender attribution, social integration, participation in activity and employment, freedom from persecution or discrimination, financial barriers, provider competence, and physical health and recovery.

The University of California, San Francisco (UCSF), Gender QoL survey was given to 51 transmen who met the standard World Professional Association for Transgender Health criteria for chest surgery. They also had to be scheduled to undergo bilateral subcutaneous inframammary mastectomies with free-nipple grafting performed by a single surgeon at UCSF starting in 2016 through 2018. 

The surveys were emailed using the Research Electronic Data Capture survey tool to patients at 6 weeks and then 1 year after surgery. Reminder emails, up to 3, were sent as necessary. There were 3 points in the study where patients also completed a previously validated generic QoL measure—the World Health Organization Quality of Life–Brief Form—for comparison.

The median age of patients was 30 years old. About 82% of patients identified as male, a majority of them being White (69%) and college educated (58%). More than half of those surveyed reported a history of anxiety and/or depression and 18% reported being unemployed at the time of surgery.

While baseline QoL scores were collected for 51 participants, 36 patients (71%) completed postoperative surveys at Week 6 and 22 patients (43%) completed surveys at Year 1. This resulted in only 35% of patients completing surveys at all 3 time points. 

The results of the World Health Organization Quality of Life–Brief Form survey demonstrated a statistically significant increase in the median quality of life 1 year after surgery with the largest improvements seen in the psychological health and the social health categories. 

The USCF Gender QoL survey detected a larger improvement in QoL at Week 6 and Year 1 after surgery. All 6 of the surveyed categories saw improvement: psychological, social, physical, environmental, gender identity, social health, and physical appearance. The largest improvement was in physical appearance section, followed by social health and gender identity. The effect sizes were larger in the UCSF Gender QoL compared to the World Health Organization survey. 

Every patient surveyed after surgery reported they would choose to undergo the procedure again knowing what they do at present. Of those surveyed at Year 1, 61% of patients agreed that they were satisfied with the appearance of their scars and 9% were not. The surveyed also asked about different public and private situations, with 96% of patients feeling comfortable in the workplace, 43% were comfortable with their chest exposed at the beach or pool, and 83% felt comfortable around their partner with their chest exposed. 

While there are limitations, note the study investigators, the UCSF Gender QOL survey is one of the first patient-reported outcomes tools for evaluating QoL in trans male patients after gender affirming chest reconstruction. This survey will provide a tool for future research into various aspects of gender affirming surgery. 

Reference:

1. Alcon A, Kennedy A, Wang E, et al. Quantifying the Psychosocial Benefits of Masculinizing Mastectomy in Trans Male Patients with Patient-Reported Outcomes: The University of California, San Francisco, Gender Quality of Life Survey. Plastic & Reconstructive Surgery. 2021;147(5):731e-740e.