Little regret, high satisfaction years after gender-affirming mastectomy

Key takeaways:

• More than 2 years after surgery, the median satisfaction score for gender-affirming mastectomy was the highest possible rating.
• None of the adults who underwent gender-affirming mastectomy requested reversal.

Individuals who underwent gender-affirming mastectomy reported low rates of regret and high levels of satisfaction more than 2 years after surgery, according to a cross-sectional survey study published in JAMA Surgery.

“Gender-affirming mastectomy is the most common gender-affirming procedure in the U.S. and is performed on transgender or nonbinary individuals who were assigned female sex at birth,” Lauren Bruce, BA, from the University of Michigan Medical School, Ann Arbor, and colleagues wrote. “We aimed to measure long-term satisfaction with decision and decisional regret using previously validated instruments in individuals who had gender-affirming mastectomy more than 2 years ago in order to inform patients considering gender-affirming mastectomy and policymakers regulating these operations.”

Bruce and colleagues conducted a cross-sectional survey study of 235 adults who underwent gender-affirming mastectomy at a U.S. referral center from 1990 to February 2020. All participants were sent a survey of patient-reported outcomes from February to July 2022.

The primary outcome was long-term patient-reported outcomes measured by the Holmes-Rovner Satisfaction with Decision Scale and the Decision Regret Scale.

Postoperative time for respondents ranged from 2 to 23.6 years. Overall, 139 (59.1%) patients with a median age of 27.1 years at the time of surgery responded to the survey. The 96 nonrespondents had a median age of 26.4 years at the time of surgery with a longer postoperative follow-up period (median, 4.6 vs. 3.6 years; P = .002) and lower rates of depression (44% vs. 68%; P < .001) and anxiety (44% vs. 70%; P < .001) compared with respondents, according to past medical history at the time of surgery.

Researchers noted that none of the respondents nor the nonrespondents requested or underwent a reversal procedure for gender-affirming mastectomy.

Of respondents, the median Holmes-Rovner Satisfaction with Decision Scale score was 5 on a 5-point scale, indicating the highest satisfaction with surgery. In addition, the median Decision Regret Scale score was 0 on a 100-point scale, indicating the lowest levels of regret after surgery.

According to the researchers, these findings suggest the need for instruments calibrated specifically to the experience of undergoing gender-affirming surgery.

“While prospective, multicenter work is needed, these results are consistent with previous ad hoc studies and affirm the overwhelmingly low levels of regret following gender-affirming surgery,” the researchers wrote.