乌鸦传媒

People who underwent gender-affirming mastectomy reported high satisfaction and minimal regret over their surgical decision, a small cross-sectional study showed.

Among 139 individuals who responded to a survey 2 to 24 years after their surgery, the median score on a 5-point satisfaction scale was 5, with higher scores indicating more satisfaction, reported Megan Lane, MD, MS, of the University of Michigan in Ann Arbor, and co-authors in .

The median score on a 100-point regret scale was 0, with lower scores indicating less regret.

"Based on our prior experience with this patient population, we expected people to be very satisfied with their decision to get surgery, but we were surprised to find how little these results varied," Lane told 乌鸦传媒 in an email. "We couldn't identify characteristics associated with dissatisfaction statistically because there was very little variation in responses."

Mean satisfaction scores for survey respondents were 4.8, and mean regret scores were 4.2. No participants reported reversal procedures, and 25% of respondents underwent another gender-affirming surgery following mastectomy. At the time of surgery, 89% of respondents were taking testosterone.

"Although regret is often discussed as a serious concern surrounding gender-affirming surgery, evidence that supports this claim is limited," Lane and co-authors noted. While low rates of regret have been found in , "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," they added.

In an , Loren Schechter, MD, of Rush University Medical Center in Chicago, and co-authors noted that "when rates of regret in gender-affirming surgery are compared with other surgical interventions, the results are striking."

A systematic review found that for a variety of surgeries in other specialties, rates of satisfaction and regret were a mean of 14.4%, "higher than that reported in this study and most other studies examining gender-affirming surgery," Schechter and co-authors wrote. "Interestingly, no legislative efforts are aimed at banning these procedures."

Schechter and co-authors also highlighted the inclusion of nonbinary individuals in the study. "This study lends further support to the durability of surgical results in this population," they wrote.

The study included 139 respondents and 96 non-respondents to a survey sent to patients who had gender-affirming mastectomy at the University of Michigan between 1990 and 2020, and who were 18 or older at the time of the survey. To assess long-term satisfaction and regret after the surgery -- which is performed on transgender or nonbinary people assigned female sex at birth -- the authors surveyed patients who underwent the procedure at least 2 years ago.

Respondents and non-respondents had median ages of 27.1 and 26.4 years at the time of surgery, respectively, and the median time from surgery was 3.6 and 4.6 years, respectively. Most survey respondents were white (76%). Respondents had higher rates of a depression or anxiety diagnosis in their past medical history than nonrespondents (P<0.001).

At the time of survey completion, 63% of respondents self-reported their gender identity as male, 12% identified as nonbinary, and 21% identified with multiple gender identities.

The surveys included the scale and the , validated instruments that were developed for other patient populations, including those receiving menopause-related hormone replacement therapy, antidepressants, breast cancer treatment, and prostate cancer treatment. "Our findings suggest the need for condition-specific instruments and validation in the transgender population," Lane and colleagues observed.

Thirteen respondents had "strong discordance" between their satisfaction and decisional regret scores, which were scored on reverse scales, Lane and co-authors noted. These respondents "were noted to have high satisfaction and high regret, suggesting a possible error due to item order" after potentially misreading instructions, though these scores usually highly correlated. They were excluded for this reason.

Limitations the authors acknowledged included the cross-sectional, single-center design of the study, and variation in follow-up time, which made identifying an association between time elapsed and regret difficult. They also noted the potential misreading of survey instructions for the 13 excluded respondents and potential respondent bias.

Other details, like procedures following mastectomy performed outside the institution, and information on patient counseling, were not collected.

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