Assessing post-op quality of life (QOL) and patient-reported satisfaction with transgender top surgery (male chest wall reconstruction) at NYU Langone Medical Center
Grace Poudrier, B.A., Whitney Saia, FNP-C, Alexes Hazen, MD.
NYU Langone Medical Center, New York, NY, USA.
Background: The construction of an aesthetically pleasing male chest is typically the first and oftentimes the only gender-affirming surgical procedure sought by transmasculine individuals, initiated by patients who wish to align their physical body (chest wall) with a preferred gender identity. Technical goals of this procedure include the removal of breast tissue and excess skin, proper repositioning and reshaping of the nipple-areola complex (NAC), and the minimization of chest wall scars. Despite the immense practical importance of top surgery in the transition process, literature on long-term patient satisfaction and associated Quality of Life metrics in scarce.
Methods: An original survey —designed to gauge post-op quality of life, satisfaction with top surgery outcomes, and patient-reported barriers to accessing top surgery in the NYC/tristate area —was distributed to 100 former top surgery patients via email. Completion of the online survey was voluntary, subjects did not receive any compensation for participating, and responses were anonymous. All participants were at least 3 months post-operative.
Quantitative and qualitative data were collected in the following domains:
1) Patient-reported satisfaction with the functional and aesthetic outcomes of their top surgery
2) Barriers encountered (if any) in the surgical decision making process
3) Chest binding history and associated health outcomes
4) Pre- versus post-op Quality of Life and sexual satisfaction
5) Short and long term satisfaction with decision to undergo top surgery
To date, 55 participants have completed the survey.
RESULTS: Time elapsed since top surgery ranged from 3 months to 8+ years post-operative. For self-reported gender identity, the majority of participants identified as ‘trans man' (65.96%) or as ‘male' (44.68%), followed by ‘genderqueer/ gender non-conforming' (19.15%) and ‘different identity (please state)' (6.38%). For 98% of respondents, top surgery was their first transition-related surgery. Average age at time of surgery was 32 years (range: 21-58 years). Duration of pre-operative chest binding ranged from 3 months-20+ years (mean: 4.8; median 3.5 years). The practice of chest binding was independently associated with 33 different self-reported negative health outcomes (e.g.: skin irritation, asthma, chest pain/tightness, back pain, physical discomfort, overheating, acne).
In the surgical decision making process, ‘financial barriers' and ‘lack of insurance coverage' were the most frequently reported barriers, followed by ‘difficulty finding a surgeon I liked and trusted.' Upon comparison of pre versus post-op self-reported QOL and sexuality scores, statistically significant increases were noted in the following domains (95% confidence interval): self-confidence, mental health, bodily satisfaction, social functioning, sexual confidence, and sexual satisfaction. Zero respondents reported post-operative regret.
Conclusion: In the surgical decision making processes of NYC/tristate area patients, two factors— (1) lack of insurance coverage and (2) lack of trans-competent plastic surgeons who take insurance— stand out as underemphasized barriers to medically necessary transition-related health care.
As funding for transgender top surgery continues to be disputed by public and private insurance companies throughout the U.S, our findings contribute to a much-needed body of evidence that top surgery improves the QOL and mental health of transmasculine individuals to a marked extent.
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