Chest Masculinization Surgery: Patients Top Questions Validated by Machine Learning Analysis
Brittany Ward1, Thayer Mukherjee2, Christopher C Tseng1, Boris Paskhover3, Jonathan D Keith4
1Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers-New Jersey Medical School, Newark, NJ; 2Plastic and Reconstructive Surgery, Yale School of Medicine, New Haven, CT; 3Department of Otolaryngology, Rutgers-New Jersey Medical School, Newark, NJ; 4East Coast Advanced Plastic Surgery, Livingston, NJ
Background Treating gender dysphoria by performing gender-affirming surgery is a medical necessity that is associated with a better quality of life and lower rates of morbidity and mortality in transgender patients, however, patients are frequently exposed to low quality, biased information about the procedure. One resource is Realself.com -- a website that features high quality information on plastic surgery procedures and includes a section where users ask questions and receive answers from board certified plastic surgeons. As chest masculinization is commonly performed, we analyzed the associated questions to better inform plastic surgeons about which are most important to patients. Methods 187 questions on the topic of “FTM chest masculinization surgery” from Realself.com were collected using Scrapy, an automated web crawling tool. Each question was categorized as preoperative or postoperative, then assigned an additional category developed by the authors based on the question topics. A machine learning workflow was applied to determine the 3 most common preoperative and postoperative patient questions about chest masculinization based on our crowdsourced data. Results 64% of questions related to preoperative topics. Patients primarily asked about recommendations for the optimal surgical technique to fit their physical features and inquired about information regarding various surgical techniques and logistics. Questions about cost, insurance coverage, and surgeon availability were prevalent. The majority of post-operative questions related to complications and symptoms with 18 about nipple graft issues, 8 about surgical site swelling, 6 about sensation changes, 3 about scarring, 3 about bleeding, and 1 about general skin appearance. 4 patients expressed general dissatisfaction with their surgical result while 24 specifically asked about a revision, including questions about whether one is needed and if it is possible given the details provided by the user. Conclusions Machine learning analysis confirmed that preoperative patients were concerned about best approaches to achieve their desired appearance, while postoperative patients were focused on potential problems with their results. Interestingly, 2 preoperative questions were related to breast reduction surgery rather than chest masculinization, indicating that patients may lack an understanding about the difference between the procedures, which could lead to logistical issues. These 3 most common preoperative and postoperative questions can be utilized in a patient education handout and highlighted on a practice’s website to ensure patients can easily find the information that they are most likely seeking. This would allow surgeons to better anticipate and address patient concerns and proactively manage their surgical expectations.
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