High levels of satisfaction, and low levels of regret, after gender affirming mastectomy

Gender-affirming mastectomies for transmasculine and nonbinary individuals can be life changing.

Recent research from the University of Michigan finds that in addition to changing lives, most patients are highly satisfied with their decision to undergo surgery longterm.  

The study published in JAMA Surgery aimed to determine how patients who received a gender affirming mastectomy at a single major health system felt about their decision years afterward.

The research showed an overwhelmingly positive response – the median satisfaction score was a 5 on a 5-point scale, the highest possible rating. The median decision regret score was 0.0 on a 100-point scale where lower scores mean less regret.

In another indirect measure of satisfaction, none of the patients in the study pursued a reversal of their mastectomy.

The study’s authors analyzed records for 235 patients and sent a survey to all of them; 139 responded. The 139 participants were between two to 20 years out from their procedure and the median age was 27 years old.

The participants were asked a series of questions that have been validated for their ability to measure satisfaction and regret in other medical and surgical conditions.

“We wanted to make sure that our questions would produce quality data that could be compared to other conditions when looking at satisfaction and regret levels for gender-affirming care,” said Megan Lane, MD, a plastic surgery resident at Michigan Medicine and co-lead author of the paper. Lane recently completed the National Clinician Scholars Program at IHPI.

Due to low dissatisfaction numbers, it wasn’t possible to look at any reasons for or factors related to dissatisfaction with gender-affirming mastectomy.

In an invited commentary on the new paper, a trio of authors from Rush University write, "In gender-affirming surgery, concerns regarding the potential for regret are often used to deny or limit access to medically necessary care. However, when rates of regret in gender-affirming surgery are compared with other surgical interventions, the results are striking."

Lane and her co-authors say new survey tools are needed to explore this more thoroughly.

Additional authors include Lauren Bruce, B.A.; Andrew Bolze, B.A.; Maria Ibarra, M.S.; Gaines Blasdel, B.S.; from the University of Michigan Medical School, Ann Arbor. Alexander N. Khouri, M.D.; Jennifer B. Hamill, M.P.H.; Jessica J. Hsu, M.D., Ph.D.; Edwin G. Wilkins, M.D.; Megan Lane, M.D., M.S. from the Section of Plastic Surgery, University of Michigan, Ann Arbor. Shokoufeh Khalatbari, M.S. from the Michigan Insititute for Clinical Health Research, Ann Arbor, Michigan. Shane D. Morrison, M.D., M.S. from the University of Washington, Seattle, Washington.

This study was funded through the Plastic Surgery Foundation Pilot Grant Program. Biostatistical support was funded through the National Center for Advancing Translational Sciences via the Michigan Institute for Clinical and Health Research.

Paper cited: “Long-Term Regret and Satisfaction With Decision Following Gender-Affirming Mastectomy,” JAMA Surgery. 10.1001