A small study has found that even after a long time, patients are satisfied with the surgery.
The study published in JAMA Surgery on Wednesday shows that women who underwent a mastectomy to affirm their gender, also known as top surgery, experienced extremely low levels of regret about the decision and high levels of satisfaction.
The study stated that the results were 'overwhelmingly positive' compared with other medical and non-medical decisions.
Not everyone who receives gender affirming care will undergo surgery. Most people who undergo surgery do so as a last step in their medical transition.
The procedure of gender-affirming breast surgery is to shape the skin and tissue on the chest of transmasculine people or those who are nonbinary, so that it aligns with what is commonly thought of as the male chest. The study states that it's the most popular gender-affirming surgery in the US.
Researchers surveyed 235 women who underwent a gender affirming mastectomy at University of Michigan. The survey was conducted in the past year when the participants had between 2 and 23.6% of their surgeries behind them.
The survey measures the quality of life after surgery. The survey wasn't designed specifically for trans patients, but it is used by oncologists to gauge how people feel about treatment and screening. The survey can be used to assess how someone feels about medical procedures in non-clinical settings.
Nearly 60% of the participants correctly answered the survey and returned it to researchers. The median score on the Satisfaction with Decision Scale was 5, indicating highest level of satisfaction. The median Decision Regret Scale was zero on a scale of 100 points, which means that not one patient regretted having the surgery.
No survey respondent underwent a reversal. The study found that about a quarter of respondents underwent a gender affirming procedure following their mastectomy. This suggests 'consistent and sustained decision-making'.
In order for future research to be generalizable and to include people from multiple medical centers, the authors of the study said that the research only involved a single center. Researchers say that because the follow-up times vary, there is also a chance of bias.
The research builds upon earlier studies that showed a high level of satisfaction among those who underwent a form of surgery as part of gender affirming care. Many of these studies were based on short-term satisfaction survey results.
A review of several studies published in 2021 looked at patients' satisfaction levels after surgery, both short- and long term. It found that only 1% of transfeminine or transmasculine women regretted their decision.
Oscar Manrique, co-author of the review and not involved in the new study, said: "I was surprised that the regret rate is very, very, low."
Manrique, a surgeon at the University of Rochester Medical Center School of Medicine and Dentistry, said, "I thought we'd have a higher number of regrets like we do sometimes with other types of surgery." I believe that the reason why the US has such a low regret rate, is because of the strict guidelines for these surgeries.
Before a patient can undergo surgery at most medical centers they are required to participate in holistic treatment, which involves a multidisciplinary team of doctors. Most people get therapy and do other things to deal with gender dysphoria. This is the distress that can be felt by a person due to their gender, which may include anxiety or depression, low self esteem, self harm, suicide, or trauma-related responses such as hypervigilance.
The majority of US medical centers adhere to the guidelines set forth by the World Professional Association for Transgender Health. The guidelines state that a person must be able to consent to treatment and make an informed decision in order to qualify for a mastectomy. The patient must be of legal age and have serious medical or mental concerns that can be controlled reasonably at the time surgery. Hormone treatment is not required for surgery.
Guidelines also stipulate that the person has to have a persistent and well-documented case of gender dysphoria. This means that a surgery is usually something they've been considering for some time.
Manrique explained that it's not like we'd just do surgery if Mary and John decided to come in and say "hey, I'm having surgery today." Manrique said that a patient is assessed from head-to-toe and we then go over their expectations and the risks and benefits associated with any surgery. This is why I think the regret rate for surgery is so low. These guidelines provide patients with access to adequate medical treatment.
Dozens have passed laws restricting gender affirming treatment. This will likely be a hot topic in the future, but almost every major medical organization has acknowledged that gender-affirming surgery is a medical need.
Even if it is life-saving, a gender-affirming operation can transform an adult's life.
Manrique stated that the program "changes their lives completely, allows them to become more productive and confident in society and to allow someone to fully live their lives." 'That's huge.'
In an editorial that was published along with the new study by Dr. Loren Shechter of Rush University Medical Center, Chicago, he wrote: 'When rates of regret for gender-affirming surgeries are compared to other surgical interventions the results are shocking.
The editorial stated that a review of satisfaction and remorse surveys across a variety of surgical specialties revealed a mean regret rate of 14.4%. This means many more people regret surgery of other types than those who have gender affirming surgery.
The commentary stated that 'interestingly, no legislative efforts have been made to ban these procedures.