Mona Ascha1, Daniel C Sasson1, Rachita Sood1, Jeremy W Cornelius2, Jacob M Schauer3, Adariane Runge4, Abigail L Muldoon4, Noopur Gangopadhyay5, Lisa Simons4,6, Diane Chen4,5,6,7, Julia F Corcoran8, Sumanas W Jordan1. 1. Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 2. Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 3. Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 4. Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois. 5. Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. 6. Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 7. Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 8. Division of Plastic, Reconstructive and Cosmetic Surgery, University of Illinois at Chicago, Chicago.
Abstract
Importance: Transgender and nonbinary (TGNB) adolescents and young adults (AYA) designated female at birth (DFAB) experience chest dysphoria, which is associated with depression and anxiety. Top surgery may be performed to treat chest dysphoria. Objective: To determine whether top surgery improves chest dysphoria, gender congruence, and body image in TGNB DFAB AYA. Design, Setting, and Participants: This is a nonrandomized prospective cohort study of patients who underwent top surgery between December 2019 and April 2021 and a matched control group who did not receive surgery. Patients completed outcomes measures preoperatively and 3 months postoperatively. This study took place across 3 institutions in a single, large metropolitan city. Patients aged 13 to 24 years who presented for gender-affirming top surgery were recruited into the treatment arm. Patients in the treatment arm were matched with individuals in the control arm based on age and duration of testosterone therapy. Exposures: Patients in the surgical cohort underwent gender-affirming mastectomy; surgical technique was at the discretion of the surgeon. Main Outcomes and Measures: Patient-reported outcomes were collected at enrollment and 3 months postoperatively or 3 months postbaseline for the control cohort. The primary outcome was the Chest Dysphoria Measure (CDM). Secondary outcomes included the Transgender Congruence Scale (TCS) and Body Image Scale (BIS). Baseline demographic and surgical variables were collected, and descriptive statistics were calculated. Inverse probability of treatment weighting (IPTW) was used to estimate the association of top surgery with outcomes. Probability of treatment was estimated using gradient-boosted machines with the following covariates: baseline outcome score, age, gender identity, race, ethnicity, insurance type, body mass index, testosterone use duration, chest binding, and parental support. Results: Overall, 81 patients were enrolled (mean [SD] age, 18.6 [2.7] years); 11 were lost to follow-up. Thirty-six surgical patients and 34 matched control patients completed the outcomes measures. Weighted absolute standardized mean differences were acceptable between groups with respect to body mass index, but were not comparable with respect to the remaining demographic variables baseline outcome measures. Surgical complications were minimal. IPTW analyses suggest an association between surgery and substantial improvements in CDM (-25.58 points; 95% CI, -29.18 to -21.98), TCS (7.78 points; 95% CI, 6.06-9.50), and BIS (-7.20 points; 95% CI, -11.68 to -2.72) scores. Conclusions and Relevance: Top surgery in TGNB DFAB AYA is associated with low complication rates. Top surgery is associated with improved chest dysphoria, gender congruence, and body image satisfaction in this age group.
Importance: Transgender and nonbinary (TGNB) adolescents and young adults (AYA) designated female at birth (DFAB) experience chest dysphoria, which is associated with depression and anxiety. Top surgery may be performed to treat chest dysphoria. Objective: To determine whether top surgery improves chest dysphoria, gender congruence, and body image in TGNB DFAB AYA. Design, Setting, and Participants: This is a nonrandomized prospective cohort study of patients who underwent top surgery between December 2019 and April 2021 and a matched control group who did not receive surgery. Patients completed outcomes measures preoperatively and 3 months postoperatively. This study took place across 3 institutions in a single, large metropolitan city. Patients aged 13 to 24 years who presented for gender-affirming top surgery were recruited into the treatment arm. Patients in the treatment arm were matched with individuals in the control arm based on age and duration of testosterone therapy. Exposures: Patients in the surgical cohort underwent gender-affirming mastectomy; surgical technique was at the discretion of the surgeon. Main Outcomes and Measures: Patient-reported outcomes were collected at enrollment and 3 months postoperatively or 3 months postbaseline for the control cohort. The primary outcome was the Chest Dysphoria Measure (CDM). Secondary outcomes included the Transgender Congruence Scale (TCS) and Body Image Scale (BIS). Baseline demographic and surgical variables were collected, and descriptive statistics were calculated. Inverse probability of treatment weighting (IPTW) was used to estimate the association of top surgery with outcomes. Probability of treatment was estimated using gradient-boosted machines with the following covariates: baseline outcome score, age, gender identity, race, ethnicity, insurance type, body mass index, testosterone use duration, chest binding, and parental support. Results: Overall, 81 patients were enrolled (mean [SD] age, 18.6 [2.7] years); 11 were lost to follow-up. Thirty-six surgical patients and 34 matched control patients completed the outcomes measures. Weighted absolute standardized mean differences were acceptable between groups with respect to body mass index, but were not comparable with respect to the remaining demographic variables baseline outcome measures. Surgical complications were minimal. IPTW analyses suggest an association between surgery and substantial improvements in CDM (-25.58 points; 95% CI, -29.18 to -21.98), TCS (7.78 points; 95% CI, 6.06-9.50), and BIS (-7.20 points; 95% CI, -11.68 to -2.72) scores. Conclusions and Relevance: Top surgery in TGNB DFAB AYA is associated with low complication rates. Top surgery is associated with improved chest dysphoria, gender congruence, and body image satisfaction in this age group.
Authors: Nicholas G Cuccolo; Christine O Kang; Elizabeth R Boskey; Ahmed M S Ibrahim; Louise L Blankensteijn; Amir Taghinia; Bernard T Lee; Samuel J Lin; Oren Ganor Journal: Aesthetic Plast Surg Date: 2019-08-26 Impact factor: 2.326
Authors: Jamie E Mehringer; Jacqueline B Harrison; Kit M Quain; Judy A Shea; Linda A Hawkins; Nadia L Dowshen Journal: Pediatrics Date: 2021-02-03 Impact factor: 7.124
Authors: Grace Poudrier; Ian T Nolan; Tiffany E Cook; Whitney Saia; Catherine C Motosko; John T Stranix; Jennifer E Thomson; M David Gothard; Alexes Hazen Journal: Plast Reconstr Surg Date: 2019-01 Impact factor: 4.730
Authors: Rachita Sood; Diane Chen; Abigail L Muldoon; Liqi Chen; Mary J Kwasny; Lisa K Simons; Noopur Gangopadhyay; Julia F Corcoran; Sumanas W Jordan Journal: J Adolesc Health Date: 2021-04-10 Impact factor: 5.012
Authors: Tim C van de Grift; Peggy T Cohen-Kettenis; Thomas D Steensma; Griet De Cuypere; Hertha Richter-Appelt; Ira R H Haraldsen; Rieky E G Dikmans; Susanne C Cerwenka; Baudewijntje P C Kreukels Journal: Arch Sex Behav Date: 2015-10-16