- This study addressed the clinical question of whether patient-reported outcomes persist several years after gender-affirming mastectomy.
- Researchers conducted a cross-sectional survey of 152 individuals, with a median 3.4 years post-surgery, between February and July 2022.
- Participants reported high satisfaction, with median BODY-Q Chest scores of 87/100 and GCLS Chest scores of 5.0/5.0.
- The authors concluded that gender-affirming mastectomy is associated with high satisfaction and psychological functioning years after surgery.
- These findings provide evidence supporting the persistent benefits of gender-affirming mastectomy for patients and providers.
Sustained Well-being After Gender-Affirming Mastectomy
Gender-affirming care, including hormonal and surgical interventions, is recognized for alleviating gender dysphoria and improving mental health for transgender and gender-diverse individuals [1, 2, 3]. For transmasculine patients, gender-affirming mastectomy is a critical procedure for aligning physical appearance with gender identity, often undertaken with masculinizing hormone therapy [4, 5]. While studies have documented immediate postoperative improvements in body image and psychological function, a scarcity of data exists on the durability of these benefits over extended periods [1, 6]. This evidence gap creates uncertainty for clinicians and patients in shared decision-making and long-term care planning [7]. A recent study now provides needed insight into patient-reported outcomes several years following gender-affirming mastectomy.
Investigating Long-Term Patient Outcomes
While the short-term psychological and physical benefits of gender-affirming mastectomy are well-established, the central clinical question has been whether these positive outcomes persist over time. The absence of long-term, patient-reported data has been a significant limitation in the field. To address this, a new study was designed with the specific objective of moving beyond the immediate postoperative window to evaluate chest satisfaction, psychological functioning, and overall quality of life in individuals several years after their procedure.
Study Design and Outcome Measures
The researchers conducted a cross-sectional survey study between February and July 2022, gathering patient-reported outcomes at a single point in time. The study's inclusion criteria specifically targeted individuals who were more than two years postoperative from gender-affirming mastectomy, a design choice intended to capture sustained outcomes rather than transient early-phase results. To assess these outcomes, the study employed validated instruments. Satisfaction with physical results was measured using the BODY-Q Chest and Nipples scales, tools designed to quantify patient satisfaction with the appearance of the chest after surgery. To evaluate broader well-being, the researchers used the Gender Congruence and Life Satisfaction (GCLS) scale. This instrument assesses not just physical satisfaction but also the degree to which an individual's chest aligns with their internal gender identity (Chest subscale), alongside measures of overall psychological health (Psychological Functioning subscale) and life satisfaction.
Key Findings: High Satisfaction Persists
The survey yielded a robust dataset, with 152 of 237 eligible patients completing the instruments for a 64% response rate. The cohort's median age was 31 years, and the median time since surgery was 3.4 years, confirming the study's focus on long-term follow-up. The findings indicate a high degree of enduring satisfaction. Responders reported a median BODY-Q Chest score of 87 out of 100 and a median Nipples score of 90 out of 100, reflecting strong satisfaction with the surgical aesthetics years later. The psychological benefits were similarly durable. The median Gender Congruence and Life Satisfaction (GCLS) Chest score was 5.0 out of 5.0, indicating a maximal sense of alignment between their chest and gender identity. This was accompanied by a high median GCLS Psychological Functioning score of 4.8 out of 5.0 and a positive median Life Satisfaction score of 3.9 out of 5.0.
Clinical Implications and Future Directions
These findings demonstrate that gender-affirming mastectomy is associated with high, persistent satisfaction with chest appearance, psychological functioning, and overall quality of life several years after the procedure. The high scores on both the BODY-Q and GCLS scales provide quantitative evidence affirming the durable benefits of the surgery. For practicing physicians, these data offer a solid foundation for counseling patients, allowing for evidence-based discussions about the expected longevity of positive physical and psychological outcomes. The results can help manage patient expectations and support the informed consent process. For policymakers, this evidence reinforces the medical necessity of gender-affirming surgery by documenting its lasting positive impact, which can inform insurance coverage decisions. While this study provides valuable cross-sectional data, the authors suggest that future research should build on this work with multi-center, prospective studies to track outcomes over even longer periods and further solidify the understanding of the long-term effects of gender-affirming interventions.
References
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2. Cooney EE, Muschialli L, Yeh PT, et al. Provision of gender-affirming care for trans and gender-diverse adults: a systematic review of health and quality of life outcomes, values and preferences, and costs. EClinicalMedicine. 2025. doi:10.1016/j.eclinm.2025.103458
3. Shelemy L, Cotton S, Crane C, Knight MTD. Systematic review of prospective adult mental health outcomes following affirmative interventions for gender dysphoria. International Journal of Transgender Health. 2024. doi:10.1080/26895269.2024.2333525
4. Berner A, Mackenzie T, Kulkarni S, et al. Breast cancer in a transgender man. CA A Cancer Journal for Clinicians. 2025. doi:10.3322/caac.70021
5. Phuyal D, Yacoub S, Belardo ZE, Rampazzo A, Gharb BB. The Impact of Testosterone Supplementation on Surgical Complications in Gender-Affirming Mastectomy: A Meta-Analysis. Aesthetic Plastic Surgery. 2026. doi:10.1007/s00266-026-05692-8
6. Nobili A, Glazebrook C, Arcelus J. Quality of life of treatment-seeking transgender adults: A systematic review and meta-analysis. Reviews in Endocrine and Metabolic Disorders. 2018. doi:10.1007/s11154-018-9459-y
7. Scalia P, Tighe K, Elwyn G, et al. A systematic review of decision aids for gender affirming therapy. Translational Andrology and Urology. 2021. doi:10.21037/tau-20-1000