Patient-Reported Outcomes Needed for Chest Masculinization

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To the Editor:
The article, “Chest Surgery in Female to Male Transgender Individuals,” presents data on the techniques, outcomes, and complications of chest masculinization as part of gender-confirming surgery.1 The authors add important data on their experience with chest-wall contouring among the female-to-male transgender population, which are comparable with previously published data.2 With increased societal acceptance of the transgender population, more individuals may seek chest masculinization as part of gender-confirming surgery. It is of considerable importance that plastic surgeons remain up-to-date on current and best-practice techniques, such as those presented in the aforementioned article.
Aspects of gender-confirming surgery improve the quality of life of transgender patients and reduce, in part, the psychosocial sequelae faced by this population.3 However, data on patient-reported outcomes after gender-confirming surgery have been sparsely presented and are often analyzed in a nonstandardized and unreliable fashion when presented. The authors of this study are astute to these limitations and acknowledge the shortcomings of the patient satisfaction data they present. A more in-depth and standardized assessment of patient-reported outcomes, such as Breast-Q,4 could add substantially to our understanding of all outcomes of gender-confirming surgery. Currently, no such instrument exists for the transgender population. This leaves a significant deficit in the outcomes data, and we see this as a potential area for improvement in the plastic surgery literature.
Our transgender patients are often marginalized and discriminated against in the healthcare field.5 With the known benefits of gender-confirming surgery, it is crucial that our surgical research be rigorous and high quality. Chest masculinization remains the most common gender-confirming surgical procedure in the female-to-male transgender community. However, the aesthetic versus medical necessity of these procedures is often debated. Chest masculinization and feminization may offer the optimal procedures on which to focus the production of a patient-reported outcome measure similar to the Breast-Q, but for our transgender patients. Our data have the potential to impact how the public and private sectors understand, and ultimately reimburse for, these procedures.6 Therefore, efficacious and generalizable studies are needed. We should strive to not only deliver improved surgical techniques for our transgender patients, like the authors present, but also standardized and reliable data we can compare across studies to determine the effects they have on quality-of-life outcomes.
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