Assessing Gender-Affirming Chest Surgery Outcomes: Does Gender Identity Alter Gaze?

Area of Science:

• Plastic surgery
• Ophthalmology
• Psychology

Background:

• Aesthetic outcomes of gender-affirming chest surgery vary.
• Nipple-areolar complex placement and scar orientation significantly impact results.
• Observer gender identity may also influence perception of surgical outcomes.

Purpose of the Study:

• To compare attention and perception of gender-affirming chest surgery outcomes between laypersons with different gender identities.
• To investigate how observer gender identity affects the assessment of chest aesthetics and perceived gender post-surgery.

Main Methods:

• Enrolled transgender and cisgender participants.
• Presented images of surgery-naïve, masculinized, and feminized chests.
• Captured gaze data using eye-tracking technology and participants scored perceived gender and aesthetics.

Main Results:

• Transgender participants fixated longer on nipples in male and feminized chests.
• Cisgender participants fixated longer on scars in masculinized and feminized chests.
• Cisgender viewers perceived feminized chests as more masculine and masculinized chests as more feminine compared to transgender viewers.

Conclusions:

• This is the first study using eye-tracking to evaluate layperson assessment of chests after gender-affirming surgery.
• Observer gender identity significantly affects visual attention and gender perception of post-surgical chests.
• Findings highlight the subjective nature of aesthetic evaluation in gender-affirming care.