Patient-Reported Outcome (PROMIS) Scores Improve After Gender-Affirming Mastectomy

Ad hoc and patient-reported outcome measures not specific to transgender surgery limit assessment of the impact of gender-affirming procedures. Patient-Reported Outcomes Measurement Information System (PROMIS) was developed as an objective and validated instrument to measure patient-related outcomes. In our study, we aimed to describe and analyze mean T-score changes in PROMIS before and after gender-affirming mastectomy.

A single-institution retrospective review of a prospectively maintained database was conducted on patients undergoing gender-affirming mastectomy (GAM) between October 2016 and July 2023. Along with demographic data, PROMIS T-scores for different health domains related to gender dysphoria were collected preoperatively and at postoperative months 1, 3, and 6. Tukey-Kramer adjustment statistical analysis and linear mixed-effect model were employed to accommodate both fixed and random effects from nonindependence in the data with adjusted P < 0.05 being considered statistically significant.

A total of 185 patients were included. The average age was 23.7 years. Seven percent of patients were identified as nonbinary; 91% received preoperative hormonal therapy. Furthermore, 87.7% completed the survey on postoperative month 1 (POM1), 68.3% on POM3, and 47.5% on POM6. Baseline anxiety was found significantly worse (T-score, 60.4) compared to general US population. Satisfaction with social roles, anxiety, depression, social isolation, and anger demonstrated significantly improved T-scores after GAM on POM1, 3, and 6 compared to preoperative values.

Female-to-male transgender patients undergoing GAM demonstrated lasting improvements in satisfaction with social roles, anxiety, depression, social isolation, and anger over the period of 6 months postoperatively. PROMIS represents a relevant and useful tool to measure patient-reported outcomes in patients undergoing gender-affirming surgery.