Timing and Satisfaction in Chest Masculinization Surgery: A Transgender Quality of Life Questionnaire-Based Analysis...

This study investigated how age at the time of surgery influences patient-reported outcomes using the Transgender Quality of Life Questionnaire (TRANS-Q).

We conducted a retrospective survey from 2021 to 2023 among trans masculine individuals who underwent bilateral mastectomy at a single academic institution. The TRANS-Q was distributed postoperatively (n = 131; response rate: 49.2%). In addition, three items assessing the perceived ideal age for surgery were added. Participants were stratified into three age groups based on age at the time of surgery (16-20, 21-30, ≥31 years). Primary outcomes were group comparisons across TRANS-Q items. Secondary outcomes included predictors of (1) overall satisfaction, (2) ideal age for surgery, (3) self-confidence during sex, and (4) scar appearance. Predictors, selected based on clinical rationale, were incision technique, body mass index (BMI), mental disorder, resection weight, satisfaction scores, and age group. Analyses included nonparametric group comparisons and proportional odds logistic regression.

Across all age cohorts satisfaction scores were high. The only significant intergroup variation concerned the ideal age for surgery: younger patients expressed a preference for earlier intervention compared to older cohorts (p < 0.001). Regression models identified BMI and incision technique as relevant predictors of satisfaction and scar appearance, respectively. Mental health diagnoses were weakly associated with earlier preferred timing.

Our findings affirm the benefit of chest masculinization across age groups, while highlighting that younger patients favor earlier surgical timing. This underscores the need for age-sensitive counseling. Personalized timing strategies-rooted in autonomy-may optimize long-term outcomes in gender-affirming care.