Gender-Based Differences in Mental Health Outcomes Following Breast Surgery: Insights from Epic Cosmos

Individuals with conditions affecting the appearance of the breast may suffer from psychosocial distress contributing to mental health disease. Breast surgery is one solution offered to mitigate these effects. Psychosocial distress of breast appearance may be experienced differently among genders. This study investigates the interplay of breast surgery, mental health conditions, and gender.

Retrospective data from 2010 to 2020 were queried from Cosmos, a national deidentified database from the Epic electronic health record, for patients diagnosed as having the nononcologic breast conditions gynecomastia, breast hypertrophy or macromastia, and asymmetry. Patients were divided into male and female cohorts. Primary outcomes compared the rates of anxiety, depression, and suicidality in those who did or did not receive breast surgery.

There were 232,138 patients with breast diagnoses, 30,521 (13.15%) of whom underwent breast surgery. Mental health diagnoses were significantly lower for female surgical patients compared with female nonsurgical patients. Males, however, demonstrated an opposite trend, in which surgical patients experienced higher rates of anxiety (24.3% vs 19.9%; P < 0.001), depression (22.4% vs 19.7%; P = 0.003), and self-harm (2.7% vs 1.6%; P < 0.001).

Breast surgery is experienced differently among genders as demonstrated by the mental health outcomes in this study. A concerning trend was identified in which males who underwent surgery were more likely to suffer from mental health conditions, most notably in the preoperative period. Enhanced gender-specific counseling may help address the heightened risk of mental health conditions, particularly in males, identified in this study.