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McCranie AS, Desjardins HE, Allenby TH, Mathes DW, Wong CJ. Patient Satisfaction Using BREAST-Q and Breast Implant Illness after Breast Reconstruction in Transwomen. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5787. [PMID: 38741598 PMCID: PMC11090625 DOI: 10.1097/gox.0000000000005787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/12/2024] [Indexed: 05/16/2024]
Abstract
Background Gender-affirming breast augmentation comprises an increasing portion of breast augmentations performed by plastic surgeons. Satisfaction and breast implant illness (BII) symptoms in this population have not been well studied. This study aimed to evaluate satisfaction and BII symptoms in transwomen who received nontextured implants as part of their breast reconstruction. Methods We conducted a retrospective review of transwomen who underwent breast augmentation for gender-affirming surgery. We performed telephone survey evaluation using the BREAST-Q questionnaire preoperatively, 6 months and 1 year after breast implant placement. Survey evaluation asking about BII symptoms was also administered at the same time points. Results Twenty-six patients completed the BREAST-Q survey, which demonstrated significantly improved satisfaction postoperatively at 6 and 12 months when compared with median preoperative scores for psychosocial (P < 0.001; P < 0.001), sexual (P < 0.001; P < 0.001), and overall satisfaction with breasts (P < 0.001; P < 0.001). Physical well-being of the chest decreased at 6 months (P < 0.001) but improved in comparison with 12 months (P < 0.001). Thirty-four patients completed the BII survey, with 18% reporting symptoms at 3 months and 29% at 1 year. Zero patients requested explantation. Conclusions Transwomen exhibit a significant increase in breast, psychosocial, and sexual well-being after breast augmentation. However, patients experienced a decreased physical well-being, and many report symptoms associated with BII. These results can be used to better counsel these individuals preoperatively and set reasonable postoperative expectations. Further studies investigating long-term satisfaction in larger cohorts are needed.
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Affiliation(s)
- Alec S. McCranie
- From Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Haley E. Desjardins
- From Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Taylor H. Allenby
- From Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - David W. Mathes
- From Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Corrine J. Wong
- Division of Plastic and Reconstructive Surgery, Denver Health, Denver, Colo
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Sanchez Figueroa N, Kuruoglu D, Fahradyan V, Tran N, Sharaf B, Martínez-Jorge J. Feminizing Gender Affirming Breast Surgery: Procedural Outcomes at a Single Academic Institution. Aesthet Surg J Open Forum 2024; 6:ojae032. [PMID: 38813116 PMCID: PMC11134292 DOI: 10.1093/asjof/ojae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024] Open
Abstract
Background Implant-based breast augmentation is a gold standard procedure for transfeminine patients to create a more feminine-appearing chest. In many cases, ancillary procedures are performed simultaneously to achieve an optimal aesthetic result. Objectives To determine the clinical outcomes of patients undergoing feminizing gender-affirming breast surgery in a single academic institution. Methods A retrospective electronic chart review of feminizing gender-affirming breast surgery patients at Mayo Clinic, Rochester, from 2017 to 2022 was conducted. Patients' demographics and surgical outcomes were gathered. A survival analysis was performed to obtain the time-to-event complication rate. Results Over 5 years, 46 patients (92 breasts) were included. The mean age was 39 years (standard deviation [SD] ±15), and most had an above-normal body mass index (BMI) (58.7%). Thirty (65%) had previous gender-affirming surgeries. The mean implant volume was 289 mL (SD ±95; 140-520). Most implants were placed in a subglandular plane (81%) with an inframammary fold incision (91.3%). All implants used were smooth, round cohesive silicone gel implants. Ancillary procedures were performed in 32 patients (69.57%). Eight patients presented complications (4 major vs 4 minor) in a median postoperative follow-up of 372 vs 392 days; at 1-month follow-up, the probability of a complication having occurred is 2.17% (95% CI: 0%-6.3%) vs 5% (95% CI: 0%-11.5%), and at 1 year, the probability is 10.21% (95% CI: 0%-20.9%) vs 12.5% (95% CI: 0%-23.4%), which remains the same up to 4 years. Conclusions Breast augmentation with implants is a safe procedure to achieve feminization of the breast with a low rate of complications. Level of Evidence 4
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Affiliation(s)
| | | | | | | | | | - Jorys Martínez-Jorge
- Corresponding Author: Dr Jorys Martinez-Jorge, 200 1st Street SW, Rochester, MN 55905, USA. E-mail:
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Knoedler S, Knoedler L, Geldner B, Ghanad I, Kim BS, Alfertshofer M, Machens HG, Broer PN, Pomahac B, Kauke-Navarro M, Paik AM. Isolated and combined breast augmentation in transgender patients: Multi-institutional insights into early outcomes and risk factors. J Plast Reconstr Aesthet Surg 2024; 90:149-160. [PMID: 38367411 DOI: 10.1016/j.bjps.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND The increasing demand for gender-affirming surgery (GAS) in transgender and gender-diverse healthcare highlights the importance of breast augmentation surgery (BAS) for transfeminine patients. Despite its significance, there is a lack of research on postoperative outcomes of BAS. METHODS We analyzed the multi-institutional American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) (2008-2021) database to identify female transgender individuals (TGIs) who underwent BAS surgery, both isolated and combined with concurrent GAS procedures. We evaluated 30-day outcomes, including the incidence of mortality, reoperation, readmission as well as surgical and medical complication occurrence. RESULTS Of 1699 female TGIs, 92% underwent isolated BAS and 7.7% underwent combined BAS. The mean age and body mass index (BMI) were 36 ± 12 years and 27 ± 6.6 kg/m2, respectively. Isolated BAS showed a 2.8% complication rate, while combined BAS had a higher rate with 9.1%. Specifically, all complications occurred in patients undergoing BAS with concurrent genitourinary surgery (n = 85; 14%), whereas no adverse events were recorded after combined BAS and facial feminization (n = 19) or chondrolaryngoplasty (n = 19). In patients seeking combined BAS, advanced age (p = 0.05) and nicotine abuse (p = 0.004) were identified as risk factors predisposing to adverse events, whereas American Society of Anesthesiology class 1 was found to be protective (p = 0.02). CONCLUSIONS Isolated BAS in TGIs demonstrates a positive safety profile. Combined surgeries, particularly with genitourinary procedures, pose higher risks. Identifying risk factors such as smoking and advanced age is crucial for patient selection and surgical planning. These findings can aid in refining patient eligibility and inform surgical decision-making for BAS.
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Affiliation(s)
- Samuel Knoedler
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA; Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Leonard Knoedler
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Benedikt Geldner
- Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Iman Ghanad
- Department of Hand-, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - Bong-Sung Kim
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Michael Alfertshofer
- Division of Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Hans-Guenther Machens
- Department of Plastic Surgery and Hand Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Peter Niclas Broer
- Department of Plastic, Reconstructive, Hand and Burn Surgery, Bogenhausen Academic Teaching Hospital, Munich, Germany.
| | - Bohdan Pomahac
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
| | - Martin Kauke-Navarro
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
| | - Angie M Paik
- Division of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, USA.
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4
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Kamran R, Jackman L, Chan C, Suk Y, Jacklin C, Deck E, Wietek N, Stepney M, Harrison C, Jain A, Rodrigues J. Implementation of Patient-Reported Outcome Measures for Gender-Affirming Care Worldwide: A Systematic Review. JAMA Netw Open 2023; 6:e236425. [PMID: 37010869 PMCID: PMC10071345 DOI: 10.1001/jamanetworkopen.2023.6425] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/12/2023] [Indexed: 04/04/2023] Open
Abstract
Importance Gender-affirming care is a key clinical area that can benefit from implementation of patient-reported outcome measures (PROMs). Identifying barriers to and enablers of PROM implementation is needed to develop an evidence-based implementation strategy. Objective To identify (1) PROMs previously implemented for gender-affirming care and constructs measured, (2) how patients completed PROMs and how results were reported and used, and (3) barriers to and enablers of PROM implementation. Evidence Review In this systematic review, PubMed, Embase, MEDLINE, PsycINFO, CINAHL, and Web of Science were searched from inception to October 25, 2021, and updated on December 16, 2022. Gray literature was searched through gray literature database, online search engine, and targeted website searching. Inclusion criteria were (1) original articles of (2) a formally developed PROM or ad hoc instrument administered for gender-affirming care to (3) patients accessing gender-affirming care. The Critical Appraisal Skills Programme tool was used to evaluate quality of included studies. This review was registered on PROSPERO (CRD42021233080). Findings In total, 286 studies were included, representing 85 395 transgender and nonbinary patients from more than 30 countries. A total of 205 different PROMs were used in gender-affirming care. No studies described using an implementation science theory, model, or framework to support PROM deployment. Key barriers to PROM implementation included issues with evidence strength and quality of the PROM, engaging participants, and PROM complexity. Key enablers of PROM implementation included using PROMs validated for gender-affirming care, implementing PROMs able to be deployed online or in person, implementing PROMs that are shorter and reduce patient burden, engaging key stakeholders and participants as part of developing an implementation plan, and organizational climate. Conclusions and Relevance In this systematic review of barriers to and enablers of PROM implementation in gender-affirming care, PROM implementation was inconsistent and did not follow evidence-based approaches in implementation science. There was also a lack of patient input in creating implementation strategies, suggesting a need for patient-centered approaches to PROM implementation. Frameworks created from these results can be used to develop evidence-based PROM implementation initiatives for gender-affirming care and have potential generalizability for other clinical areas interested in implementing PROMs.
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Affiliation(s)
- Rakhshan Kamran
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Liam Jackman
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia Chan
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Yujin Suk
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Eve Deck
- Department of Family Medicine, Western University, London, Ontario, Canada
| | - Nina Wietek
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Melissa Stepney
- Centre for Academic Primary Care, University of Bristol, Bristol, United Kingdom
| | - Conrad Harrison
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Abhilash Jain
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Jeremy Rodrigues
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
- Department of Plastic Surgery, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, United Kingdom
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Swami V, Todd J, Tylka TL. Measuring positive breast experience: Development and psychometric evaluation of the Breast Appreciation Scale (BrAS). Body Image 2022; 43:275-291. [PMID: 36206650 DOI: 10.1016/j.bodyim.2022.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/08/2022] [Accepted: 09/20/2022] [Indexed: 11/06/2022]
Abstract
Existing measures of women's breasted experiences have focused on negative experiences, which de-centres women's meaning-making and relationships with their breasts. To rectify this, we developed a novel measure of women's positive breasted experiences, the Breast Appreciation Scale (BrAS), and examined the psychometric properties of this novel measure across four studies. Study 1, with 307 United Kingdom women, led to the extraction of a 9-item, unidimensional model of BrAS scores that showed adequate composite reliability and 4-week test-retest reliability. Study 2, with 297 United Kingdom women, showed that the unidimensional model of BrAS scores had adequate fit and evidenced convergent, concurrent, discriminant, and incremental validity. Study 3, with 295 women from the United Kingdom, provided additional support for factorial validity and concurrent validity, and additionally provided evidence of known-groups validity insofar as mothers had greater breast appreciation than non-mothers. Study 4 showed that the BrAS was scalar invariant across women from Australia, the United Kingdom, and the United States (N = 573) and provided additional evidence of concurrent validity. Based on these results, we conclude that the BrAS is a psychometrically valid measure of women's positive breasted experiences that can be utilised in future research.
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Affiliation(s)
- Viren Swami
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, United Kingdom; Centre for Psychological Medicine, Perdana University, Kuala Lumpur, Malaysia.
| | - Jennifer Todd
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, United Kingdom; Centre for Psychological Medicine, Perdana University, Kuala Lumpur, Malaysia
| | - Tracy L Tylka
- Department of Psychology, The Ohio State University, Columbus, OH, United States
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