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Saarinen M, Suominen S, Sintonen H, Kolehmainen M, Ojala K. Patient-reported satisfaction and health-related quality of life after chest masculinization in transgender men using the BODY-Q Chest module and the 15D instrument. J Plast Reconstr Aesthet Surg 2024; 96:43-49. [PMID: 39047514 DOI: 10.1016/j.bjps.2024.07.006] [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: 03/06/2024] [Revised: 05/13/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024]
Abstract
Chest masculinization is the most common surgical intervention in transgender men. Studies indicate good patient-reported postoperative satisfaction, but only recently has a patient-reported outcome instrument, the BODY-Q Chest module, been developed and validated for this patient group. This study aimed to evaluate postoperative patient-reported satisfaction and health-related quality of life (HRQoL) using the BODY-Q Chest module and the 15D after surgical chest masculinization in transgender men. The data comprised all patients receiving chest masculinization from 2005 to 2018. The patients were invited by letter to complete the BODY-Q Chest module and the 15D questionnaire in May 2020. Of the 220 patients invited, 123 completed the survey, resulting in a response rate of 56%. The median chest and nipple scores were 76 and 68 out of 100, respectively. The number of secondary corrections was negatively associated with the chest score (p value < 0.001). The 15D index score was lower compared with the age-standardized male population (p value < 0.001), but similar to the age-standardized female population. Psychiatric comorbidity was associated with lower 15D index scores (p value < 0.001). There were no statistically significant differences between the BODY-Q Chest module scores or the 15D index score among the different surgical techniques. The postoperative satisfaction with chest masculinization was good and in line with previous literature. HRQoL resembles that of the reference population. The periareolar technique is not associated with better satisfaction despite causing less scar burden. The negative association between the chest score and number of secondary corrections is unsettling and requires further examination in a prospective setting.
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Affiliation(s)
- Mirjam Saarinen
- Department of Plastic Surgery, Helsinki University Hospital and the University of Helsinki, Helsinki, Finland.
| | - Sinikka Suominen
- Department of Plastic Surgery, Helsinki University Hospital and the University of Helsinki, Helsinki, Finland
| | - Harri Sintonen
- Department of Public Health, University of Helsinki, Finland
| | - Maija Kolehmainen
- Department of Plastic Surgery, Helsinki University Hospital and the University of Helsinki, Helsinki, Finland
| | - Kaisu Ojala
- Department of Plastic Surgery, Helsinki University Hospital and the University of Helsinki, Helsinki, Finland
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2
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Schafer RE, Fodor R, Marlar R, Jensen KK, Meyers A, Isakov R, Ferrando C, Rampazzo A, Gharb BB. Nonbinary and Transgender Male Patient Preferences for Gender-Affirming Top Surgery. Ann Plast Surg 2024:00000637-990000000-00506. [PMID: 38984723 DOI: 10.1097/sap.0000000000004052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
BACKGROUND This study aimed to identify patient preferences and outcomes of chest masculinization surgery in patients identifying as nonbinary versus transgender (trans-) males. METHODS Patients who underwent chest masculinization (2003-2022) were included. Demographics, medical comorbidities, surgical approaches, complications, secondary procedures, and BODY-Q chest module survey responses were compared between cohorts. RESULTS Three hundred two patients were included. Thirteen percent identified as nonbinary and 87% as trans-male. The most common surgical approach in both groups was double incision with free nipple-areola graft (63% vs 71%, P = 0.33). Nonbinary patients more frequently opted for double incision without free nipple areola graft compared to trans-male patients (18% vs 2.7%, P < 0.001). Other unique surgical requests of nonbinary patients included nipple areola preservation and small breast mound preservation (5.2%) and balance between losing bulk and achieving a more androgynous appearance (5.3%). The survey response rate was 31% (93/302). Both groups reported improved quality of life postoperatively (P = 0.16). Three nonbinary patients elected not to keep their nipple-areola complexes (P = 0.005). Trans-male patients were more likely to report having a male chest as very important for their gender identity (82% vs 95%, P = 0.043). Nonbinary patients were less likely to prefer small nipples (82% vs 95%, P = 0.033) and 18% stated that they preferred no nipples (vs 2.7% trans-male patients, P < 0.001). CONCLUSIONS Nonbinary patients have distinct surgical preferences regarding nipple-areola complexes. Chest masculinization planning can differ for this group of patients compared to their trans-male counterparts.
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Affiliation(s)
- Rachel E Schafer
- From the Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | - R'ay Fodor
- From the Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | - Riley Marlar
- From the Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | - Kate K Jensen
- From the Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | - Abigail Meyers
- From the Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | - Raymond Isakov
- From the Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
| | - Cecile Ferrando
- Obstetrics and Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH
| | - Antonio Rampazzo
- From the Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
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3
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Bertrand AA, DeLong MR, McCleary SP, Nahabet EH, Slack GC, DaLio AL, Weimer AK, Kwan L, Bernacki J, Rudkin GH. Gender-Affirming Mastectomy: Psychosocial and Surgical Outcomes in Transgender Adults. J Am Coll Surg 2024; 238:890-899. [PMID: 38294149 DOI: 10.1097/xcs.0000000000000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
BACKGROUND Limited literature exists examining the effects of gender-affirming mastectomy on transmasculine and nonbinary patients that is prospective and uses validated survey instruments. STUDY DESIGN The psychosocial functioning of transmasculine and nonbinary patients was compared between patients who underwent gender-affirming mastectomy and those who had not yet undergone surgery. Participants were enrolled in a single-site, combined study of surgical and psychosocial outcomes, including a cross-sectional cohort of preoperative and postoperative patients, as well as separate prospective cohort. Participants completed the BREAST-Q psychosocial and sexual well-being modules, the BODY-Q satisfaction with chest and nipples modules, the Body Image Quality of Life Inventory, the Transgender Congruence Scale, the Patient Health Questionnaire-9, and the Generalized Anxiety Disorder-7 scale before and after surgery. We also examined how patient demographic factors correlated with postoperative surgical and psychosocial outcomes. RESULTS A total of 111 transmasculine and nonbinary patients 18 to 63 years of age (mean ± SD 26.5 ± 8) underwent mastectomy and were included in the study. All were included in the cross-sectional cohort, and 20 were enrolled in the prospective cohort. More than one-third (34.2%) of patients were nonbinary. After surgery, psychosocial and sexual well-being, satisfaction, body image-related quality of life, and gender congruence were increased (p < 0.001) in both cohorts, and depression (p < 0.009 cross-sectional), and anxiety (p < 0.001 cross-sectional) were decreased. The most common adverse event was hypertrophic scarring, which occurred in 41 (36.9%) participants. CONCLUSIONS In this study of transmasculine and nonbinary adults, gender-affirming mastectomy was followed by substantial improvements in psychosocial functioning.
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Affiliation(s)
- A A Bertrand
- From the Division of Plastic and Reconstructive Surgery (Bertrand, DeLong, McCleary, Nahabet, Slack, DaLio, Rudkin), University of California, Los Angeles, Los Angeles, CA
| | - Michael R DeLong
- From the Division of Plastic and Reconstructive Surgery (Bertrand, DeLong, McCleary, Nahabet, Slack, DaLio, Rudkin), University of California, Los Angeles, Los Angeles, CA
| | - Sean P McCleary
- From the Division of Plastic and Reconstructive Surgery (Bertrand, DeLong, McCleary, Nahabet, Slack, DaLio, Rudkin), University of California, Los Angeles, Los Angeles, CA
| | - Edward H Nahabet
- From the Division of Plastic and Reconstructive Surgery (Bertrand, DeLong, McCleary, Nahabet, Slack, DaLio, Rudkin), University of California, Los Angeles, Los Angeles, CA
| | - Ginger C Slack
- From the Division of Plastic and Reconstructive Surgery (Bertrand, DeLong, McCleary, Nahabet, Slack, DaLio, Rudkin), University of California, Los Angeles, Los Angeles, CA
| | - Andrew L DaLio
- From the Division of Plastic and Reconstructive Surgery (Bertrand, DeLong, McCleary, Nahabet, Slack, DaLio, Rudkin), University of California, Los Angeles, Los Angeles, CA
| | - Amy K Weimer
- Departments of Internal Medicine (Weimer, Bernacki), University of California, Los Angeles, Los Angeles, CA
| | - Lorna Kwan
- Urology (Kwan), University of California, Los Angeles, Los Angeles, CA
| | - Jessica Bernacki
- Departments of Internal Medicine (Weimer, Bernacki), University of California, Los Angeles, Los Angeles, CA
| | - George H Rudkin
- From the Division of Plastic and Reconstructive Surgery (Bertrand, DeLong, McCleary, Nahabet, Slack, DaLio, Rudkin), University of California, Los Angeles, Los Angeles, CA
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Colwell AS, Ramly EP, Chung KC. Measuring Outcomes in Aesthetic Surgery by Board-Certified Plastic Surgeons. Plast Reconstr Surg 2024; 153:98-105. [PMID: 37566517 DOI: 10.1097/prs.0000000000010985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
SUMMARY Aesthetic surgery is a visual specialty in which plastic surgeons and patients work together to enhance or restore facial and body harmony. The field of aesthetic surgery is advanced through descriptive technical procedures and outcomes research. With increasing competition in cosmetic medicine, aesthetic surgery stands to benefit from an evidence-based approach to document the high standards of care from board-certified plastic surgeons. In this article, the authors highlight challenges, current objective and subjective outcomes, and a path forward.
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Affiliation(s)
- Amy S Colwell
- From the Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School
| | - Elie P Ramly
- From the Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School
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Boonipat T, Sanchez Figueroa NG, Huang T, Martinez-Jorge J. The impact of chest contouring aesthetics outcomes: a pilot eye tracking study. Case Reports Plast Surg Hand Surg 2023; 11:2287027. [PMID: 38179208 PMCID: PMC10763852 DOI: 10.1080/23320885.2023.2287027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/13/2023] [Indexed: 01/06/2024]
Abstract
Eye-tracking technology was used to assess aesthetic surgical outcomes in transgender and gender diverse patients who are assigned female at birth and who seek gender affirming chest surgery. Post-surgery, observers focused more on scars than on the nipple-areolar complex. Ratings for similarity to cis-male chests significantly increased. This series highlights the objective evaluation of visual perception and masculinity assessments using eye-tracking.
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Affiliation(s)
- Thanapoom Boonipat
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Tony Huang
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jorys Martinez-Jorge
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA
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Morgenstern M, Barron S, Jia E, Friedman R, Perez-Iglesias CT, Garvey SR, Kang CO, Lee BT, Tobias AM, Cauley RP. The Effect of Preoperative Diagnosis of Depression and/or Anxiety on Patient-Reported Outcomes Following Chest Wall Masculinization Surgery. Aesthet Surg J 2023; 44:102-111. [PMID: 37556831 DOI: 10.1093/asj/sjad252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Individuals with gender dysphoria have disproportionately high rates of depression and anxiety compared to the cisgender population. Although the benefits of gender affirmation surgery have been well documented, it is unclear whether depression and anxiety affect postoperative patient-reported outcomes (PRO). OBJECTIVES The authors evaluated the impact of preoperative anxiety or depression on clinical and PRO in patients undergoing chest masculinization surgery. METHODS Patients who underwent chest masculinization surgery within a 5-year period were reviewed. Demographics and clinical variables were abstracted from medical records. PRO of chest, nipple, and scar satisfaction were obtained postoperatively with the BODY-Q. Groups were stratified by preoperative anxiety, preoperative depression, both, or no history of mental health diagnosis. Univariate and multivariate analyses were performed. RESULTS Of 135 patients with complete survey responses, 10.4% had anxiety, 11.9% depression, 20.7% both diagnoses, and 57.0% no diagnosis. Clinical data and outcomes were similar. Patients with preoperative depression correlated with lower satisfaction scores for scar appearance (P = .006) and were significantly more likely to report feelings of depression postoperatively (P = .04). There were no significant differences in chest or nipple satisfaction among groups. CONCLUSIONS Although anxiety and depression are prevalent in gender minorities, we found no association with postoperative clinical outcomes. Patients with preoperative depression were more likely to report lower satisfaction with scar appearance and feelings of depression postoperatively. However, there were no differences in chest or nipple satisfaction. These results highlight the importance of perioperative mental health counseling but also suggest that patients can be satisfied with their results despite a coexisting mental health diagnosis. LEVEL OF EVIDENCE: 4
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Ibrahiem SMS. "Post Bariatric Male Chest Re-shaping Using L-shaped Excision Technique". Aesthetic Plast Surg 2023; 47:2502-2510. [PMID: 35715533 DOI: 10.1007/s00266-022-02971-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/24/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Male chest deformity after massive weight loss is complex and challenging to treat because of differing grades of excessive parenchyma/fat ptosis, nipple malposition, over-stretched skin, ill-defined infra-mammary fold, and prominent axillary rolls. Patients are eager to restore balanced upper body dominance. Two fundamental techniques are used for large breasts with moderate to poor skin elasticity; (1) the inferior pedicle Wise skin pattern and (2) double incision with free nipple graft technique.The author presents his experience in treating such severe breast deformities, besides correcting the prominent axillary rolls using an L-shaped mastectomy excision. MATERIALS AND METHODS Between March 2017 and December 2020, 55 consecutive patients were treated surgically for male chest re-contouring using the L-shaped mastectomy technique. Ages ranged from 20 to 57 years (median, 31 years). The average body mass index (BMI) was 29. The average follow-up period was 17 months (13-44 months). RESULTS Fifty-one patients (92.8%) reported greater levels of postoperative satisfaction with their results owing to lack of any major complication and minimal minor complications (two cases of minor ischemia that healed spontaneously, two small hematomas, two small seromas, and four hypertrophic scars). CONCLUSION The L-shaped excision is a useful procedure for severe grade gynecomastia with an atypical presentation in the form of complex chest deformity and prominent axillary roll after massive weight loss patients. The technique is associated with minor complications that are treated in an office setting. The technique preserves normal pigmentation and sensitivity of the nipple-alveolar complex. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Saad Mohamed Saad Ibrahiem
- Assistant Professor of plastic and reconstructive surgery, Faculty of Medicine, Medical Campus, Alexandria University, 21111, Alexandria, Egypt.
- We Care Professionals Medical Center, Kuwait City, Kuwait.
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Dalaei F, de Vries CE, Cano SJ, Kaur MN, Poulsen L, Pfob A, Mou D, Repo JP, Salzillo R, Opyrchal J, Sørensen JA, Pusic AL, Klassen AF. BODY-Q Normative Scores: Psychometric Validation of the BODY-Q in the General Population in Europe and North America. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5401. [PMID: 38025628 PMCID: PMC10653602 DOI: 10.1097/gox.0000000000005401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/20/2023] [Indexed: 12/01/2023]
Abstract
Background BODY-Q is a rigorously developed patient-reported outcome measure designed to measure outcomes of weight loss and body contouring patients. To allow interpretation and comparison of BODY-Q scores across studies, normative BODY-Q values were generated from the general population. The aim of this study was to examine the psychometric properties of BODY-Q in the normative population. Methods Data were collected using two crowdsourcing platforms (Prolific and Amazon Mechanical Turk) in 12 European and North American countries. Rasch measurement theory (RMT) was used to examine reliability and validity of BODY-Q scales. Results RMT analysis supported the psychometric properties of BODY-Q in the normative sample with ordered thresholds in all items and nonsignificant chi-square values for 167 of 176 items. Reliability was high with person separation index of greater than or equal to 0.70 in 20 of 22 scales and Cronbach alpha values of greater than or equal to 0.90 in 17 of 22 scales. Mean scale scores measuring appearance, health-related quality of life, and eating-related concerns scales varied as predicted across subgroups with higher scores reported by participants who were more satisfied with their weight. Analysis to explore differential item functioning by sample (normative versus field-test) flagged some potential issues, but subsequent comparison of adjusted and unadjusted person estimates provided evidence that the scoring algorithm worked equivalently for the normative sample as in the field-test samples. Conclusions The BODY-Q scales showed acceptable reliability and validity in the normative sample. The normative values can be used as reference in research and clinical practice in combination with local estimates for parallel analysis and comparison.
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Affiliation(s)
- Farima Dalaei
- From the Research Unit of Plastic Surgery, Odense University Hospital, Denmark
- University of Southern Denmark, Odense, Denmark
- OPEN, Odense Explorative Patient Network, Odense, Denmark
| | - Claire E.E. de Vries
- Department of Surgery, OLVG, Amsterdam, the Netherlands
- Department of Surgery, Brigham and Women’s Hospital, Harvard University, Boston, Mass
| | | | - Manraj N. Kaur
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass
| | - Lotte Poulsen
- From the Research Unit of Plastic Surgery, Odense University Hospital, Denmark
- University of Southern Denmark, Odense, Denmark
| | - André Pfob
- University Breast Unit, Department of Obstetrics and Gynecology, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany
| | - Danny Mou
- Department of General Surgery, Brigham and Women’s Hospital, Harvard University, Boston, Mass
| | - Jussi P. Repo
- Unit of Musculoskeletal Surgery, Department of Orthopedics and Traumatology, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Rosa Salzillo
- Department of Plastic, Reconstructive and Aesthetic Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Jakub Opyrchal
- Department of Oncologic and Reconstructive Surgery, Maria Sklodowska-Curie Memorial National Cancer Center, Gliwice, Poland
| | - Jens A. Sørensen
- From the Research Unit of Plastic Surgery, Odense University Hospital, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Andrea L. Pusic
- Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass
| | - Anne F. Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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Saarinen M, Ojala K, Suominen S, Repo J. Validation of the BODY-Q Chest module in Finnish trans men undergoing chest wall masculinization. Scand J Surg 2023; 112:180-186. [PMID: 37264645 DOI: 10.1177/14574969231176111] [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] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND OBJECTIVE The aim of gender affirmation surgery is to ease gender dysphoria. In transgender men, chest wall masculinization is the most common gender affirmation surgery. The BODY-Q Chest module is currently the only instrument developed to measure health-related quality of life (HRQL) in men undergoing chest wall surgery. Linguistic validation and cultural adaption to Finnish were performed previously. The study aims to validate the BODY-Q Chest module in transgender men who have undergone surgical chest wall masculinization. METHODS All transgender patients who underwent chest wall masculinization at Helsinki University Hospital between 2005 and 2018 were invited to the study. The BODY-Q Chest module comprises two scales-chest and nipple. Data were obtained using the BODY-Q Chest module, the 15D questionnaire, and specifically targeted items designed by the authors. The statistical analyses were conducted to exclude selection bias, evaluate validity of the instrument, and compare it to other instruments. RESULTS Of the 220 patients invited, 123 participated in the survey (response rate 56%). Ceiling effects were observed with 18.9% and 20.5% scoring maximum points. Cronbach's alpha was 0.92 and 0.88 for the chest and nipple scales, respectively. In exploratory factor analysis, both scales loaded to one factor confirming unidimensionality. Correlation with the generic 15D questionnaire was low. CONCLUSIONS The BODY-Q Chest module provides valid scores with sufficient consistency and reliability when measuring HRQL in transgender men undergoing chest wall masculinization. Moreover, it offers specificity that existing or generic instruments cannot provide. Ceiling effect was expected due to the postoperative status of participants.
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Affiliation(s)
- Mirjam Saarinen
- Department of Plastic SurgeryHelsinki University Hospital and the University of Helsinki P.O. Box 281Stenbackinkatu 1100029 Helsinki Finland
| | - Kaisu Ojala
- Department of Plastic Surgery, Helsinki University Hospital and the University of Helsinki, Helsinki, Finland
| | - Sinikka Suominen
- Department of Plastic Surgery, Helsinki University Hospital and the University of Helsinki, Helsinki, Finland
| | - Jussi Repo
- Department of Orthopedics and Traumatology, Unit of Musculoskeletal Surgery, Tampere University Hospital and the University of Tampere, Tampere, Finland
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10
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Ibrahiem SMS. Do the Small Scars Lead to Better Results? Analysis of the Long-Term Outcomes of Patients Undergoing Male Chest Remodeling Surgery in Patients with Maximum Weight Loss. Aesthetic Plast Surg 2023; 47:127-128. [PMID: 36123507 DOI: 10.1007/s00266-022-03102-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Saad Mohamed Saad Ibrahiem
- Faculty of Medicine, Alexandria University, Medical Campus, Alexandria, 21111, Egypt.
- We Care Professionals Medical Center, Kuwait City, Kuwait.
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Day DL, Klit A, Lang CL, Mejdahl MK, Holmgaard R. High Self-Reported Satisfaction After Top Surgery in Gender-Affirming Surgery: A Single-Center Study. Transgend Health 2023; 8:124-129. [PMID: 37013096 PMCID: PMC10066763 DOI: 10.1089/trgh.2021.0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose Top surgery, or masculinization of the chest, is often the first and sometimes only procedure in gender-affirming surgery for transgender- and gender-diverse persons assigned female at birth. In recent years, there has been improved access to care for transgender individuals and increased demand for top surgery. Our aim was to investigate the degree of satisfaction with the postoperative outcome after top surgery in transgender men. Methods Ninety transgender men who underwent top surgery between September 1, 2013 and August 31, 2018 were included. Patients were surveyed from 5 to 62 months after surgery. Participants' files were evaluated for complications, and 84 (response rate 93.3%) participants answered a questionnaire evaluating patient satisfaction postoperatively. Results Patients were either satisfied or partially satisfied with the overall experience of undergoing surgery and the postoperative result in 90.5% of responses. Patients were very satisfied with their clothed appearance in 89.3% of responses, whereas only 44.1% were very satisfied with their nonclothed appearance and 46.4% partially satisfied. Patients were also very satisfied with postoperative scars in 47.6% of responses and nipple reconstruction in 48.8%. Only two patients expressed their regret. Conclusion Satisfaction outcomes after top surgery are generally positive, especially in respect of clothed appearance, self-confidence, and self-acceptance.
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Affiliation(s)
- Deborah-Leigh Day
- Department of Plastic Surgery and Burns, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anders Klit
- Department of Plastic Surgery and Burns, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Lyngsaa Lang
- Department of Plastic Surgery and Burns, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mathias Kvist Mejdahl
- Department of Plastic Surgery and Burns, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Rikke Holmgaard
- Department of Plastic Surgery and Burns, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Romano G, Bouaoud J, Schmidt M, Rausky J, Stivala A, Atlan M, Cristofari S. Improvements in Transgender Masculinizing Chest Surgery: A Pilot Study of a Tailored Approach with a Life Satisfaction Assessment. Transgend Health 2023. [DOI: 10.1089/trgh.2021.0212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Affiliation(s)
- Golda Romano
- Department of Plastic and Reconstructive surgery, Sorbonne University, Paris, France
- Department of Plastic and Reconstructive Surgery, Gustave Roussy Cancer Campus, Villejuif, France
- Department of Plastic and Reconstructive Surgery, Tenon Hospital, Paris, France
| | - Jebrane Bouaoud
- Department of Plastic and Reconstructive surgery, Sorbonne University, Paris, France
- Department of Plastic and Reconstructive Surgery, Gustave Roussy Cancer Campus, Villejuif, France
- Department of Maxillofacial Surgery and Stomatology, Pitié-Salpétrière Hospital, AP-HP, Paris, France
| | - Magali Schmidt
- Department of Plastic and Reconstructive surgery, Sorbonne University, Paris, France
- Department of Plastic and Reconstructive Surgery, Tenon Hospital, Paris, France
| | - Jonathan Rausky
- Department of Plastic and Reconstructive surgery, Sorbonne University, Paris, France
- Department of Plastic and Reconstructive Surgery, Tenon Hospital, Paris, France
| | - Alessio Stivala
- Department of Plastic and Reconstructive surgery, Macon General Hospital, Macon, France
| | - Michael Atlan
- Department of Plastic and Reconstructive surgery, Sorbonne University, Paris, France
- Department of Plastic and Reconstructive Surgery, Tenon Hospital, Paris, France
| | - Sarra Cristofari
- Department of Plastic and Reconstructive surgery, Sorbonne University, Paris, France
- Department of Plastic and Reconstructive Surgery, Tenon Hospital, Paris, France
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Timmermans FW, Ruyssinck L, Mokken SE, Buncamper M, Veen KM, Mullender MG, Claes KEY, Bouman MB, Monstrey S, van de Grift TC. An external validation of a novel predictive algorithm for male nipple areolar positioning: an improvement to current practice through a multicenter endeavor. J Plast Surg Hand Surg 2023; 57:103-108. [PMID: 34743656 DOI: 10.1080/2000656x.2021.1994982] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The correct positioning of nipple-areolar complexes (NAC) during gender-affirming mastectomies remains a particular challenge. Recently, a Dutch two-step algorithm was proposed predicting the most ideal NAC-position derived from a large cisgender male cohort. We aimed to externally validate this algorithm in a Belgian cohort. The Belgian validation cohort consisted of cisgender men. Based on patient-specific anthropometry, the algorithm predicts nipple-nipple distance (NN) and sternal-notch-to-nipple distance (SNN). Predictions were externally validated using the performance measures: R2-value, means squared error (MSE) and mean absolute percentage error (MAPE). Additionally, data were collected from a Belgian and Dutch cohort of transgender men having undergone mastectomy with free nipple grafts. The observed and predicted NN and SNN were compared and the inter-center variability was assessed. A total of 51 Belgian cisgender and 25 transgender men were included, as well as 150 Dutch cisgender and 96 transgender men. Respectively, the performance measures (R2-value, MSE and MAPE) for NN were 0.315, 2.35 (95%CI:0-6.9), 4.9% (95%CI:3.8-6.1) and 0.423, 1.51 (95%CI:0-4.02), 4.73%(95%CI:3.7-5.7) for SNN. When applying the algorithm to both transgender cohorts, the predicted SNN was larger in both Dutch (17.1measured(±1.7) vs. 18.7predicted(±1.4), p= <0.001) and Belgian (16.2measured(±1.8) vs. 18.4predicted(±1.5), p= <0.001) cohorts, whereas NN was too long in the Belgian (22.0measured(±2.6) vs. 21.2predicted(±1.6), p = 0.025) and too short in the Dutch cohort (19.8measured(±1.8) vs. 20.7predicted(±1.9), p = 0.001). Both models performed well in external validation. This indicates that this two-step algorithm provides a reproducible and accurate clinical tool in determining the most ideal patient-tailored NAC-position in transgender men seeking gender-affirming chest surgery.
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Affiliation(s)
- Floyd W Timmermans
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands.,Center of Expertise on Gender Dysphoria, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands
| | - Laure Ruyssinck
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Sterre E Mokken
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Public Health Institute, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands
| | - Marlon Buncamper
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Kevin M Veen
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Margriet G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands.,Center of Expertise on Gender Dysphoria, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Public Health Institute, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands
| | - Karel E Y Claes
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Mark-Bram Bouman
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands.,Center of Expertise on Gender Dysphoria, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Public Health Institute, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands
| | - Stanislas Monstrey
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Timotheus C van de Grift
- Center of Expertise on Gender Dysphoria, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Public Health Institute, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands
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14
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Kaur MN, Gallo L, Wang Y, Rae C, McEvenue G, Semple J, Johnson N, Savard K, Pusic AL, Coon D, Klassen AF. Health State Utility Values in Patients Undergoing Chest Masculinization Surgery. J Plast Reconstr Aesthet Surg 2023; 81:26-33. [PMID: 37068381 DOI: 10.1016/j.bjps.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 01/18/2023] [Accepted: 02/03/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Chest masculinization surgery is the most common gender-affirming procedure performed in transgender and gender-diverse individuals. While evidence on the health-related quality of life (HRQL) impact of chest masculinization is starting to emerge, data on health state utility values (HSUVs) associated with the surgery is largely missing. The objectives of this study were to estimate the HSUVs using EQ-5D for patients seeking chest masculinization surgery and assess the determinants of EQ-5D score at 6 months postoperatively. METHODS Patients seeking chest masculinization at a single community plastic surgery clinic by 2 surgeons completed 3 patient-reported outcome measures - EQ-5D-3L, Patient Health Questionnaire (PHQ)-9, and BODY-Q Chest module - preoperatively and postoperatively at 6 weeks and 6-months. Friedman test was used to assess the differences in PROM scores at the 3 timepoints. Simple and backward stepwise regression analyses of 6-month postoperative EQ-5D scores were performed. RESULTS A total of 113 patients (mean [SD] age, 25.7 [6.9] years) were included. The mean [SD] EQ-5D scores at preoperative, postoperative 6 weeks and 6 months were 0.81 [0.15], 0.84 [0.15] and 0.87 [0.12], respectively. Postoperatively, problems were most frequently reported in the dimensions "pain/discomfort" and "anxiety/depression". Preoperative PHQ-9 score was a predictor of 6-month postoperative EQ-5D scores following simple (p < 0.01) and backward stepwise linear regression analysis (p < 0.01). CONCLUSION Chest masculinization was associated with an improvement in overall HRL at 6 months postoperatively; however, this did not achieve statistical significance. Preoperative depression severity was a significant determinant of postoperative HRL. Consequently, additional support must be offered to patients who have a higher level of preoperative depression.
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Affiliation(s)
- Manraj N Kaur
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis S, Boston, MA 02116, USA.
| | - Lucas Gallo
- Department of Surgery, Division of Plastic Surgery, McMaster University, 1280 Main Street W, Hamilton, ON, Canada L8N 3Z5
| | - Yi Wang
- Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street W, Hamilton, ON, Canada L8N 3Z5
| | - Charlene Rae
- Department of Pediatrics, McMaster University, 3N27, 1280 Main Street W, Hamilton, ON, Canada L8N 3Z5
| | - Giancarlo McEvenue
- Doctor Giancarlo Plastic Surgery Clinic, 4600 Linton Blvd, Suite 310, Delray Beach, FL 33445, USA
| | - John Semple
- Division of Plastic Surgery, Women's College Hospital, 76 Grenville St, Toronto, ON, Canada M5S 1B2
| | - Natasha Johnson
- Department of Pediatrics, McMaster University, 3N27, 1280 Main Street W, Hamilton, ON, Canada L8N 3Z5
| | - Kinusan Savard
- Fleming College, 599 Brealey Dr, Peterborough, ON, Canada K9J 7B1
| | - Andrea L Pusic
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis S, Boston, MA 02116, USA
| | - Devin Coon
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis S, Boston, MA 02116, USA
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, 3N27, 1280 Main Street W, Hamilton, ON, Canada L8N 3Z5
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15
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Dalaei F, de Vries CEE, Poulsen L, Kaur MN, Pfob A, Mou D, Jacobsen AL, Repo JP, Salzillo R, Opyrchal J, Klassen AF, Sørensen JA, Pusic AL. General population normative scores for interpreting the BODY-Q. Clin Obes 2022; 12:e12528. [PMID: 35611607 PMCID: PMC9541838 DOI: 10.1111/cob.12528] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/25/2022] [Accepted: 05/03/2022] [Indexed: 12/22/2022]
Abstract
The BODY-Q is a patient-reported outcome measure used to assess outcomes in patients undergoing weight loss and/or body contouring surgery (BC) following massive weight loss. Normative values for the BODY-Q are needed to improve data interpretation and enable comparison. Thus, the aim of this study was to determine normative values for the BODY-Q. Participants were recruited internationally through two crowdsourcing platforms. The participants were invited to complete the BODY-Q scales through an URL link provided within the crowdsourcing platforms. General linear analyses were performed to compare normative means between countries and continents adjusted for relevant covariates. Normative reference values were stratified by age, body mass index (BMI), and gender. The BODY-Q was completed by 4051 (2052 North American and 1999 European) participants. The mean age was 36 years (±14.7 SD) and ranged from 17 to 76 years, the mean BMI was 26.4 (±6.7 SD) kg/m2 , and the sample consisted of 1996 (49.3%) females and 2023 (49.9%) males. Younger age and higher BMI were negatively associated with all BODY-Q scales (p < .001). This study provides normative values for the BODY-Q scales to aid in the interpretation of BODY-Q scores in research and clinical practise. These values enable us to understand the impact of weight loss and BC on patients' lives.
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Affiliation(s)
- Farima Dalaei
- Research Unit of Plastic SurgeryOdense University Hospital, University of Southern DenmarkOdenseDenmark
- OPEN, Odense Explorative Patient NetworkOdenseDenmark
| | - Claire E. E. de Vries
- Department of Surgery, OLVGAmsterdamNetherlands
- Department of Surgery, Brigham and Women's HospitalHarvard UniversityBostonMassachusettsUSA
| | - Lotte Poulsen
- Research Unit of Plastic SurgeryOdense University Hospital, University of Southern DenmarkOdenseDenmark
| | - Manraj N. Kaur
- Brigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - André Pfob
- University Breast Unit, Department of Obstetrics and GynecologyHeidelberg University HospitalHeidelbergBaden‐WürttembergGermany
| | - Danny Mou
- Department of General SurgeryBrigham and Women's Hospital, Harvard UniversityBostonMassachusettsUSA
| | - Amalie L. Jacobsen
- Department of Plastic SurgeryOdense University Hospital, University of Southern DenmarkOdenseDenmark
| | - Jussi P. Repo
- Unit of Musculoskeletal Surgery, Department of Orthopedics and TraumatologyTampere University Hospital and University of TampereTampereFinland
| | - Rosa Salzillo
- Department of Plastic, Reconstructive and Aesthetic SurgeryCampus Bio‐Medico University of RomeRomeItaly
| | - Jakub Opyrchal
- Department of Plastic SurgeryT. Marciniaka Specialized HospitalWroclawPoland
| | - Anne F. Klassen
- Department of PediatricsMcMaster UniversityHamiltonOntarioCanada
| | - Jens Ahm Sørensen
- Research Unit of Plastic SurgeryOdense University Hospital, University of Southern DenmarkOdenseDenmark
| | - Andrea L. Pusic
- Department of Surgery, Brigham and Women's HospitalHarvard UniversityBostonMassachusettsUSA
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16
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Timmermans FW, Mokken SE, Smit JM, Bouman MB, van de Grift TC, Mullender MG, Middelkoop E. The Impact of Incisional Negative Pressure Wound on Scar Quality and Patient Reported Outcomes: a Within-Patient Controlled, Randomized Trial. Wound Repair Regen 2022; 30:210-221. [PMID: 35146830 PMCID: PMC9306814 DOI: 10.1111/wrr.13001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/04/2022] [Accepted: 01/09/2022] [Indexed: 11/28/2022]
Abstract
Literature provides a moderate level of evidence for the beneficial effects of incisional negative pressure wound therapy (iNPWT) on scar quality. The purpose of this study was to establish if iNPWT results in improved scar outcomes in comparison to the standard of care. Therefore, a within‐patient randomised controlled, open‐label trial was conducted in transgender men undergoing gender‐affirming mastectomies. A unilateral side was randomised to receive iNPWT (PICO™, Smith&Nephew) without suction drains and contrastingly the standard dressing (Steri‐Strips™) with suction drain. Scar quality and questionnaires were bilaterally measured by means of objective assessments and patient‐reported outcome measures (PROM) at 1, 3 and 12 months. Objective scar outcomes were scar pliability (Cutometer®), colouration (DSM‐II) and scar width (3‐D imaging). PROM outcomes were related to scars (POSAS and SCAR‐Q) and body satisfaction (BODY‐Q). From 85 included patients, 80 were included for analyses. No significant difference between treatments was seen in the quantitative outcomes of scar pliability, colour, and width. For qualitative scar outcomes, several significant findings for iNPWT were found for several subscales of the POSAS, SCAR‐Q, and BODY‐Q. These effects could not be substantiated with linear mixed‐model regression, signifying no statically more favourable outcome for either treatment option. In conclusion, this study demonstrated that some PROM outcomes were more favourable for the iNPWT compared to standard treatment. In contrast, the quantitative outcomes showed no beneficial effects of iNPWT on scar outcomes. This suggests that iNPWT is of little benefit as a scar‐improving therapy.
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Affiliation(s)
- F W Timmermans
- Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Amsterdam UMC, location VUmc, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands
| | - S E Mokken
- Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Amsterdam UMC, location VUmc, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands
| | - J M Smit
- Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Amsterdam UMC, location VUmc, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands
| | - M B Bouman
- Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Amsterdam UMC, location VUmc, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands.,Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Public Health, Amsterdam, the Netherlands
| | - T C van de Grift
- Amsterdam UMC, location VUmc, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands.,Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Public Health, Amsterdam, the Netherlands
| | - M G Mullender
- Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Amsterdam UMC, location VUmc, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands.,Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Public Health, Amsterdam, the Netherlands
| | - E Middelkoop
- Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Amsterdam UMC, location VUmc, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands.,Association of Dutch Burn Centers, Red Cross Hospital, Vondellaan 13, Beverwijk, the Netherlands
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17
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Jørgensen MG, Cho BY, Hansen FG, Schmidt VJ, Sørensen JA, Toyserkani NM. Patients Decision-Making Characteristics Affects Gynecomastia Treatment Satisfaction: A Multicenter Study Using the BODY-Q Chest Module. Aesthetic Plast Surg 2021; 46:1053-1062. [PMID: 34704122 DOI: 10.1007/s00266-021-02633-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patient satisfaction is the most critical outcome in gynecomastia treatment. However, patient satisfaction may be affected by the patient's decision-making trait, such as exhaustively searching for the best outcome or being content with an outcome that satisfies a preconceived requirement. OBJECTIVE To assess whether patient's decision-making characteristic affect their satisfaction with gynecomastia treatment. METHODS This was a cross-sectional study including patients treated for gynecomastia between January 2009 and December 2019 at two tertiary hospitals in Denmark. Alive patients were sent the BODY-Q: Chest module, the SF-36 questionnaire, and the Maximizer/Satisficer decision-making survey. Patients were classified as Maximizers if they scored more than 40 points on the Maximizer/Satisficer survey. Percentage score differences (PDs) in quality of life scales were calculated between Maximizers and Satisficers. RESULTS In total, 192 gynecomastia patients were included in this study and classified as Maximizers (n = 152) or Satisficers (n = 40). Maximizers were younger and more had gynecomastia following abuse of anabolic steroids than Satisficers (p < 0.05). With respect to bodily satisfaction, Maximizers showed significantly worse satisfaction with nipples (PDs: - 12.98%), psychological function (PDs: - 13.68%) and social function (PDs: - 8.77%, p < 0.05). In addition, Maximizers had significantly worse emotional role functioning (- 11.03%), vitality (PDs: - 11.72%) and mental health (PDs: - 10.00%, p < 0.05). CONCLUSION Patients exhibiting maximizing-type decision-making characteristics have worse satisfaction with gynecomastia treatment and poorer psychosocial health. This information may facilitate patient counseling and alignment of treatment expectations. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Mads Gustaf Jørgensen
- Department of Plastic and Reconstructive Surgery, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Odense, Denmark.
- Clinical Institute, University of Southern Denmark, Odense, Denmark.
- Open Patient data Explorative Network, OPEN, Odense University Hospital, Odense, Denmark.
| | - Bu Youn Cho
- Department of Plastic Surgery and Breast Surgery, Zealand University Hospital, Copenhagen University, Roskilde, Denmark
| | - Frederik Gulmark Hansen
- Department of Plastic and Reconstructive Surgery, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Odense, Denmark
| | - Volker-Jürgen Schmidt
- Department of Plastic Surgery and Breast Surgery, Zealand University Hospital, Copenhagen University, Roskilde, Denmark
| | - Jens Ahm Sørensen
- Department of Plastic and Reconstructive Surgery, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Odense, Denmark
- Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Navid Mohamadpour Toyserkani
- Department of Plastic Surgery and Breast Surgery, Zealand University Hospital, Copenhagen University, Roskilde, Denmark
- Department of Plastic Surgery and Burns Treatment, Rigshospitalet, Copenhagen, Denmark
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18
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Abstract
SUMMARY Evidence-based medicine, as described by Dr. Sackett, is defined as the "conscientious, explicit, and judicious use of current best evidence, combined with individual clinical expertise and patient preferences and values, in making decisions about the care of individual patients." In the late 2000s, seminal articles in Clinics in Plastic Surgery and Plastic and Reconstructive Surgery introduced evidence-based medicine's role in plastic surgery and redefined varying levels of evidence. The American Society of Plastic Surgeons sponsored the Colorado Springs Evidence-Based Medicine Summit that set forth a consensus statement and action plan regarding the increased incorporation of evidence-based medicine into the field; this key meeting ushered a new era among plastic surgeons worldwide. Over the past decade, Plastic and Reconstructive Surgery has incorporated evidence-based medicine into the Journal through an increase in articles with level I and II evidence, new sections of the Journal, and the introduction of validated tools to help authors perform prospective and randomized studies that ultimately led to best practices used today. Plastic surgery is a specialty built on problem-solving and innovation, values starkly in-line with evidence-based medicine. Evidence-based medicine is becoming more ingrained in our everyday practice and plastic surgery culture; however, we must work actively to ensure that we continue this trend. In the next decade, we will possibly see that level I and II evidence articles start to inhabit many of our journal issues.
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19
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Martin SA, Patel V, Morrison SD, Kahn D, Satterwhite T, Nazerali R. Assessing Gender-Affirming Chest Surgery Outcomes: Does Gender Identity Alter Gaze? Aesthetic Plast Surg 2021; 45:1860-1868. [PMID: 34114074 DOI: 10.1007/s00266-021-02378-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/22/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Outcomes of gender-affirming chest surgery can be variable. Placement of nipple-areolar complexes and orientation of scars can drastically affect the aesthetic outcomes of these procedures, as may observer gender identity. Here, we compared attention and perception of outcomes following gender-affirming chest surgery between laypersons, based on gender identity. METHODS Transgender and cisgender participants were enrolled and shown images of surgery naïve chests and postoperative masculinized and feminized chests, blinded to the gender identity of the photographed subject. Gaze data were captured using the Tobii X2 60 eye-tracking device. Participants scored the perceived gender and aesthetic appearance of each image. RESULTS Eighteen cisgender and 14 transgender participants were enrolled. When viewing male chests, transgender participants spent significantly longer fixated on the nipples (naïve: 802 vs. 395 ms; p = 0.02, masculinized: 940 vs. 692 ms, p = 0.002). For masculinized chests, cisgender participants spent significantly longer fixated on the inframammary scar (483 vs. 391 ms; p = 0.04). On images of feminized chests, transgender participants spent longer viewing the nipples when compared to cisgender participants (1017 vs. 847 ms; p = 0.04). Cisgender viewers spent longer fixating on the postoperative scar on feminized chests (113 vs. 59 ms; p = 0.02) and also viewed feminized chests as significantly more masculine and masculinized chests as more feminine, when compared to transgender participants (p < 0.05). CONCLUSIONS This is the first study to use eye-tracking to assess how laypersons assess chests for gender determination. The findings suggest that observer gender identity has an effect on areas of focus and gender perception of chests that underwent gender-affirmation surgery. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Shanique A Martin
- Division of Plastic Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Viren Patel
- Department of Plastic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Shane D Morrison
- Section of Plastic Surgery, University of Michigan School of Medicine, Ann Arbor, MI, USA.
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, 48109, USA.
| | - David Kahn
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford Hospital and Clinics, Palo Alto, CA, USA
| | | | - Rahim Nazerali
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford Hospital and Clinics, Palo Alto, CA, USA
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20
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de Vries CEE, Mou D, Poulsen L, Breitkopf T, Makarawung DJS, Wiezer MJ, van Veen RN, Hoogbergen MM, Sorensen JA, Liem RSL, Nienhuijs SW, Tavakkoli A, Pusic AL, Klassen AF. Development and Validation of New BODY-Q Scales Measuring Expectations, Eating Behavior, Distress, Symptoms, and Work Life in 4004 Adults From 4 Countries. Obes Surg 2021; 31:3637-3645. [PMID: 34041700 DOI: 10.1007/s11695-021-05462-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 04/28/2021] [Accepted: 05/05/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE The BODY-Q is a rigorously developed patient-reported outcome measure (PROM) for patients seeking treatment for obesity and body contouring surgery. A limitation of the uptake of the BODY-Q in weight management treatments is the absence of scales designed to measure eating-specific concerns. We aimed to develop and validate 5 new BODY-Q scales measuring weight loss expectations, eating behaviors, distress, symptoms, and work life. MATERIAL AND METHODS In phase 1 (qualitative), patient and expert input was used to develop and refine the new BODY-Q scales. In phase 2 (quantitative), the scales were field-tested in bariatric and weight management clinics in the United States (US), The Netherlands, and Denmark between June 2019 and January 2020. Data were also collected in the US and Canada in September 2019 through a crowdworking platform. Rasch measurement theory (RMT) analysis was used for item reduction and to examine reliability and validity. RESULTS The new BODY-Q scales were refined through qualitative input from 17 patients and 20 experts (phase 1) and field-tested in 4004 participants (phase 2). All items showed ordered thresholds and good fit to the Rasch model. The RMT analysis provided evidence of reliability, with PSI values ≥0.72, Cronbach alpha values ≥0.83, and test-retest values ≥0.79. Better scores on 4 scales (exception expectations scale) correlated with lower BMI, with the strongest correlation between the eating-related distress scale scores and BMI (r= -0.249, P < 0.001). CONCLUSION The new BODY-Q scales can be used in research and clinical practice to assess weight loss treatments from the patient perspective.
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Affiliation(s)
- Claire E E de Vries
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA. .,Department of Surgery, OLVG, Amsterdam, The Netherlands.
| | - Danny Mou
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Lotte Poulsen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Trisia Breitkopf
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | | | - Marinus J Wiezer
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Maarten M Hoogbergen
- Department of Plastic and Reconstructive Surgery, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Jens A Sorensen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Ronald S L Liem
- Department of Surgery, Groene Hart Hospital, Gouda, The Netherlands.,Dutch Obesity Clinic, The Hague, The Netherlands
| | - Simon W Nienhuijs
- Department of Surgery, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Ali Tavakkoli
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Andrea L Pusic
- Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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21
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Seventy-Fifth Anniversary of Plastic and Reconstructive Surgery: How Evidence-Based Medicine Has Transformed Plastic Surgery. Plast Reconstr Surg 2021; 147:1235-1241. [PMID: 33890912 DOI: 10.1097/prs.0000000000007913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Kuzon WM, Morrison SD. Commentary on: The BODY-Q Chest Module: Further Validation in a Canadian Chest Masculinization Surgery Sample. Aesthet Surg J 2021; 41:575-576. [PMID: 33135739 DOI: 10.1093/asj/sjaa249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Klassen AF, McEvenue G, Wang Y, Rae C, Kaur M, Johnson N, Savard K, Semple J, Pusic A. The BODY-Q Chest Module: Further Validation in a Canadian Chest Masculinization Surgery Sample. Aesthet Surg J 2021; 41:566-574. [PMID: 32770219 DOI: 10.1093/asj/sjaa224] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The BODY-Q Chest module is a patient-reported outcome (PRO) instrument that measures satisfaction with how the chest (10 items) and nipples (5 items) look. This PRO instrument was previously field tested in an international sample of people seeking treatment for gynecomastia (n = 174), weight loss (n = 224), and chest masculinization (n = 341). OBJECTIVES The aim of this study was to examine the psychometric performance of the BODY-Q Chest module in a new chest masculinization surgery sample. METHODS Data were collected from patients attending a private plastic surgery outpatient clinic in Canada between January 2018 and June 2019. Rasch measurement theory analysis was used to examine how the scales performed psychometrically. RESULTS The sample provided 266 assessments (115 preoperative, 151 postoperative). All items had ordered thresholds, providing evidence that the 4 response options for each scale worked as expected. Item fit was within ±2.5 for all items, with all Bonferroni adjusted chi-square values nonsignificant. The data for the chest (χ2(20) = 18.72, P = 0.54) and nipples (χ 2(10) = 12.28, P = 0.27) scales fit the requirements of the Rasch model. Reliability was high with person separation index and Cronbach's α values of ≥0.95 for the chest and ≥0.87 for the nipple scales, respectively. More depressive symptoms on the Patient Health Questionnaire-9 and lower health-related quality of life scales were weakly correlated with worse scores on the chest and nipple scales (P < 0.001). CONCLUSIONS The BODY-Q Chest module was shown to be scientifically sound in an independent sample of patients seeking chest masculinization surgery.
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Affiliation(s)
| | | | - Yi Wang
- McMaster University, Hamilton, Ontario, Canada
| | | | - Manraj Kaur
- McMaster University, Hamilton, Ontario, Canada
| | | | | | - John Semple
- Women’s College Hospital, Toronto, Ontario, Canada
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Junn A, Khetpal S, Smetona J, Dinis J, Hirschman A, Mozaffari MA, Singh A, Ching AH, Alperovich M, Lu X, Persing JA. Hockey stick incision: a modified technique for chest wall masculinization. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:600. [PMID: 33987298 DOI: 10.21037/atm-20-7678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Chest wall masculinization is often performed for transgender men in order to address gender dysphoria. Peri-areolar and double-incision mastectomy with free nipple grafts, are the most common techniques employed in chest masculinization surgery, but are limited by their relative inconsistency and inefficiency in reconstructing a natural anterior contour that comprehensively resembles that of a cis-masculine chest. The purpose of this study is two-fold. The first is to describe the "hockey stick" approach, which expands on the widely performed double-incision mastectomy to the axilla, with an additional step of revising lateral chest wall folds of tissue excess. This technique is scalable to the degree of pre-operative excess tissue on the anterior and lateral chest wall. The second is to compare the "hockey stick" incision to existing reconstructive options, with respect to clinical outcomes and patient satisfaction. Methods Patients who received chest masculinization surgery at Yale-New Haven Hospital were included. A retrospective chart review, comprising demographic variables, procedural details, and post-operative events, was conducted. Selected modules from a validated survey instrument, the BODY-Q, were measured. Patients were classified by body mass index and incision, which included peri-areolar, inframammary fold, and "hockey stick" incision by date. Results Twenty-seven of 73 (37.0%) participants completed the full survey and were included in the analysis. The "hockey stick" incision had comparable patient satisfaction and post-operative outcomes, compared to peri-areolar and double-incision mastectomy with free nipple graft techniques. Greater BMI patients had a higher incidence of wound dehiscence, compared to other weight classifications. Conclusions The "hockey stick" incision is a readily performed, effective surgical technique for building a cis-masculine appearing chest in transgender men with efficient and predictable outcomes. While performed in patients with higher BMI, the "hockey stick" confers equivalent patient satisfaction and clinical outcomes to peri-areolar and double-incision mastectomy.
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Affiliation(s)
- Alexandra Junn
- Division of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Sumun Khetpal
- Division of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - John Smetona
- Division of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Jacob Dinis
- Division of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Allister Hirschman
- Division of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Mohammad Ali Mozaffari
- Division of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Anusha Singh
- Division of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT, USA.,Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Ann Hui Ching
- Division of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT, USA.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Michael Alperovich
- Division of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Xiaona Lu
- Division of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - John A Persing
- Division of Plastic and Reconstructive Surgery, Yale University School of Medicine, New Haven, CT, USA
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Incidence of Complications in Chest Wall Masculinization for the Obese Female-to-Male Transgender Population: A Case Series. World J Plast Surg 2021. [DOI: 10.52547/wjps.10.2.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Klassen AF, Kaur MN, de Vries CEE, Poulsen L, Breitkopf T, Pusic A. The BODY-Q Cellulite Scale: A Development and Validation Study. Aesthet Surg J 2021; 41:206-217. [PMID: 32303735 DOI: 10.1093/asj/sjaa100] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Cellulite is a localized metabolic disorder of the subcutaneous tissue. To measure the impact of cellulite and its treatment(s) on patients' health-related quality of life, a psychometrically sound patient-reported outcome measure is needed. OBJECTIVES The authors sought to develop and field test a new BODY-Q cellulite scale to measure the appearance of cellulite. METHODS Appearance-related codes from the original BODY-Q qualitative interviews were reexamined, and a set of cellulite-specific items was developed and refined through cognitive patient interviews (n = 10) and expert input (n = 17). This scale was field-tested in adults with cellulite through 2 crowdworking platforms. Rasch Measurement Theory analysis was employed to refine the scale and examine its psychometric properties. RESULTS The field-test sample included 2129 participants. The 15-item scale was reduced in length to 11 items. Data from the sample fit the Rasch model (X2 [99] = 21.32, P = 0.06). All items had ordered thresholds and mapped out a targeted clinical hierarchy. The reliability statistics for the person separation index was 0.94 and for Cronbach's alpha was 0.97. In terms of validity, worse scores on the cellulite scale were associated with being more bothered by how the cellulite looked overall, having more severe cellulite on the Patient-Reported Photo-numeric Cellulite Severity Scale, and having more self-reported cellulite and more areas of the body with cellulite. CONCLUSIONS The BODY-Q cellulite scale can be utilized to measure appearance of cellulite and provides a solid basis for future studies evaluating the impact of cellulite and its treatment.
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Affiliation(s)
| | | | - Claire E E de Vries
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Lotte Poulsen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | | | - Andrea Pusic
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
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Endoscopic Axillary Approach Improves Patient Satisfaction of Gynecomastia Subcutaneous Mastectomy: A Cross-Sectional Study Using the BODY-Q Chest Module. Aesthetic Plast Surg 2020; 44:2011-2020. [PMID: 31555872 DOI: 10.1007/s00266-019-01501-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/17/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Gynecomastia is a common condition that refers to the benign enlargement of male breasts. Several minimally invasive techniques were invented to avoid visible scars in the chest area, but have limited effects on the dense fibroglandular breast tissue, and open excision remains the mainstay of treatment. Endoscopic subcutaneous mastectomy has the superiority of visualization, facilitating accurate dissection and hemostasis, also enabling inconspicuous scars. This study was designed to evaluate the patient-reported outcomes of the endoscopic axillary approach in treating gynecomastia, to interpret the differences between it and the conventional periareolar open excision method, and to present our experience utilizing this technique as a reliable alternative for Simon I and II gynecomastia. METHODS Eighty-three participants diagnosed with Simon I or II gynecomastia were included in this cross-sectional study, among which 31 were preoperative and 52 were postoperative patients. Postoperative participants were divided into two groups according to whether endoscopic axillary subcutaneous mastectomy (axillary group, n = 25) or periareolar open excision (periareolar group, n = 27) was performed. Patient-reported outcomes were assessed using the BODY-Q questionnaire, including the chest, nipples, body image, social, appearance-related distress, and scar domain, with scores ranging from 0 to 100. RESULTS The BODY-Q score of both axillary and periareolar postoperative groups showed significant improvement on chest (p < 0.001), nipples (p < 0.001), body image (p < 0.001), and appearance-related distress (p < 0.005) scales, compared with the preoperative group. Of the scar scale, the axillary group rated higher scores than the periareolar group (p = 0.019), analysis of the individual scale items showed more positive responses in questions "Location of your scars?" (p < 0.001) and "How your scars look when they are not covered by clothes?" (p < 0.001), the item "Having to dress in a way to hide your scars?" also had a somewhat more positive responses from participants (p = 0.095). CONCLUSIONS The present findings indicate that compared with the periareolar excision, patients who underwent gynecomastia subcutaneous mastectomy through endoscopic axillary approach have higher scar satisfaction with postoperative outcomes, this probably because of the well-hidden scar at the axilla, which leverages the psychologic burden of the patient after surgery. Future prospective studies are needed to measure changes over the entire patient journey, to find out the predictable factors of postoperative patient satisfaction, and determine how the objective outcomes relate to changes in patient's health-related quality of life. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .
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de Vries CE, Klassen AF, Hoogbergen MM, Alderman AK, Pusic AL. Measuring Outcomes in Cosmetic Abdominoplasty. Clin Plast Surg 2020; 47:429-436. [DOI: 10.1016/j.cps.2020.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Prospective Analysis and Comparison of Periareolar Excision (Delivery) Technique and Pull-Through Technique for the Treatment of Gynecomastia. Aesthetic Plast Surg 2020; 44:1079-1080. [PMID: 32100080 DOI: 10.1007/s00266-020-01645-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 02/12/2020] [Indexed: 10/24/2022]
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Poulsen L, Simonsen N, Klassen AF, Cano S, Rose M, Juhl CB, Stoving RK, Andries A, Sorensen JA. Comparison of the Moorehead-Ardelt quality of life questionnaire and the BODY-Q in Danish patients undergoing weight loss and body contouring surgery. Clin Obes 2020; 10:e12351. [PMID: 31898419 DOI: 10.1111/cob.12351] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 11/25/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023]
Abstract
This study compared the measurement properties of the Moorehead-Ardelt quality of life questionnaire-II (MAQOL-II) and the BODY-Q, to determine which was more suitable for measuring patient-reported outcome (PRO) in Danish bariatric surgery (BS) and body contouring surgery (BC) patients. We examined content validity against the COSMIN guidelines and compared psychometric performance using Rasch measurement theory methods and criteria. MAQOL-II data were obtained from the Danish Bariatric Surgery Database from September 2010 to November 2017, and BODY-Q data were collected from June 2015 to March 2018. The MAQOL-II failed to meet recommended standards for content validity, while all criteria were met for the BODY-Q. A total of 16 965 MAQOL-II and 2259 BODY-Q assessments were obtained. A random sample was selected from the MAQOL-II dataset to match the BODY-Q sample. Psychometrically, the BODY-Q performed better than the MAQOL-II. For example, Cronbach's α was 0.82 for the MAQOL-II vs ≥0.90 for all BODY-Q scales. Fifty percent (3/6) of MAQOL-II items had disordered thresholds, while all BODY-Q items had ordered thresholds (123/123). Poor item fit was revealed for 17% (1/6) of MAQOL-II and 8% (10/123) of BODY-Q items. For scale reliability, person separation index was 0.79 for the MAQOL-II and 0.88 (0.81-0.93) for the BODY-Q. In conclusion, the MAQOL-II does not meet today's standards for a rigorously developed PRO measure. The BODY-Q, on the other hand, gives substantial, accurate and interpretable measurement and should be recommended for use in PRO in BS and BC patients.
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Affiliation(s)
- Lotte Poulsen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Nina Simonsen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | | | - Michael Rose
- Department of Plastic Surgery, Hospital of Southwest Jutland, Esbjerg, Denmark
| | - Claus B Juhl
- Department of Endocrinology, Hospital of Southwest Jutland, Esbjerg, Denmark
| | - Rene K Stoving
- Department of Endocrinology and The Psychiatric Services of Southern Denmark, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Alin Andries
- Department of Endocrinology, Hospital of Southwest Jutland, Esbjerg, Denmark
| | - Jens A Sorensen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
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Geerards D, van den Berg L, Pusic AL, Hoogbergen MM, Klassen AF, van der Hulst RRWJ, Sidey-Gibbons CJ. Deriving an overall appearance domain score by applying bifactor IRT analysis to the BODY-Q appearance scales. Qual Life Res 2019; 29:1065-1072. [PMID: 31758485 PMCID: PMC7142051 DOI: 10.1007/s11136-019-02366-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2019] [Indexed: 12/05/2022]
Abstract
Purpose With the BODY-Q, one can assess outcomes, such as satisfaction with appearance, in weight loss and body contouring patients using multiple scales. All scales can be used independently in any given combination or order. Currently, the BODY-Q cannot provide overall appearance scores across scales that measure a similar super-ordinate construct (i.e., overall appearance), which could improve the scales’ usefulness as a benchmarking tool and improve the comprehensibility of patient feedback. We explored the possibility of establishing overall appearance scores, by applying a bifactor model to the BODY-Q appearance scales. Methods In a bifactor model, questionnaire items load onto both a primary specific factors and a general factor, such as satisfaction with appearance. The international BODY-Q validation patient sample (n = 734) was used to fit a bifactor model to the appearance domain. Factor loadings, fit indices, and correlation between bifactor appearance domain and satisfaction with body scale were assessed. Results All items loaded on the general factor of their corresponding domain. In the appearance domain, all items demonstrated adequate item fit to the model. All scales had satisfactory fit to the bifactor model (RMSEA 0.045, CFI 0.969, and TLI 0.964). The correlation between the appearance domain summary scores and satisfaction with body scale scores was found to be 0.77. Discussion We successfully applied a bifactor model to BODY-Q data with good item and model fit indices. With this method, we were able to produce reliable overall appearance scores which may improve the interpretability of the BODY-Q while increasing flexibility.
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Affiliation(s)
- Daan Geerards
- Patient-Reported Outcomes, Value & Experience (PROVE) Center, Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.,Department of Surgery, Harvard Medical School, Boston, MA, USA.,Department of Plastic and Reconstructive Surgery, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Lisa van den Berg
- Patient-Reported Outcomes, Value & Experience (PROVE) Center, Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.,Department of Surgery, Harvard Medical School, Boston, MA, USA.,Department of Plastic and Reconstructive Surgery, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Andrea L Pusic
- Patient-Reported Outcomes, Value & Experience (PROVE) Center, Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.,Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Maarten M Hoogbergen
- Department of Plastic and Reconstructive Surgery, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - René R W J van der Hulst
- Department of Plastic and Reconstructive Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Chris J Sidey-Gibbons
- Patient-Reported Outcomes, Value & Experience (PROVE) Center, Department of Surgery, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA. .,Department of Surgery, Harvard Medical School, Boston, MA, USA. .,Department of Symptom Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Subcutaneous Mastectomy Improves Satisfaction with Body and Psychosocial Function in Trans Men: Findings of a Cross-Sectional Study Using the BODY-Q Chest Module. Plast Reconstr Surg 2019; 144:144e-145e. [PMID: 31246851 DOI: 10.1097/prs.0000000000005734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Reply: Subcutaneous Mastectomy Improves Satisfaction with Body and Psychosocial Function in Trans Men: Findings of a Cross-Sectional Study Using the BODY-Q Chest Module. Plast Reconstr Surg 2019; 144:145e-147e. [PMID: 31246852 DOI: 10.1097/prs.0000000000005735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Validation of the Finnish version of the BODY-Q patient-reported outcome instrument among patients who underwent abdominoplasty. J Plast Reconstr Aesthet Surg 2019; 72:933-940. [DOI: 10.1016/j.bjps.2019.02.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 12/31/2018] [Accepted: 02/12/2019] [Indexed: 01/30/2023]
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Klassen AF, Kaur M, Johnson N, Kreukels BP, McEvenue G, Morrison SD, Mullender MG, Poulsen L, Ozer M, Rowe W, Satterwhite T, Savard K, Semple J, Sørensen JA, van de Grift TC, van der Meij-Ross M, Young-Afat D, Pusic AL. International phase I study protocol to develop a patient-reported outcome measure for adolescents and adults receiving gender-affirming treatments (the GENDER-Q). BMJ Open 2018; 8:e025435. [PMID: 30344182 PMCID: PMC6196938 DOI: 10.1136/bmjopen-2018-025435] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION A critical barrier to outcome assessment in gender-affirming healthcare is the lack of a specific patient-reported outcome measure (PROM). This phase I protocol describes an international collaboration between investigators in Canada, Denmark, the Netherlands and the USA who have coalesced to develop a new PROM (ie, the GENDER-Q) to evaluate outcomes of psychological, hormonal and surgical gender-affirming treatments. METHODS AND ANALYSIS This phase I study uses an interpretive description approach. Participants aged 16 years and older seeking any form of gender-affirming treatments in centres located in Canada, Denmark, the Netherlands and the USA will be invited to take part in qualitative interviews. Participants will review BREAST-Q and FACE-Q scales hypothesised to contain content relevant to specific gender-affirming treatments. Interviews will elicit new concepts for additional scale development. Each interview will be digitally recorded, transcribed and coded. The main outcome of this phase I study will be the development of a conceptual framework and set of scales to measure outcomes important to evaluating gender-affirming treatments. To this end, analysis will be used to add/drop/revise items of existing scales to achieve content validity. For new concepts, coding will assign top-level domains and themes/subthemes to participant quotes. Codes will be used to develop an item pool to inform scale development. Draft scales will be shown to transgender and gender diverse persons and experts to obtain feedback that will be used to refine and finalise the scales. The field-test version of the GENDER-Q will be translated by following rigorous methods to prepare for the international field-test study. ETHICS AND DISSEMINATION This study is coordinated at McMaster University (Canada). Ethics board approval was received from the Hamilton Integrated Ethics Board (Canada), the Medical Ethical Committee at VUmc (The Netherlands) and Advarra (USA). Findings will be published in peer-reviewed journals and presented at national and international conferences and meetings.
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Affiliation(s)
| | - Manraj Kaur
- McMaster University, Hamilton, Ontario, Canada
| | | | - Baudewijntje Pc Kreukels
- Department of Medical Psychology, Amsterdam Public Health research institute, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Shane D Morrison
- Division of Plastic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Washington, USA
| | - Margriet G Mullender
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam Public Health Research Institute, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Lotte Poulsen
- Department of Plastic and Reconstructive Surgery, Odense University Hospital, Odense, Denmark
| | - Mujde Ozer
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam Public Health Research Institute, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Will Rowe
- McMaster University, Hamilton, Ontario, Canada
| | | | | | - John Semple
- Women's College Hospital, Toronto, Ontario, Canada
| | - Jens Ahm Sørensen
- Department of Plastic and Reconstructive Surgery, Odense University Hospital, Odense, Denmark
| | - Tim C van de Grift
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam Public Health Research Institute, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Maeghan van der Meij-Ross
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam Public Health Research Institute, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Danny Young-Afat
- Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Andrea L Pusic
- Brigham and Women's Hospital, Boston, Massachusetts, USA
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