To determine the impact of gender-affirming mastectomy on depression, anxiety, and body image.
There are many cross-sectional and ad-hoc studies demonstrating the benefits of gender-affirming surgery. There are few prospective investigations of patient-reported outcomes in gender-affirming surgery using validated instruments.
In this prospective study, patients presenting the University of Michigan for gender-affirming Mastectomy were surveyed preoperatively and six-months postoperatively. Primary outcomes were patient-reported measurements of anxiety measured by GAD-7, depression measured by PHQ-9, body image measured by BODY-Q and BIQLI, psychosocial and sexual functioning measured by BREAST-Q, and satisfaction with decision measured by BREAST-Q. Linear regression analysis was used to control for presence of complication and existing history of mental health conditions.
70 patients completed the study. The average age of participants was 26.7. The mean PHQ-9 score preoperatively was 7.8 and postoperatively was 5.4 (p=0.001). The mean preoperative and postoperative GAD-7 scores were 7.6 and 4.6 respectively (p<0.001). There were significant improvements in both psychosocial (35 to 79.2, p<0.001) and sexual (33.9 to 67.2, p<0.001) functioning related to chest appearance as measured by the BREAST-Q as well as global psychosocial functioning (-15.6 to +21.9, p<0.001) as measured by the BIQLI. Satisfaction with chest contour (14.3 to 93.8, p<0.001) and nipple appearance (29.3 to 85.9, p<0.001) measured by the BODY-Q significantly improved. Patients had a mean satisfaction with outcome score of 93.1.
Patients undergoing gender-affirming mastectomy in this single-center prospective study reported significant improvements in anxiety, depression, body image, psychosocial and sexual functioning following this procedure. Patients were extremely satisfied with the decision to undergo this operation.

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