BMI is Not Associated with Chest-Specific Body Image, Complications or Revisions in Gender-Affirming Mastectomy: A Single-Center Cross-Sectional Study

Cole Roblee; Tannon Topple; Jennifer B Hamill; Maria Ibarra; Andrew Bolze; Alexander N Khouri; Jessica J Hsu; Megan Lane; William M Kuzon Jr; Edwin G Wilkins; Shane D Morrison

doi:10.1097/SLA.0000000000006143

BMI is Not Associated with Chest-Specific Body Image, Complications or Revisions in Gender-Affirming Mastectomy: A Single-Center Cross-Sectional Study

Ann Surg. 2023 Oct 23. doi: 10.1097/SLA.0000000000006143. Online ahead of print.

Authors

Cole Roblee^{1

2}, Tannon Topple³, Jennifer B Hamill¹, Maria Ibarra⁴, Andrew Bolze⁴, Alexander N Khouri¹, Jessica J Hsu¹, Megan Lane^{1

5}, William M Kuzon Jr¹, Edwin G Wilkins^{1

5}, Shane D Morrison^{6

7}

Affiliations

¹ Section of Plastic Surgery, University of Michigan, Ann Arbor MI.
² Rosalind Franklin University of Medicine and Science, North Chicago IL.
³ University of Minnesota Twin Cities School of Medicine, Minneapolis, MN.
⁴ University of Michigan Medical School, Ann Arbor MI.
⁵ Institute for Healthcare Policy and Innovation, Ann Arbor MI.
⁶ Division of Plastic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA.
⁷ Department of Urology, University of Washington Medical Center, Seattle, WA.

PMID: 37870257
DOI: 10.1097/SLA.0000000000006143

Abstract

Objective: To analyze the impact of Body Mass Index (BMI) on clinical and patient-reported outcomes following gender-affirming mastectomy (GM).

Background: BMI is a barrier for obese patients seeking GM despite increasing evidence that it is safe in this population. Currently little is known about the impact of BMI on chest-specific body image and satisfaction following GM.

Methods: This single-center, cross-sectional study included individuals 18 years and older who underwent GM between 1990-2020 and were at least 2 years post-operative. Patient-reported chest-specific body image was measured using the BODY-Q and Gender Congruence and Life Satisfaction (GCLS) chest subscales. Satisfaction was measured using the Holmes-Rovner Satisfaction with Decision (SWD) scale. Clinical and demographic variables were identified from chart review. Bivariate analysis was performed to determine if BMI was associated with chest-specific body image, satisfaction, complications within 30 days or revisions in GM.

Results: Two hundred twenty-seven individuals meeting eligibility criteria were contacted to participate and one hundred thirty-seven responded (60.4% response rate). The mean age was 29.1 (SD=9.0) and mean BMI was 30.9 (SD=8.0), with 26.4% (N=60) of the cohort having a BMI>35. Chest-specific body image, and satisfaction with decision did not vary by BMI or breast resection weight. Complications and revisions were not associated with BMI.

Conclusion: Individuals undergoing GM reported high rates of satisfaction following GM regardless of BMI. Complication and revision rates did not vary significantly by BMI or breast resection weight. Surgeons should re-evaluate the role BMI plays in patient selection and counseling for GM.