Advertisement

Outcome Measures in Gender-Confirming Chest Surgery: A Systematic Scoping Review

Abstract

Background

The aim of this scoping review was to provide an overview of outcome measures in gender-confirming chest surgery.

Methods

A comprehensive literature search was performed in PubMed, EMBASE, CINAHL, PsycINFO, Scopus and the Cochrane Library to find studies evaluating gender-confirming chest surgery in a non-cis gender population. The systematic scoping review followed the PRISMA extension for scoping reviews. Data were charted for outcome measures including complications, reoperations, revision surgery, aesthetic outcome and patient-reported outcome measures.

Results

Our search yielded 849 records, which were screened on title, abstract and full text. Of these, 47 were included in the review. Feminising gender-confirming chest surgery was evaluated in 11 studies, and masculinising gender-confirming chest surgery was evaluated in 39 studies. Clinician-reported outcome categories were used in 40 studies and included complications, reoperation, revision surgery and aesthetic outcome. Categories of patient-reported outcomes were used in 29 studies and included aesthetic outcome, functional outcome and mental health parameters. The summary of outcome domains and classifications showed that there are large variations in outcome evaluation between studies. Although several studies reported on similar outcome categories, there was a high level of heterogeneity of domains and classifications of outcomes.

Conclusions

Evaluation of outcomes in gender-confirming chest surgery showed large variations in reporting, and further streamlining of reporting is therefore required to be able to compare surgical outcomes between studies.

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 the Table of Contents or the online Instructions to Authors www.springer.com/00266.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Fig. 1

References

  1. 1.

    Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, DeCuypere G, Feldman J, Fraser L, Green J, Knudson G, Meyer WJ, Monstrey S, Adler RK, Brown GR, Devor AH, Ehrbar R, Ettner R, Eyler E, Garofalo R, Karasic DH, Lev AI, Mayer G, Meyer-Bahlburg H, Hall BP, Pfaefflin F, Rachlin K, Robinson B, Schechter LS, Tangpricha V, Van Trotsenburg M, Vitale A, Winter S, Whittle S, Wylie KR, Zucker K (2012) Standards of care for the health of transsexual, transgender, and gender-nonconforming people, Version 7. Int J Transgenderism 13:165–232

  2. 2.

    Wilson SC, Morrison SD, Anzai L, Massie JP, Poudrier G, Motosko CC, Hazen A (2018) Masculinizing top surgery. Ann Plast Surg 80:679–683

  3. 3.

    Gargon E, Gurung B, Medley N, Altman DG, Blazeby JM, Clarke M, Williamson PR (2014) Choosing important health outcomes for comparative effectiveness research: a systematic review. PLoS ONE. https://doi.org/10.1371/journal.pone.0099111

  4. 4.

    Gorst SL, Gargon E, Clarke M, Blazeby JM, Altman DG, Williamson PR (2016) Choosing important health outcomes for comparative effectiveness research: an updated review and identification of gaps. PLoS ONE. https://doi.org/10.1371/journal.pone.0146444

  5. 5.

    Dodd S, Clarke M, Becker L, Mavergames C, Fish R, Williamson PR (2018) A taxonomy has been developed for outcomes in medical research to help improve knowledge discovery. J Clin Epidemiol 96:84–92

  6. 6.

    Walton MK, Powers JH, Hobart J, Donald P, Marquis P, Vamvakas S, Isaac M, Molsen E, Cano S, Burke LB (2015) Clinical outcome assessments: conceptual foundation-report of the ISPOR clinical outcomes assessment—emerging good practices for outcomes research task force. Value Health 18:741–752

  7. 7.

    Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, Moher D, Peters MDJ, Horsley T, Weeks L, Hempel S, Akl EA, Chang C, McGowan J, Stewart L, Hartling L, Aldcroft A, Wilson MG, Garritty C, Lewin S, Godfrey CM, MacDonald MT, Langlois EV, Soares-Weiser K, Moriarty J, Clifford T, Tunçalp Ö, Straus SE (2018) PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 169:467–473

  8. 8.

    Donabedian A (1966) Evaluating the quality of medical care. Milbank Meml Fund Q 44:166–206

  9. 9.

    Agarwal CA, Scheefer MF, Wright LN, Walzer NK, Rivera A (2018) Quality of life improvement after chest wall masculinization in female-to-male transgender patients: a prospective study using the BREAST-Q and Body Uneasiness Test. J Plast Reconstr Aesthet Surg 71:651–657

  10. 10.

    Esmonde N, Heston A, Jedrzejewski B, Ramly E, Annen A, Guerriero J, Hansen J, Berli J (2019) What is “non-binary” and what do I need to know? A primer for surgeons providing chest surgery for transgender patients. Aesthet Surg J. https://doi.org/10.1093/asj/sjy166

  11. 11.

    Frey JD, Yu JZ, Poudrier G, Motosko CC, Saia WV, Wilson SC, Hazen A (2018) Modified nipple flap with free areolar graft for component nipple-areola complex construction. Plast Reconstr Surg 142:331–336

  12. 12.

    McEvenue G, Xu FZ, Cai R, McLean H (2018) Female-to-male gender affirming top surgery: a single surgeon’s 15-Year retrospective review and treatment algorithm. Aesthet Surg J 38:49–57

  13. 13.

    Lane M, Ives GC, Sluiter EC, Waljee JF, Yao TH, Hu HM, Kuzon WM (2018) Trends in gender-affirming surgery in insured patients in the United States. Plast Reconstr Surg Glob Open. https://doi.org/10.1097/GOX.0000000000001738

  14. 14.

    van de Grift TC, Elfering L, Greijdanus M, Smit JM, Bouman MB, Klassen AF, Mullender MG (2018) Subcutaneous mastectomy improves satisfaction with the body and psychosocial function in trans men: findings of a cross-sectional study using the BODY-Q chest module. Plast Reconstr Surg 142:1125–1132

  15. 15.

    van de Grift TC, Elaut E, Cerwenka SC, Cohen-Kettenis PT, Kreukels BPC (2018) Surgical satisfaction, quality of life, and their association after gender-affirming surgery: a follow-up study. J Sex Marital Ther 44:138–148

  16. 16.

    Olson-Kennedy J, Warus J, Okonta V, Belzer M, Clark LF (2018) Chest reconstruction and chest dysphoria in transmasculine minors and young adults comparisons of nonsurgical and postsurgical cohorts. JAMA Pediatr 172:431–436

  17. 17.

    Whitehead DM, Weiss PR, Podolsky D (2018) A single surgeonʼs experience with transgender female-to-male chest surgery. Ann Plast Surg 81:353–359

  18. 18.

    Wolter A, Scholz T, Pluto N, Diedrichson J, Arens-Landwehr A, Liebau J (2018) Subcutaneous mastectomy in female-to-male transsexuals: optimizing perioperative and operative management in 8 years clinical experience. J Plast Reconstr Aesthet Surg 71:344–352

  19. 19.

    Bertrand B, Perchenet A, Colson TRR, Drai D, Casanova D (2017) Female-to-male transgender chest reconstruction: a retrospective study of patient satisfaction. Ann Chir Plast Esthet 62:303–307

  20. 20.

    Bluebond-Langner R, Berli JU, Sabino J, Chopra K, Singh D, Fischer B (2017) Top surgery in transgender men: how far can you push the envelope? Plast Reconstr Surg. https://doi.org/10.1097/PRS.0000000000003225

  21. 21.

    Cizek S, Nguyen N, Lyon L, Zaritsky E, Weiss E (2017) Combined hysterectomy and mastectomy surgery for transgender patients in an integrated health care setting. Int J Transgenderism 18:382–388

  22. 22.

    Donato DP, Walzer NK, Rivera A, Wright L, Agarwal CA (2017) Female-to-male chest reconstruction: a review of technique and outcomes. Ann Plast Surg 79:259–263

  23. 23.

    Frederick MJ, Berhanu AE, Bartlett R (2017) Chest surgery in female to male transgender individuals. Ann Plast Surg 78:249–253

  24. 24.

    Top H, Balta S (2017) Transsexual mastectomy: selection of appropriate technique according to breast characteristics. Balk Med J 34:147–155

  25. 25.

    Knox ADC, Ho AL, Leung L, Hynes S, Tashakkor AY, Park YS, Macadam SA, Bowman CC (2017) A review of 101 consecutive subcutaneous mastectomies and male chest contouring using the concentric circular and free nipple graft techniques in female-to-male transgender patients. Plast Reconstr Surg. https://doi.org/10.1097/PRS.0000000000003388

  26. 26.

    Kääriäinen M, Salonen K, Helminen M, Karhunen-Enckell U (2017) Chest-wall contouring surgery in female-to-male transgender patients: a one-center retrospective analysis of applied surgical techniques and results. Scand J Surg 106:74–79

  27. 27.

    Russo GL, Tanini S, Innocenti M (2017) Masculine chest-wall contouring in FtM transgender: a personal approach. Aesthet Plast Surg 41:369–374

  28. 28.

    Marinkovic M, Newfield RS (2017) Chest reconstructive surgeries in transmasculine youth: experience from one pediatric center. Int J Transgenderism 18:376–381

  29. 29.

    van de Grift TC, Elfering L, Bouman M-BB, Buncamper ME, Mullender MG (2017) Surgical indications and outcomes of mastectomy in transmen: a prospective study of technical and self-reported measures. Plast Reconstr Surg. https://doi.org/10.1097/PRS.0000000000003607

  30. 30.

    Papadopulos NA, Zavlin D, Lellé JD, Herschbach P, Henrich G, Kovacs L, Ehrenberger B, Machens HG, Shaff J (2017) Combined vaginoplasty technique for male-to-female sex reassignment surgery: operative approach and outcomes. J Plast Reconstr Aesthet Surg 70:1483–1492

  31. 31.

    Stojanovic B, Bizic M, Bencic M, Kojovic V, Majstorovic M, Jeftovic M, Stanojevic D, Djordjevic ML (2017) One-stage gender-confirmation surgery as a viable surgical procedure for female-to-male transsexuals. J Sex Med 14:741–746

  32. 32.

    van de Grift TC, Kreukels BPCC, Elfering L, Özer M, Bouman MB, Buncamper ME, Smit JM, Mullender MG (2016) Body image in transmen: multidimensional measurement and the effects of mastectomy. J Sex Med 13:1778–1786

  33. 33.

    Bjerrome Ahlin H, Kölby L, Elander A, Selvaggi G (2014) Improved results after implementation of the Ghent algorithm for subcutaneous mastectomy in female-to-male transsexuals. J Plast Surg Hand Surg 48:362–367

  34. 34.

    Davis SA, Colton Meier S (2014) Effects of testosterone treatment and chest reconstruction surgery on mental health and sexuality in female-to-male transgender people. Int J Sex Health 26:113–128

  35. 35.

    Weigert R, Frison E, Sessiecq Q, Al Mutairi K, Casoli V (2013) Patient satisfaction with breasts and psychosocial, sexual, and physical well-being after breast augmentation in male-to-female transsexuals. Plast Reconstr Surg 132:1421–1429

  36. 36.

    Forster NA, Künzi W, Giovanoli P (2013) The reoperation cascade after breast augmentation with implants: what the patient needs to know. J Plast Reconstr Aesthet Surg 66:313–322

  37. 37.

    Antoszewski B, Bratos R, Sitek A, Fijalkowska M (2012) Long-term results of breast reduction in female-to-male transsexuals. Pol Przegl Chir 84:144–151

  38. 38.

    Cregten-Escobar P, Bouman MB, Buncamper ME, Mullender MG (2012) Subcutaneous mastectomy in female-to-male transsexuals: a retrospective cohort-analysis of 202 patients. J Sex Med 9:3148–3153

  39. 39.

    Berry MG, Curtis R, Davies D (2012) Female-to-male transgender chest reconstruction: a large consecutive, single-surgeon experience. J Plast Reconstr Aesthet Surg 65:711–719

  40. 40.

    Morath S, Papadopulos N, Schaff J (2011) Operative management and techniques of mastectomy in female-to-male transsexuals. Handchir Mikrochir Plast Chir 43:232–239

  41. 41.

    Namba Y, Watanabe T, Kimata Y (2009) Mastectomy in female-to-male transsexuals. Acta Med Okayama 63:243–247

  42. 42.

    Ott J, van Trotsenburg M, Kaufmann U, Schrögendorfer K, Haslik W, Huber JC, Wenzl R (2010) Combined hysterectomy/salpingo-oophorectomy and mastectomy is a safe and valuable procedure for female-to-male transsexuals. J Sex Med 7:2130–2138

  43. 43.

    Nelson L, Whallett EJ, McGregor JC (2009) Transgender patient satisfaction following reduction mammaplasty. J Plast Reconstr Aesthet Surg 62:331–334

  44. 44.

    Schaff J, Papadopulos NA (2009) A new protocol for complete phalloplasty with free sensate and prelaminated osteofasciocutaneous flaps: experience in 37 patients. Microsurgery 29:413–419

  45. 45.

    Monstrey S, Selvaggi G, Ceulemans P, Van Landuyt K, Bowman C, Blondeel P, Moustapha Hamdi, De Cuypere G (2008) Chest-wall contouring surgery in female-to-male transsexuals: a new algorithm. Plast Reconstr Surg 121:849–859

  46. 46.

    Newfield E, Hart S, Dibble S, Kohler L (2006) Female-to-male transgender quality of life. Qual Life Res 15:1447–1457

  47. 47.

    Takayanagi S, Nakagawa C (2006) Chest wall contouring for female-to-male transsexuals. Aesthet Plast Surg 30:204–206

  48. 48.

    De Cuypere G, T’Sjoen G, Beerten R, Selvaggi G, De Sutter P, Hoebeke P, Monstrey S, Vansteenwegen A, Rubens R (2005) Sexual and physical health after sex reassignment surgery. Arch Sex Behav 34:679–690

  49. 49.

    Kanhai RCJ, Hage JJ, Mulder JW (2000) Long-term outcome of augmentation mammaplasty in male-to-female transsexuals: a questionnaire survey of 107 patients. Br J Plast Surg 53:209–211

  50. 50.

    Kanhai RCJ, Hage JJ, Asscheman H, Mulder JW (1999) Augmentation mammaplasty in male-to-female transsexuals. Plast Reconstr Surg 104:541–542

  51. 51.

    Kanhai RCJ, Hage JJ, Karim RB, Mulder JW (1999) Exceptional presenting conditions and outcome of augmentation mammaplasty in male-to-female transsexuals. Ann Plast Surg 43:476–483

  52. 52.

    Hage JJ, Bloem JJ (1995) Chest wall contouring for female-to-male transsexuals: amsterdam experience. Ann Plast Surg 34:59–66

  53. 53.

    Lim S (1986) Surgery in transsexuals. Ann Acad Med Singap 15:122–126

  54. 54.

    Ratnam SS, Lim SM (1982) Augmentation mammoplasty for the male transsexual. Singap Med J 23:107–109

  55. 55.

    Lindsay WR (1979) Creation of a male chest in female transsexuals. Ann Plast Surg 3:39–45

  56. 56.

    Pusic AL, Reavey PL, Klassen AF, Scott A, McCarthy C, Cano SJ (2009) Measuring patient outcomes in breast augmentation: introducing the BREAST-Q© augmentation module. Clin Plast Surg 36:23–32

  57. 57.

    Klassen AF, Cano SJ, Alderman A, Soldin M, Thoma A, Robson S, Kaur M, Papas A, Van Laeken N, Taylor VH, Pusic AL (2016) The BODY-Q: a patient-reported outcome instrument for weight loss and body contouring treatments. Plast Reconstr Surg Glob Open. https://doi.org/10.1097/GOX.0000000000000665

  58. 58.

    El-Hadi H, Stone J, Temple-Oberle C, Harrop AR (2018) Gender-affirming surgery for transgender individuals: perceived satisfaction and barriers to care. Plast Surg 26:263–268

Download references

Author information

Correspondence to Anders Tolstrup.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest to disclose.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed Consent

For this type of study, informed consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Tolstrup, A., Zetner, D. & Rosenberg, J. Outcome Measures in Gender-Confirming Chest Surgery: A Systematic Scoping Review. Aesth Plast Surg 44, 219–228 (2020). https://doi.org/10.1007/s00266-019-01523-1

Download citation

Keywords

  • Sex reassignment surgery
  • Gender confirmation surgery
  • Transgender persons
  • Clinician-reported outcome measures
  • Patient-reported outcome measures
  • Scoping review