Chest Reconstruction/Breast Augmentation Surgery Satisfaction and Regret

The increasing availability of plastic surgery as a part of gender transition occurs at the same time that more enlightened social awareness has resulted in an increase in the incidence of reported gender variances in the general population. At the same time advances in medical diagnosis and treatment methods have resulted in more accurate diagnosis of Gender Dysphoria with psychological counseling, hormone therapy, and surgery offered as treatments.

There is no definitive agreement among medical professionals as to what is the best treatment for Gender Dysphoria, nor even agreement on the standards of diagnosis and care. Activists for transgender rights, including many physicians, even object to the medical description of being transsexual or transgender as being a “disorder” at all.

What has become clear to both professionals and to the transgender population is the need to acknowledge the wide variation in transgender experience and the need to study the long-term results of various treatments, including psychological therapy, hormone therapy and plastic surgery.

More Long-term Satisfaction Studies are Needed

Clinical studies have often reported high rates of patient satisfaction with sex reassignment surgery, but it is difficult to track specifics regarding whether such surgery was performed together with counseling and hormone therapy or instead of hormone therapy when hormone therapy was not feasible for health reasons. Another significant factor is whether the surgery performed was “top” surgery, readily available and well-tested variations of cosmetic plastic surgery procedures or “bottom” surgery, much more complicated, expensive and less available procedures, or both.

Post-surgery satisfaction is further complicated by having to consider the extremely wide variety of psychopathological states that patients were in prior to SRS surgery and whether or not they had achieved positive results from treatment prior to surgery. Some studies showed increased satisfaction with social and interpersonal relations, but no changes in the incidence of psychopathology; one study cautioning that sex reassignment surgery does not alter personality, and “better predictors of post-surgical success are pre-surgical ego strength and patients’ adjustment during the pre-surgery period while living in their new gender identity.

After over three decades of studies of post-surgery satisfaction following SRS surgery, there are no definitive conclusions for many reasons: there is no consensus on standards of diagnosis of Gender Dysphoria, no consensus on terms, no consensus on standards of measure for “satisfaction”, no consistency in evaluating transgender patients for surgery, and difficulty in tracking patients for long-term follow up.

Clinicians who focused on overall social/emotional functioning after surgery using internationally accepted ratings criteria found a positive change rate of 68%-86%; while other studies that focused on psychological variables reported more negative results.  All findings, both positive and negative, must be viewed skeptically in light of the many methodological weaknesses of most of the studies.

What is clear is that the number of requests for sex reassignment surgery has increased dramatically in recent years, especially for MTF breast augmentation and FTM chest reconstruction surgery. Anecdotal evidence and first-person reports on transgender websites, forums and blogs indicate high rates of satisfaction, but such evidence is by no means scientific.

If satisfaction ratings focus strictly on the aesthetic outcome of the specific surgery, in the case of FTM chest reconstruction or MTF breast augmentation, looking at satisfaction rates in studies of non-transgender (cisgender) plastic surgery patients are relevant. Most studies report high rates of satisfaction following breast augmentation for women and breast reduction for men. Both procedures number among the top 5 plastic surgery procedures performed in the US in 2011, according to the American Society for Aesthetic Plastic Surgery (ASAPS).

Satisfaction is Tied to Expectations

Satisfaction with surgical results is closely related to the surgeon’s skill and aesthetic eye, patient safety, matching the procedure to the patient’s expectations, and no adverse reactions or complications.

Patient safety is the primary concern of Board-Certified Plastic Surgeon Dr. Scott Mosser.  He does everything in his power to ensure patients are physically, mentally and emotionally ready and able to make mature, informed decisions.

Although rare, when patients experience regret after surgery, it is most often because of the patient’s unrealistic expectations. This is why Dr. Mosser emphasizes coordination with the patient’s support team, including physicians administering psychological therapy and hormone therapy, and the family member, partner, or close friend assisting in the transition.

One of the key tasks of the family, friends and partner is to help the patient learn as much as possible about the procedures available to help keep them grounded in reality and not encourage unrealistic expectations.