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. 2018 May;71(5):651-657. doi: 10.1016/j.bjps.2018.01.003. Epub 2018 Jan 31.


Background: Chest reconstruction in many female-to-male (FTM) transgender individuals is an essential element of treatment for their gender dysphoria. In existing literature, there are very few longitudinal studies utilizing validated survey tools to evaluate patient reported outcomes surrounding this surgery. The purpose of our study is to prospectively evaluate patient reported satisfaction, improvement in body image, and quality of life following FTM chest wall reconstruction.

Methods: Our study was a prospective analysis of FTM patients who underwent chest reconstruction by a single surgeon (C.A.) between April 2015 and June 2016. The patients were surveyed preoperatively and 6 months after surgery utilizing the BREAST-Q breast reduction/mastectomy questionnaire and the Body Uneasiness Test (BUT-A). Analysis was performed on their self-reported demographic information, survey results, and chart review data.

Results: Of 87 eligible patients, 42 completed all surveys and could be linked to their chart data. From the BREAST-Q surveys, significant improvements were observed in the domains of breast satisfaction, psychosocial well-being, sexual satisfaction, and physical well-being. From the BUT-A surveys, we observed significant improvement in body image, avoidance, compulsive self-monitoring, and depersonalization. Groups with mental health conditions had poorer initial BUT-A scores and greater degree of improvement after surgery.

Conclusions: As the prevalence of gender affirming surgery increases and as health policies are being developed in this area, the need for evidence-based studies surrounding specific interventions is essential. This study demonstrates significant improvement in a number of quality of life measurements in FTM patients after undergoing chest masculinization surgery.

Keywords: FTM top surgery; Female-to-male chest reconstruction; Transgender; Transgender quality of life.

MeSH terms

  • Adolescent
  • Adult
  • Esthetics
  • Female
  • Humans
  • Male
  • Mammaplasty / methods*
  • Masculinity
  • Mastectomy / methods*
  • Middle Aged
  • Patient Satisfaction
  • Prospective Studies
  • Quality of Life*
  • Thoracic Wall / surgery*
  • Transgender Persons*