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Subcutaneous Mastectomy Improves Satisfaction with Body and Psychosocial Function in Trans Men: Findings of a Cross-Sectional Study Using the BODY-Q Chest Module

2019; Lippincott Williams & Wilkins; Volume: 144; Issue: 1 Linguagem: Inglês

10.1097/prs.0000000000005734

1529-4242

Baptiste Bertrand, A.-S. Perchenet, C. Philandrianos, Dominique Casanova, Sarra Cristofari,

Cancer and Skin Lesions

Sir: We read with interest the study by van de Grift et al.1 evaluating the BODY-Q chest and nipple modules in trans men before and after transgender mastectomy. In this prospective study, the authors analyzed the postoperative satisfaction and its correlation with psychological symptoms and social well-being. We thank the authors for clearly demonstrating the benefits for trans men of surgical mastectomy with a dedicated satisfaction questionnaire. As reported by the authors, the BODY-Q chest module was created “for use in gynecomastia, postweight loss, body contouring, and gender confirming surgery.”2 However, trans men’s chests are sensibly different than those of postbariatric or gynecomastia patients. Indeed, their mammary gland is often more developed and extended above the pectoralis major muscle compared with postbariatric or gynecomastia patients. The areola and nipple are most often too large and in ectopic position. Therefore, the mastectomy procedure for trans men needs more extensive dissection and longer operative time than for gynecomastia patients. The BREAST-Q (MAPI Research Trust)3 was further validated to be appropriately used in clinical research and practice. Previous studies demonstrated its interest for trans women4 and trans men.5 When we compared the BREAST-Q and their modules of mastectomy and reconstruction and the BODY-Q chest and nipple modules, we noted a specific focus in the BREAST-Q on postoperative pain and the areolar aspects, which are absent in the BODY-Q. Thus, BREAST-Q mastectomy module questions (e.g., “In the past week, how often have you experienced sharp pains in your breast area?”) or BREAST-Q reconstruction module questions (e.g., “in the past 2 weeks, how satisfied or dissatisfied are you with the color of your reconstructed nipple-areola complex?”) could be relevant to transgender mastectomy. Indeed, the addition of many more specific questions about the areolar complex could improve the sensibility of the BODY-Q and perhaps reveal a difference in satisfaction among the three different mastectomy procedures. Indeed, the authors reported no difference with the chest and nipple modules of the BODY-Q among these three interventions.1 However, if the BREAST-Q seems to be more sensible than the BODY-Q, it is because this questionnaire was designed for women, and multiple questions are grammatically not adapted for trans men. Furthermore, the BREAST-Q is longer than the BODY-Q, and many questions are not adapted to transgender mastectomy. The perfect tool with which to objectively measure patient satisfaction is complex to create. It has to analyze extensively the subjective feeling of the patient and be simple, reliable, and as short as possible. The BODY-Q seems to contain all of these qualities. However, to compare the results of the different transgender procedures and the different transgender surgical teams internationally, we suggest adding questions that are more specific regarding postoperative results. These questions could be inspired by the BREAST-Q, previously used to evaluate the postoperative satisfaction after transgender mastectomy. Disclosure None of the authors has a financial interest in any of the products or devices mentioned in this communication. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Baptiste Bertrand, M.D., Ph.D.Anne-Sophie Perchenet, M.D.Cécile Philandrianos, M.D., Ph.D.Dominique Casanova, M.D.Department of Plastic SurgeryLa Conception HospitalAssitance PubliqueHôpitaux de MarseilleMarseille, France Sarra Cristofari, M.D., Ph.D.Department of Plastic SurgerySaint-Louis HospitalAssitance PubliqueHôpitaux de ParisParis, France