A double (or bilateral) mastectomy is not only a major surgery, but it also holds significant importance as a treatment for breast cancer, regardless of the patient’s gender. Moreover, it serves as a gender-affirming surgery for trans-masculine and non-binary individuals. In a recent study, the researchers had the opportunity to examine the experiences of 235 eligible participants who underwent this procedure. Out of these, 139 individuals responded to the study authors. Interestingly, the respondents included not only men (88) but also non-binary (17) and gender non-conforming individuals (34).
To assess the satisfaction levels of the participants, the researchers employed various statistical surveys. While there were dominant identities within the sample, the experiences and outcomes of the surgery varied greatly. Some individuals encountered complications that required follow-up surgeries, although these cases were relatively rare.
What stood out the most was the overwhelming lack of dissatisfaction and regret expressed by the participants. In fact, the consistency of these sentiments hindered the researchers from conducting more complex analyses. On a 5-point scale, the mean satisfaction score was an impressive 4.8, with a median value of 5. Similarly, on a 100-point scale measuring regret, with 100 representing full regret, the mean score was 4.2, and the median score was zero.
Dr. Megan Lane, leading the study at the University of Michigan in Ann Arbor, acknowledged the remarkable results in the paper’s conclusions. She stated, “The lack of variation in scores impeded the ability to perform a statistical analysis to establish characteristics associated with satisfaction with decision and regret. There were no individuals who underwent reversal procedures. While prospective, multicenter work is needed, these results are consistent with previous ad hoc studies and affirm the overwhelmingly low levels of regret following gender-affirming surgery.”
These findings align with other studies that have reported dissatisfaction rates of around 1 percent for gender-affirming surgeries. Additionally, they challenge the baseless claim that regrets regarding these procedures may manifest years later without any scientific evidence to support it.
The research team even compared their results with 44 other studies focusing on surgery regrets unrelated to gender-affirming care. Surprisingly, only one study had a lower regret rate, which pertained to surgery for treating urinary incontinence, with a mean score of 2.5. In contrast, a previous study found that 18 percent of individuals who underwent knee replacement surgery experienced regret. Yet, there is no call to end knee replacement surgery or any legislative action against it.
An accompanying commentary highlights the double standard surrounding gender-affirming care, where regret receives disproportionate attention in the media and legislative bodies. The study emphasizes that regret is a complex issue and rarely stems from one’s identity alone. Trans and non-binary individuals not only face challenges related to surgery but also endure stigmatization and social exclusion for being true to themselves.
The invited commentary authors assert that public health efforts should focus on strengthening support systems for at-risk populations, while medical professionals should identify vulnerabilities associated with social determinants of health instead of denying medical care based on exaggerated claims about procedural regret.
It is important to note some limitations of the study, such as the inconsistency in follow-up times among participants. The most recent procedure occurred two years before the study, while the oldest was performed 23.6 years prior. Additionally, the study was limited to procedures within the researchers’ institutions, potentially missing out on capturing the full range of experiences. Furthermore, the researchers acknowledge the possibility of responder bias among non-respondents, which could have influenced the results. To ensure the generalizability of these findings, the team suggests conducting a multicenter study involving multiple practices.
The study has been published in the esteemed journal JAMA Surgery.
