Biologically-born women who undergo breast-removal surgeries report high satisfaction and few regrets years later, according to a study funded by the Plastic Surgery Foundation.
The study, published in JAMA Surgery on Wednesday, surveyed 139 former patients last year about the decision to undergo gender-transition mastectomies at a University of Michigan medical center sometime between Jan. 1, 1990, and Feb. 29, 2020.
Among the respondents, mostly adults at the time of the procedure, none reported reversing the surgery, and one-quarter went on to have more cross-gender treatments such as hysterectomies or facial masculinization.
The median time between the surgery and a patient answering the survey questions was three-and-a-half years.
In scaled responses to survey questions, the 139 patients reported near-total contentment and “substantially low levels of decisional regret,” the study found.
Another 96 former patients contacted by the researchers failed to respond to the questionnaire.
The findings support earlier studies that had shorter follow-up interviews, Drs. Ian T. Nolan, Brielle Weinstein and Loren Schechter said in an invited commentary.
“This study contradicts claims that regret following gender-affirming surgery may not manifest for many years and highlights the disproportionate criticism encountered in gender-affirming care compared with other surgical disciplines,” wrote the three doctors, who are plastic surgeons at Rush University Medical Center in Chicago.
Noting that a recent systematic review found higher shares of patients regretting their gender-transition surgeries, the doctors chalked it up to the “ongoing stigmatization” of transgender people and a related “loss of social support systems.”
“In gender-affirming surgery, concerns regarding the potential for regret are often used to deny or limit access to medically necessary care,” Drs. Nolan, Weinstein and Schechter wrote.
The study comes as transgender surgery for minors has become a political flashpoint leading up to the 2024 election.
On June 6, CNN reported that 19 red states from Texas and Florida to Indiana and Iowa had restricted it.
According to CNN, at least 10 blue states and Washington, D.C., had passed laws protecting access to transgender procedures for minors with parental permission. They include California, New Jersey and Colorado.
While advocates of gender-transition surgeries for minors welcomed the study on Wednesday, some critics called it misleading.
“This study tells us very little about long-term regret associated with ‘transition’ mastectomies, and, because it reports on regret experienced by adults, is of little value for legislators seeking to regulate ‘transition’ mastectomies in minors,” said attorney Mary Rice Hasson, a senior fellow specializing in gender issues at the conservative Ethics and Public Policy Center.
She noted in an email that participants had the mastectomies at a median age of 27 — with most occurring between ages 23 and 33 — and said whether doctors label them elective or “medically necessary” surgeries makes a difference.
“Research shows that most de-transitioners [who return to their sex assigned at birth] say they underwent transition because they felt it was their only option to address their [gender] dysphoria,” Ms. Hasson added.
By contrast, the National Center for Transgender Equality calls gender-transition surgeries “essential” and says most youths who receive them continue to identify as transgender well into adulthood.
The Washington, D.C.-based advocacy group affirmed the Michigan study’s findings.
“All transition-related treatment, including surgery, is built on decades of research, and prescribed using rigorous standards of care,” Rodrigo Heng-Lehtinen, the center’s executive director, told The Washington Times. “Public policy should allow all patients to get the health care they need, including those who are transgender.”
About 1.6% of U.S. adults are transgender or nonbinary, the study noted.
Among the participants, 99% reported they were assigned female sex at birth and one respondent had “no sex identified.”
While some had started identifying as other genders and receiving testosterone treatments by the time of their mastectomies, others had not.
The study found that 19% of patients reported having a different gender between the time of their surgery and when they responded to the survey between two and nearly 24 years later.
Most switched genders to male and the remainder started identifying as nonbinary, multiple or “other” genders.
According to the study, 76% of participants were White. The remainder were multiracial (11%), Black (5%), Hispanic (4%), Asian (3%) or “other” (1%) racial identities.
“For many transgender or nonbinary individuals, medical and surgical affirmation is essential to treating gender dysphoria and ensuring social acceptance,” the study said.
• Sean Salai can be reached at ssalai@washingtontimes.com.