Along the Spectrum from Reduction to Mastectomy: Comparing the Opinions of an Online Transmasculine and Gender-Diverse Community on an Algorithmic Approach to Gender-Affirming Top Surgery.

BACKGROUND

Gender-diverse patients often have unique preferences for top surgery that differ from those of binary transgender men. Yet, discussions around tailored surgical options remain limited. Social media platforms provide insights into the preferences of gender-diverse individuals who frequently turn to digital spaces for information and support. This study sought to explore the diverse needs of gender-diverse respondents and gather their feedback on a pictorial algorithm designed to assist with preoperative surgical decision-making.

METHODS

A cross-sectional survey was distributed on Reddit to individuals considering or having undergone masculinizing top surgery. The survey collected data on aesthetic preferences, comfort with surgical options, surgeon communication, and the need for non-standard surgical choices. A pictorial algorithm was used to evaluate its utility in enhancing preoperative discussions. Data were analyzed for demographic differences and preferences across transgender male, non-binary, and other gender-diverse (OGD) groups.

RESULTS

Of 799 respondents, 639 met the inclusion criteria. Non-binary and OGD respondents were older (p<0.0001) and had higher education levels (p<0.0001). These groups showed a higher preference for "non-standard" chest reconstruction (p=0.02), were less likely to want nipple-areola complex (NAC) reconstruction, and reported more frequent interactions where they educated their surgeons on options (p<0.0001) and greater comfort in these discussions (p=0.0002).

CONCLUSION

This study highlights the diverse preferences and needs of gender-diverse individuals seeking masculinizing top surgery. It underscores the importance of personalized care, with a structured communication tool and algorithm aiding better patient-provider alignment for more tailored surgical outcomes.

LEVEL OF EVIDENCE IV

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