Work

Structural and sociodemographic determinants of BREAST-Q outcomes after gender-affirming breast augmentation in transgender women

Year: 2026

Type: article

Abstract: Purpose Sociodemographic factors are associated with disparities in postoperative outcomes after gender-affirming surgery, yet their relationship with patient-reported outcomes after gender-affirming breast augmentation remains unclear. We evaluated associations between patient-level and structural factors and patient-reported outcome measures (PROMs) among transgender women after breast augmentation. Methods Patients who underwent gender-affirming breast augmentation from 2015 to 2023 at two affiliated institutions, a county safety-net hospital and an academic medical center, were recruited to complete a postoperative BREAST-Q Augmentation Module survey ≥ 12 months after surgery. Six subscales were analyzed. Univariate linear regression was used to assess associations between sociodemographic, clinical, and surgical factors and BREAST-Q scores. Results Among 270 eligible patients, 65 (24 %) completed the BREAST-Q ≥ 1 year post-augmentation. Surgeries performed at the county hospital correlated with lower satisfaction with breasts (β = -15.45; p = 0.032), psychosocial well-being (β = -15.46; p = 0.042), and physical well-being (β = -14.23; p = 0.002) compared to procedures performed at the academic setting. Current tobacco use at the pre-operative visit was associated with lower postoperative psychosocial well-being (β = -23.78; p = 0.028). Severe obesity (BMI ≥ 35 kg/m²) was linked to lower implant satisfaction (β = -1.66; p = 0.013). Black patients reported higher sexual well-being compared with non-Hispanic White patients (β = +25.67; p = 0.016). No significant associations were found between other sociodemographic factors, surgical variables (implant size, shape, texture, incision), complications, or race/ethnicity for the remaining BREAST-Q subscales. Conclusion After gender-affirming breast augmentation, patient-reported satisfaction and well-being among transgender women undergoing breast augmentation appear to be shaped more by structural context and patient-level factors rather than by the technical factors of the operation alone.

Source: JPRAS Open

DOI: 10.1016/j.jpra.2026.05.011