Postoperative Opioid Prescription Size and Patient-reported Consumption Following Gender-affirming Mastectomy: A Prospective Survey Study

Background: Aligning opioid prescribing with patient needs is important for managing pain while minimizing risks. However, little is known about opioid prescribing after gender-affirming procedures. Given that gender-diverse patients are at higher risk for poor opioid-related outcomes, creating guidelines centered on patient-reported opioid use and pain experiences is critical. We conducted a prospective survey study examining opioid prescribing and consumption after gender-affirming mastectomy (GAM). Methods: Patients who underwent GAM from February to September 2021 were identified. Electronic medical record data were collected, including opioid prescription and refill amounts. Patient-reported outcomes including opioid use, nonopioid adjunct use, pain rating 1 week postoperatively, and pain management satisfaction were collected via telephone surveys 2–4 weeks postoperatively. Descriptive statistics and bivariate analyses compared outcomes between opioid consumers and nonconsumers. Results: Of 115 patients, 72 responded with complete data (62.6% response rate). Sixty-three individuals (87.5%) consumed opioids and 9 (12.5%) did not consume opioids. The median (interquartile range) opioid prescription quantity was 15 (12–17) tablets. The median (interquartile range) consumption was 10 (3–14.5) tablets ( P < 0.001). Most patients (63.4%) felt their prescription amount was appropriate, whereas 28.2% said it was too much. In all, 94.4% used nonopioid adjuncts, and 100% were satisfied with their postoperative pain management. Conclusions: Most patients undergoing GAM reported using opioids, with an average of 10 pills, and were satisfied with their postoperative pain control. Going forward, surgeons should consider tailoring prescribing to patient needs and providing nonopioid alternatives when possible.