Structural and Sociodemographic Determinants of BREAST-Q Outcomes After Gender-Affirming Breast Augmentation in Transgender Women

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 postaugmentation.Surgeries performed at the county hospital correlated with lower satisfaction with breasts ( = -15.45;p = 0.032), psychosocial well-being ( = -15.46;p = 0.042), and physical well-being ( = -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 ( = -23.78;p = 0.028).Severe obesity (BMI 35 kg/m) was linked to lower implant satisfaction ( = -1.66;p = 0.013).Black patients reported higher sexual wellbeing compared with non-Hispanic White patients ( = +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 wellbeing 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.