Patient-Reported Outcomes and Body Mass Index in Adolescents and Young Adults After Gender-Affirming Chest Surgery: A Single-Center Cross-Sectional Study

Objective: To assess the impact of body mass index (BMI) on patient-reported outcomes after gender-affirming chest surgery in adolescents. Background: Despite most previous studies finding no association between BMI and patient-reported outcomes in adults undergoing gender-affirming chest surgery, BMI eligibility requirements remain widely used. Moreover, little data exists regarding the impact of BMI on these outcomes in adolescents. Methods: A cross-sectional, patient-reported outcome survey study was conducted at a pediatric hospital from April to July 2024. Eligible individuals were at least 1-year postoperative from gender-affirming chest surgery. The primary outcome was the effect of BMI on scores from 7 validated patient-reported outcome measures, including BODY-Q Chest and Nipple, Gender Congruence and Life Satisfaction, Satisfaction with Decision, and Decision Regret Scale, compared between adolescent and young adult cohorts. Results: Among 77 participants who completed the survey, 42 (54.5%) underwent surgery as adolescents and 35 (45.5%) as young adults. Patient-reported outcomes evaluating appearance satisfaction, psychosocial well-being, and decisional satisfaction were high, whereas decisional regret was low. Scores did not significantly differ between adolescent and young adult cohorts, and most patient-reported outcome measures were not significantly influenced by BMI. Conclusion: After gender-affirming chest surgery, both adolescents and young adults reported high appearance satisfaction, psychosocial well-being, and decisional satisfaction, along with low decisional regret. For the majority of patient-reported outcomes, these positive results were not associated with BMI, suggesting that gender-affirming chest surgery is associated with high quality of life for adolescents and young adults regardless of BMI.