Background : Psychometric instruments to evaluate the effects of breast augmentation on quality of life (QoL) in cis-gender women have been validated, but they do not capture the unique obstacles confronting transgender women. We have previously created a novel instrument, the GENDER-Q, to evaluate the long-term effects of masculinizing chest reconstruction. We present a complimentary GENDER-Q QoL instrument specific to transgender women undergoing breast augmentation.
Methods : The survey was created using one-on-one and focus group interviews. The GENDER-Q consists of 29 items based on a five point Likert scale and divided into three QoL domains addressing gender identity, physical appearance, and psychosocial well-being. The GENDER-Q and the BREAST-Q, a validated instrument for cis-women undergoing breast augmentation, were prospectively administered to transgender women undergoing breast augmentation surgery pre-operatively and post-operatively. Wilcoxon signed-rank tests were used to test for significant differences between the median pre- and post-operative quality of life scores. Cronbach’s alpha was calculated to measure internal validity while the BREAST-Q survey was given simultaneously for external validity.
Results : To construct our survey, exploratory interviews with transgender women who had and had not had breast augmentation were conducted to explore issues related to breast augmentation and gender identity. A preliminary survey was then devised and a second round of focus groups conducted to evaluate the content, wording, and overall structure of the survey. Interviews were recorded, transcribed, and analyzed using qualitative methods to identify key themes, which was then used to construct our final survey. After administering the GENDER-Q and the BREAST-Q, we found a significant improvement in quality of life six weeks after surgery. Additionally, the GENDER-Q exhibited appropriate internal validity.
Conclusions : The GENDER-Q for transgender women is our second patient-reported QoL instrument for transgender patients undergoing gender-affirming surgery (GAS). The GENDER-Q is more sensitive than BREAST-Q at detecting QoL changes in transgender women. This data can facilitate changes to public policy and public access to GAS. With plans to develop additional GENDER-Q sections applicable to facial and urogenital reconstructive surgery we can provide a more comprehensive assessment of the effects of GAS. Large-scale, longitudinal studies using this new, standardized instrument to evaluate the effects of GAS can then be designed to help better establish the many benefits of GAS to influence public policy and broaden access to GAS.