Patient perceptions of postoperative scarring after gender-affirming mastectomy: A cross-sectional study.

Purpose: Double-incision gender-affirming mastectomies (GAMs) can produce prominent chest scars. While scarring may affect body image, confidence, and social participation, patient perceptions remain incompletely characterized. This study aimed to evaluate patient perceptions and psychosocial experiences related to post-GAM scarring. Methods: A cross-sectional survey was distributed to patients who underwent GAM. Participants rated statements regarding embarrassment, dissatisfaction, stigmatization, and social impact of scars using a five-point Likert scale. Additional items assessed scar width, thickness, color, and directionality. Free text responses were analyzed using thematic analysis. Responses were summarized descriptively, and Likert-scale data were dichotomized for exploratory chi-squared analysis. Results: Ninety-six responses were analyzed. Most participants were in their twenties (43%) or thirties (28%), identified as transgender men (66%) or non-binary (32%), and underwent double-incision mastectomy with free nipple graft (90%). The majority were White (67%), followed by Latinx (10%) and Asian (9%). Most participants were receiving hormone therapy (88%), and hypertrophic scarring was reported in 19%. Overall perceptions were generally favorable, with 86% denying embarrassment and 81% denying dislike of their scars (both p < 0.001). Although more participants preferred thinner scars, this difference was not statistically significant (p = 0.063). Concerns most often related to scar thickness, color, and length. Approximately 29% of participants reported stigmatization related to their scars, and 28% reported limiting shirtless activities because of scar visibility (both p < 0.001). Thematic analysis identified five primary domains: 1) scars as a source of pride and affirmation; 2) alignment between physical appearance and gender identity; 3) external perception and stigma; 4) acceptance of scars as inherent to surgery; and 5) dissatisfaction due to scar quality. Conclusion: Most patients reported neutral or positive perceptions of postoperative scarring following GAM. However, a subset of participants reported dissatisfaction related to scar quality and external perception. These findings suggest that postoperative scarring is experienced variably and may be influenced by both scar quality and social context.