Analysis of Chest Masculinization Surgery Results in Female-to-Male Transgender Patients: Demonstrating High Satisfaction beyond Aesthetic Outcomes Using Advanced Linguistic Analyzer Technology and Social Media

Background: Satisfaction rates are reported as high after subcutaneous mastectomy for chest masculinization. We examined patient satisfaction based on linguistic analysis of social media posts showing postoperative results and compared them to aesthetic quality ratings from plastic surgeons. Methods: Fifty publicly available images of subcutaneous mastectomy postoperative results of female-to-male gender transition patients were selected from Instagram. The photograph's corresponding post and comments were then analyzed for sentiment through the IBM Watson tone analyzer, which rated the presence of joy on a continuous scale from 0 to 1. Three plastic surgeons rated aesthetic quality on an ordinal scale of 1 to 10. Results of both analyses were then compared. Results: Joy was rated as a mean value of 0.74 (+/- 0.13) in posts and 0.81 (+/- 0.13) in comments. The mean ratings of results were found to be chest contour 6.1 of 10 (+/- 1.7), scar position 5.3 of 10 (+/- 1.8), scar quality 4.8 of 10 (+/- 1.9), nipple position 5.2 of 10 (+/- 1.9), and nipple quality 5.1 of 10 (+/- 2.0). A positive relationship was found between post joy and nipple quality (r = 0.33, P = 0.0169). There were no other associations detected between level of joy and the ratings of results by plastic surgeons (P > 0.05). Conclusions: Despite wide variety in surgical appearance, there is a high level of satisfaction and community support. This is in contrast to the low-quality ratings by plastic surgeons. The results demonstrate the strong psychological and functional underpinnings chest masculinization has for patients. However, surgical results can be improved through a variety of techniques such that patients have both excellent surgical results and high satisfaction.