{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T06:04:23Z","timestamp":1772604263134,"version":"3.50.1"},"reference-count":38,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T00:00:00Z","timestamp":1717718400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Gender-affirming mastectomy (GAM) improves the psychosocial functioning and quality of life of transgender and non-binary (TGNB) individuals. However, the perioperative period is often marked by emotional stress, concerns about surgical outcomes, and physical discomfort. While inpatient procedures provide multiple opportunities to engage with and educate patients, outpatient surgeries, such as GAM, pose a unique challenge as patients are followed for &lt;24 h postoperatively. Given the heightened emotional and psychological distress related to gender dysphoria TGNB individuals often experience, addressing these gaps can significantly improve outcomes. This study aims to characterize patient and surgical characteristics associated with patient-initiated communication (PIC) frequency in this population. Methods: A single-center retrospective review of TGNB patients undergoing GAM from February 2018 to November 2022 was conducted. Demographics, surgical characteristics, and frequency of and reasons for perioperative PIC (30 days before and after surgery) were recorded. The primary outcome was the incidence of perioperative PIC. The secondary outcomes included (1) the rationale for PIC and (2) patient and surgical characteristics associated with PIC. Results: A total of 352 patients were included. Of these, 285 (74.6%) initiated communication in the perioperative period, totaling 659 PICs. The median age was 25.0 (interquartile range [IQR]: 9.0) years. The median body mass index (BMI) was 28.5 (IQR: 8.5) kg\/m2. The mean number of PICs was 0.7 \u00b1 1.3 preoperatively and 1.3 \u00b1 1.7 postoperatively (p &lt; 0.001). The most frequent preoperative PIC subjects were administrative issues (AI; n = 66, 30.7%), preoperative requirements (n = 43, 20.0%), and cost and insurance (n = 33, 15.0%). The most frequent postoperative PIC subjects were wound care (n = 77, 17.3%), AI (n = 70, 15.0%), activity restrictions (n = 60, 13.5%), drainage (n = 56, 12.6%), and swelling (n = 37, 8.3%). Collectively, older patients (\u03b2 = 0.234, p = 0.001), those with a history of major depressive disorder or generalized anxiety disorder (2.4 \u00b1 3.0 vs. 1.7 \u00b1 1.9; p = 0.019), and those without postoperative drains (n = 16\/17, 94.1% vs. n = 236\/334, 70.7%; p = 0.025) engaged in higher levels of PIC. There were no significant associations between other patient characteristics, perioperative details, or complications and PIC frequency. Conclusions: Perioperative PIC is prevalent among the majority of GAM patients at our institution, with age, psychiatric diagnosis, and postoperative drain use identified as significant predictors. To mitigate PIC frequency, it is crucial to ensure adequate support staffing and provide comprehensive postoperative instructions, particularly concerning activity restrictions and drainage management. These interventions may reduce PICs in high-volume centers. Further research should investigate targeted interventions to further support TGNB patients during the perioperative period.<\/jats:p>","DOI":"10.3390\/jcm13123368","type":"journal-article","created":{"date-parts":[[2024,6,7]],"date-time":"2024-06-07T10:43:42Z","timestamp":1717757022000},"page":"3368","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Perioperative Patient-Initiated Communication in Gender-Affirming Mastectomy"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5665-9822","authenticated-orcid":false,"given":"Christian X.","family":"Lava","sequence":"first","affiliation":[{"name":"Georgetown University School of Medicine, Washington, DC 20007, USA"},{"name":"Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC 20007, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0489-3058","authenticated-orcid":false,"given":"Isabel A.","family":"Snee","sequence":"additional","affiliation":[{"name":"Georgetown University School of Medicine, Washington, DC 20007, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6672-949X","authenticated-orcid":false,"given":"Karen R.","family":"Li","sequence":"additional","affiliation":[{"name":"Georgetown University School of Medicine, Washington, DC 20007, USA"},{"name":"Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC 20007, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7518-624X","authenticated-orcid":false,"given":"George L.","family":"O\u2019Hara","sequence":"additional","affiliation":[{"name":"Georgetown University School of Medicine, Washington, DC 20007, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niyati P.","family":"Bhatt","sequence":"additional","affiliation":[{"name":"Georgetown University School of Medicine, Washington, DC 20007, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oscar J.","family":"Manrique","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, University of Rochester Medical Center, New York, NY 14627, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth L.","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC 20007, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriel A.","family":"Del Corral","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, MedStar Franklin Square Medical Center, Baltimore, MD 21237, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e2330348","DOI":"10.1001\/jamanetworkopen.2023.30348","article-title":"National Estimates of Gender-Affirming Surgery in the US","volume":"6","author":"Wright","year":"2023","journal-title":"JAMA Netw. Open"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1596","DOI":"10.1097\/PRS.0000000000001264","article-title":"Negative predictors for satisfaction in patients seeking facial cosmetic surgery: A systematic review","volume":"135","author":"Herruer","year":"2015","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1007\/s00266-019-01316-6","article-title":"Aesthetic Rhinoplasty and Nasal Obstruction: Presentation of Results of a 100-Patient Study by Using NOSE Inventory","volume":"43","author":"Kotzampasakis","year":"2019","journal-title":"Aesthetic Plast. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1177\/0272989X10364247","article-title":"Interventions to improve patient comprehension in informed consent for medical and surgical procedures: A systematic review","volume":"31","author":"Schenker","year":"2011","journal-title":"Med. Decis. Mak."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"533","DOI":"10.7326\/0003-4819-141-7-200410050-00009","article-title":"Lost in transition: Challenges and opportunities for improving the quality of transitional care","volume":"141","author":"Coleman","year":"2004","journal-title":"Ann. Intern. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1007\/s11606-011-1712-y","article-title":"Effect of standardized electronic discharge instructions on post-discharge hospital utilization","volume":"26","author":"Showalter","year":"2011","journal-title":"J. Gen. Intern. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1097\/DSS.0000000000001750","article-title":"Factors Associated with Patient-Initiated Communication After Mohs Micrographic Surgery","volume":"45","author":"Chitgopeker","year":"2019","journal-title":"Dermatol. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1290","DOI":"10.1016\/j.jaad.2020.09.003","article-title":"Predictors of patient-initiated communication after Mohs micrographic surgery: A multi-institutional prospective cohort study","volume":"85","author":"Mazmudar","year":"2021","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1080\/10810730903089614","article-title":"Older adults\u2019 health information wants in the internet age: Implications for patient-provider relationships","volume":"14","author":"Xie","year":"2009","journal-title":"J. Health Commun."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1080\/10810730.2015.1018644","article-title":"Fears, Uncertainties, and Hopes: Patient-Initiated Actions and Doctors\u2019 Responses During Oncology Interviews","volume":"20","author":"Beach","year":"2015","journal-title":"J. Health Commun."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1177\/08982643231187104","article-title":"Age as a Moderator of Health Outcomes and Trust in Physicians","volume":"36","author":"Katz","year":"2024","journal-title":"J. Aging Health"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1046\/j.1369-6513.2003.00221.x","article-title":"Patient characteristics as predictors of primary health care preferences: A systematic literature analysis","volume":"6","author":"Jung","year":"2003","journal-title":"Health Expect."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2618","DOI":"10.1001\/archinte.165.22.2618","article-title":"Trust and sources of health information: The impact of the Internet and its implications for health care providers: Findings from the first Health Information National Trends Survey","volume":"165","author":"Hesse","year":"2005","journal-title":"Arch. Intern. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1001\/jama.1997.03550120089044","article-title":"Influence of physician confidentiality assurances on adolescents\u2019 willingness to disclose information and seek future health care. A randomized controlled trial","volume":"278","author":"Ford","year":"1997","journal-title":"JAMA"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/j.jadohealth.2020.01.019","article-title":"The Unmet Need for Discussions between Health Care Providers and Adolescents and Young Adults","volume":"67","author":"Santelli","year":"2020","journal-title":"J. Adolesc. Health"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1097\/MED.0000000000000227","article-title":"Barriers to healthcare for transgender individuals","volume":"23","author":"Safer","year":"2016","journal-title":"Curr. Opin. Endocrinol. Diabetes Obes."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1111\/hsc.12941","article-title":"\u201cIt\u2019s kind of hard to go to the doctor\u2019s office if you\u2019re hated there.\u201d A call for gender-affirming care from transgender and gender diverse adolescents in the United States","volume":"28","author":"Eisenberg","year":"2020","journal-title":"Health Soc. Care Community"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.jadohealth.2016.03.017","article-title":"Youth and Caregiver Perspectives on Barriers to Gender-Affirming Health Care for Transgender Youth","volume":"59","author":"Gridley","year":"2016","journal-title":"J. Adolesc. Health"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1080\/15532739.2016.1258352","article-title":"Transgender and anxiety: A comparative study between transgender people and the general population","volume":"18","author":"Bouman","year":"2017","journal-title":"Int. J. Transgenderism"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1080\/15532739.2016.1258353","article-title":"Prevalence of anxiety symptoms and disorders in the transgender population: A systematic review of the literature","volume":"18","author":"Millet","year":"2017","journal-title":"Int. J. Transgenderism"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1037\/a0031774","article-title":"Anxiety and depression in transgender individuals: The roles of transition status, loss, social support, and coping","volume":"81","author":"Budge","year":"2013","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Hajek, A., K\u00f6nig, H.-H., Buczak-Stec, E., Blessmann, M., and Grupp, K. (2023). Prevalence and Determinants of Depressive and Anxiety Symptoms among Transgender People: Results of a Survey. Healthcare, 11.","DOI":"10.3390\/healthcare11050705"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"644","DOI":"10.15585\/mmwr.mm7224a1","article-title":"National, State-Level, and County-Level Prevalence Estimates of Adults Aged \u226518 Years Self-Reporting a Lifetime Diagnosis of Depression\u2014United States, 2020","volume":"72","author":"Lee","year":"2023","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"107791","DOI":"10.1016\/j.pec.2023.107791","article-title":"Facilitating psychological adjustment for breast cancer patients through empathic communication and uncertainty reduction","volume":"114","author":"Broadbridge","year":"2023","journal-title":"Patient Educ. Couns."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.1016\/j.socscimed.2005.02.001","article-title":"Measuring patient-centered communication in patient-physician consultations: Theoretical and practical issues","volume":"61","author":"Epstein","year":"2005","journal-title":"Soc. Sci. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/j.jaad.2010.02.038","article-title":"The use of oral midazolam for perioperative anxiolysis of healthy patients undergoing Mohs surgery: Conclusions from randomized controlled and prospective studies","volume":"64","author":"Ravitskiy","year":"2011","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1089\/trgh.2021.0091","article-title":"High Self-Reported Satisfaction After Top Surgery in Gender-Affirming Surgery: A Single-Center Study","volume":"8","author":"Day","year":"2023","journal-title":"Transgender Health"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e96","DOI":"10.1097\/BOT.0000000000000746","article-title":"Factors Associated with Patient-Initiated Telephone Calls After Orthopaedic Trauma Surgery","volume":"31","author":"Hadeed","year":"2017","journal-title":"J. Orthop. Trauma."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1016\/j.amjsurg.2021.01.029","article-title":"Visual teaching aids improve patient understanding and reduce anxiety prior to a colectomy","volume":"222","author":"Stewart","year":"2021","journal-title":"Am. J. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1177\/1203475417715208","article-title":"Using Visual Aids to Enhance Physician-Patient Discussions and Increase Health Literacy","volume":"21","author":"Pratt","year":"2017","journal-title":"J. Cutan. Med. Surg."},{"key":"ref_31","unstructured":"Callery, M. (2023). Improving Postoperative Breast Augmentation Patient Education Delivery. [Ph.D. Thesis, University of Louisville]."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1111\/jmft.12434","article-title":"Chang, S.C., Singh, A.A., & Dickey, L.M. (2018). A clinician\u2019s guide to gender-affirming care: Working with transgender and gender nonconforming clients. Oakland, CA: New Harbinger Publications Inc., 298 pp., $ 49.95","volume":"46","author":"Culver","year":"2020","journal-title":"J. Marital. Fam. Ther."},{"key":"ref_33","first-page":"23","article-title":"Gender-affirming Care for Transgender Patients","volume":"19","author":"Bhatt","year":"2022","journal-title":"Innov. Clin. Neurosci."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1550","DOI":"10.1016\/j.pec.2015.06.019","article-title":"Perceived control over health, communication and patient-physician trust","volume":"98","author":"Gabay","year":"2015","journal-title":"Patient Educ. Couns."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1002\/ajh.20944","article-title":"Patient-controlled analgesia versus continuous infusion of morphine during vaso-occlusive crisis in sickle cell disease, a randomized controlled trial","volume":"82","author":"Nieuwkerk","year":"2007","journal-title":"Am. J. Hematol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1001\/jama.2018.19186","article-title":"A Framework for Increasing Trust between Patients and the Organizations That Care for Them","volume":"321","author":"Lee","year":"2019","journal-title":"JAMA"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1080\/26895269.2022.2100644","article-title":"Standards of Care for the Health of Transgender and Gender Diverse People, Version 8","volume":"23","author":"Coleman","year":"2022","journal-title":"Int. J. Transgender Health"},{"key":"ref_38","unstructured":"(2024, April 17). Mission and Vision. World Professional Association for Transgender Health. Available online: https:\/\/www.wpath.org\/about\/mission-and-vision."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/12\/3368\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:55:20Z","timestamp":1760108120000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/12\/3368"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,7]]},"references-count":38,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,6]]}},"alternative-id":["jcm13123368"],"URL":"https:\/\/doi.org\/10.3390\/jcm13123368","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,7]]}}}