A new study published this week in JAMA Pediatrics has drawn attention for what the study allegedly discloses within its data. The study, “Top Surgery and Chest Dysphoria Among Transmasculine and Nonbinary Adolescents and Young Adults,” was published by a team of authors led by Dr. Mona Ascha of the Northwestern University Feinberg School of Medicine in Chicago. The study, conducted between December 2019 and April 2021 at three Chicago institutions, included 36 patients who received “top surgery” and 34 statistically matched patients who were the same age and received the same testosterone treatments but did not undergo surgery, and compared their outcomes. Top surgery typically involves subcutaneous mastectomy, in which breast tissue is removed and the nipple and areola are left intact or replaced to give the appearance of a natural male chest.
At first glance, this does not seem outrageous, as one would assume these women were adults capable of consenting to surgical procedures and that these women had already undergone appropriate counseling before undergoing such a serious step as having their breasts removed to cement their commitment to living as men.
However, when one takes the time to carefully read this study, there is one fact that jumps out to the discerning reader - the study discloses that of the patients that received surgery, the age range was 13 to 24. This means that in this group of 36 women it is very likely a majority of them were younger than 18, and at least one of them had to be 13 years old!
The study goes on to claim that the surgeries have a low complication rate, and result in improved “gender congruence” and body image satisfaction - based on surveys that were given to the participants three months after surgery.
As director of a major research institute, I’ve reviewed the study and its implications. They are correct, the study does prove that performing bilateral mastectomy for transgendered women does appear to have a low complication rate. This is not at all surprising, seeing that the surgery is being performed on an organ with no pathology, and therefore the complication rates would be much lower than with women receiving mastectomies for other reasons, such as cancer. The average age that a woman is diagnosed with breast cancer is 62, so therefore it stands to reason that this population in their teens and early 20s would fare much better at time of surgery.
As for the claims of gender congruence and body image satisfaction, I can say as a surgeon and a researcher that a mere three months is not enough time to make such claims. A fair assessment would have been a follow-up at six and twelve months. Alternatively, the authors could have simply framed their findings as applying to the “short-term” as is commonly done in research. While one would have thought that medical journal reviewers would have corrected this glaring error, instead the results are simply accepted as “improved” in the final published edition. This leads to the inescapable question of the possibility of political bias assisting in the selection of this study for publication.
In Illinois, as in most states, children can receive any type of medical procedure as long as they are granted the consent of at least one parent or guardian.
Despite the legality, it is tough to understand how a surgeon can cut off the healthy breasts of a 13-year-old girl. The ethical and moral implications of this are huge. Regardless of how sure that young girl is of her decision - the chance of her later regretting the decisions she made as a 13-year-old is unacceptably high. I’m extremely afraid to see what the future suicide rates may be of young children undergoing these surgeries with “parental consent.” I think it’s very likely that future physicians will look back at this work as we now do at the lobotomies of the 30’s and 40’s.
Greg J. Marchand, M.D., is a full-time surgeon and director of the Marchand Institute for Minimally Invasive Surgery, a major research institute located in Mesa, AZ. He is board certified in Minimally Invasive Gynecologic Surgery (MIGS) and in Obstetrics and Gynecology. Dr. Marchand is extensively published in Minimally Invasive Surgery and Obstetrics and Gynecology.
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