A new study of nationwide hospital databases found that at least 1,130 adolescents between 2016 and 2019 received “gender-affirming” chest surgeries in the U.S.
The study, published in JAMA Pediatrics, saw a 389% increase in adolescents (ages 12-17) obtaining chest surgeries from 2016 to 2019. An overwhelming majority (1,114) of the adolescents seeking this surgery were female (98.6%), and just 16 were male (1.4%).
“To our knowledge, this study is the largest investigation to date of gender-affirming chest reconstruction in a pediatric population,” the paper’s authors wrote, who are each affiliated with Vanderbilt University Medical Center. “The results demonstrate substantial increases in gender-affirming chest reconstruction for adolescents.”
But Leor Sapir, a fellow at the Manhattan Institute, believes the study significantly underestimates the number of adolescents who have received gender-related chest surgeries, as it only contains hospital-based data and not private surgery centers. The data was collected from the Nationwide Ambulatory Surgery Sample (NASS), an out-patient hospital surgery database in the United States.
“JAMA included only procedures performed in hospitals, not by plastic surgeons in private settings,” said Sapir. “Because these procedures yield around $10,000 per patient, many mastectomies take place outside of hospitals in surgery centers owned by plastic surgeons themselves.”
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Image provided by JAMA Pediatrics
The ages of the pediatric patients ranged from 12 to 17, with 42 (5.5%) of the recipients between 12 and 14, 131 (16%) aged 15, 291 (34.5%) aged 16, and 365 (44%) aged 17.
Race and ethnicity were collected from hospital records only in 2019, the authors note. The vast majority of patients were white (77.9%), followed by Hispanics (12.2%), blacks (2.7%), Asian or Pacific Islanders (2.5%), and Native Americans (0.5%). About 4% were categorized as “other race.”
The median total charges for chest reconstruction were $29,886 ($21,285–$45,147), a number that was adjusted for inflation, the authors note. Most of the chest surgeries (61.1%) were covered by private health insurance, 16.5% used public health insurance including Medicaid, 15.8% paid out of pocket, and 6.7% indicated “other.”
Most adolescents included in the analysis lived in a densely populated area, with 68% living in a county with over one million residents, 21.9% lived in a moderately densely populated area, and only 9.8% lived in a county with less than a quarter million residents. Over half of those who obtained chest surgeries had a family annual income of over $82,000.
Psychiatric comorbidities for patients were listed, which included anxiety (21.1%) and depression (16.2%), but this is likely a significant underestimate since these numbers were much lower than the high rates of depression typically seen among trans-identified teens. It is therefore likely that mental health data in the hospital database were not comprehensive.
In July, the same four authors, with the addition of two others, published a separate study on adults who received “gender-affirming” chest reconstruction surgeries. Their results, also using NASS outpatient hospital data, found that 21,293 individuals obtained chest surgeries between 2016 and 2019, a 143.2% increase. The large majority of chest surgeries were performed on female patients, with 82.1% receiving double mastectomies; 27.9% of trans-identifying males received breast augmentations.