Psychological Correlates after Gender-Affirming Mastectomy: Insights from a Case Report and Review of the Literature

Gender dysphoria stems from incongruence between gender identity and assigned sex, often causing significant distress related to breast anatomy in transmasculine individuals. Gender-affirming hormone therapy typically precedes mastectomy, which is a funda-mental intervention in transgender healthcare. Surgical challenges arise in patients with large breasts on lean frames, requiring customized techniques to achieve a natural, proportional, androgynous chest. This case report describes a 23-year-old transmasculine patient with macromastia and a tall, lean build who underwent gender-affirming mas-tectomy with free nipple grafts and muscular sculpture aimed at an androgynous aes-thetic. Pre- and postoperative evaluations showed marked improvements in body image, physical strength performance, and emotional well-being. Over 12 months after surgery, psychological assessments revealed significant reductions in body uneasiness and gender dysphoria, while human figure drawings demonstrated increasing bodily integration and identity congruence. The narrative literature review supports these outcomes, highlighting satisfaction rates above 90%, minimal regret, and consistent gains in psy-chosocial functioning, sexual and mental health, including reduced anxiety and de-pression. Validated patient-reported outcome measures enhance the assessment of transgender-specific outcomes. Long-term follow-ups confirm sustained psychological benefits. This evidence reinforces that gender-affirming mastectomy is medically nec-essary, particularly when tailored to individual anatomical and aesthetic needs, affirming identity and alleviating distress.