Patient Preferences for Postoperative Drains Following Gender Affirming Mastectomy: A Modified Standard Gamble Approach

<b>Introduction:</b> The necessity of postoperative drains in gender-affirming mastectomy remains unclear, with no consensus on their role in reducing complications such as seroma formation. Given this paucity of evidence, the use of drains is often at the discretion and judgment of the surgeon. Understanding patient preferences and quantifying patient risk tolerance for seroma formation and secondary procedures that may be associated with drainless mastectomy may aid in surgical decision-making and facilitate patient-centered discussions. <b>Methods:</b> Adolescent patients considering or having undergone gender-affirming mastectomy were surveyed. A modified standard gamble approach assessed risk tolerance for seroma formation requiring aspiration and the need for a secondary procedure. <b>Results:</b> Thirty participants were recruited (mean age 17.6 ± 1.3 years). Eighty percent identified as transmale, 17% as nonbinary, and 3% as gender nonconforming; 47% had a prior mastectomy. The median risk tolerance for seroma formation was 15% (interquartile range [IQR]: 5.5%-25%), and for secondary procedures, 10% (IQR: 1%-15%). Risk tolerance did not significantly differ by history of prior surgery or age. Supplementary survey findings provided insight into factors influencing concerns related to both the use of drain and drainless procedures. <b>Conclusions:</b> Risk tolerance for seroma and secondary procedures varies among patients, emphasizing the need for shared decision-making in gender-affirming mastectomy. Balancing patient preferences with surgical risks is essential to optimizing outcomes.