Panel evaluation of esthetic result after chest masculinization: Reliability and comparison with patient-reported satisfaction

Chest masculinization is the most common surgical intervention in transgender men. Patient-reported satisfaction is generally good, but we lack other tools for evaluation of the postoperative result and knowledge about the surgeons understanding of a desirable result. Panel evaluation of the esthetic result has been used widely in other surgical areas. However, regarding chest masculinization, the use of panel evaluation is limited. This study aims to evaluate esthetic postoperative result after chest masculinization by an expert panel and to assess the reliability of panel evaluation. Furthermore, we aim to compare the panel evaluation with patient-reported satisfaction. The data comprised all patients receiving chest masculinization from 2005 to 2018 with sufficient postoperative images. Sufficient images were found for 48 patients, 26 of whom filled in the patient-reported outcome tool BODY-Q Chest Module. The esthetic result was evaluated by a six-person expert panel. On a scale from 1 (worst) to 4 (best), panelists' overall score yielded a median of 3.2. Inter-rater reliability was low. Scores given by female and male panelists did not differ significantly. When evaluating items scored by both the panelists and the patients, no significant correlation emerged. We conclude that the esthetic result after chest masculinization is generally good. However, even professionals lack a consensus on the desired result. The panel evaluation in this study proved to be unreliable, but due to biases in patient-reported outcomes, we call for the development of a validated clinician-reported tool for assessment of esthetic result after chest masculinization.