Patient Preferences for Scar Orientation After Gender-Affirming Mastectomy: A Survey Study

Background Gender-affirming mastectomy (GAM) most commonly uses the double-incision technique, producing prominent transverse chest scars. Although effective, these scars are highly visible and may influence postoperative aesthetic satisfaction. Incision orientation is typically determined by the surgeon, yet little is known about which patterns patients find favorable. This study evaluated patient preferences for double incision orientations to inform preoperative discussions. Methods A cross-sectional survey was distributed to individuals with a history of or considering GAM. Participants ranked connected and non-connected incision patterns from most to least aesthetically pleasing. Rankings were converted to weighted preference scores using the Borda count method. The Friedman test, with post hoc Wilcoxon signed-rank tests and Bonferroni correction, assessed preference differences. Results 104 responses were analyzed. Participants were primarily 20–29 (49%) or 30–39 years old (28%), identified as transgender men (66%) or non-binary (31%), and mostly underwent GAM (85%). Friedman testing demonstrated significant differences among incision types (p<0.001). Curved incisions were most strongly preferred across connected and non-connected designs (all p<0.001). In non-connected designs, curved incisions received the highest weighted score (460), ranked first by 66% of participants, followed by angular incisions (345). In connected designs, curved incisions again ranked highest (451; 65% first-choice), followed by inverted V incisions (298). Large V and inverse-diagonal patterns were least favored. Conclusions Patients considering double-incision GAM show varied scar orientation preferences, with curved incisions following the natural pectoralis contour most favored. Discussing scar orientation may support more informed preoperative discussions and shared decision-making when multiple surgical options are feasible.