Development of the BODY-Q Chest Module Evaluating Outcomes Following Chest Contouring Surgery

Background: Plastic surgery to improve chest appearance is becoming increasingly popular. The BODY-Q is a patient-reported outcome (PRO) instrument designed for weight loss and/or body contouring. In this paper, we describe the development of a new module for masculinizing chest contouring surgery. Methods: Qualitative methods were used to develop and refine the content of the BODY-Q Chest Module, which was subsequently field-tested in Canada, USA, Netherlands and Denmark between June 2016 and June 2017. Participants were men and trans men aged 16 years or older and seen for gynecomastia, weight loss or trans men chest surgery. Data were collected using either a web-based application or paper questionnaire. Rasch Measurement Theory (RMT) analysis was performed. Results: The sample included 739 participants (i.e., 174 gynecomastia, 224 weight loss, 341 gender confirming). RMT analysis refined a 10-item chest and 5-item nipple scale. All items had ordered thresholds and good item fit, and scales evidenced reliability, i.e., Person Separation Index and Cronbach's alpha values were 0.95 and 0.98 (chest scale) and 0.87 and 0.94 (nipple scale). Scores for both scales correlated more strongly with similar (satisfaction with the body) versus dissimilar (psychological and social function) BODY-Q scales. The mean score for the chest and nipples scales was significantly higher (p