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Clinics in Plastic Surgery

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https://www.readbyqxmd.com/read/29908634/gender-surgery-a-truly-multidisciplinary-field
#1
EDITORIAL
Loren S Schechter, Bauback Safa
No abstract text is available yet for this article.
July 2018: Clinics in Plastic Surgery
https://www.readbyqxmd.com/read/29908633/sexual-function-after-shallow-and-full-depth-vaginoplasty-challenges-clinical-findings-and-treatment-strategies-urologic-perspectives
#2
REVIEW
Maurice M Garcia
This article presents an ordered review of the role of sexual function in discussion and planning before genital gender-affirming surgery and through recovery to initiation of sexual activity after surgery. Strategies are proposed to optimize sexual function postoperatively. Clinical observations are reviewed and genital and surgical anatomy is reviewed to explain the rationale for the treatment strategies proposed. The importance of offering shallow-depth vaginoplasty to all patients is discussed. Lastly, specific strategies to maximize and enhance recovery of erogenous sensation after surgery are focused on...
July 2018: Clinics in Plastic Surgery
https://www.readbyqxmd.com/read/29908632/urologic-complications-after-phalloplasty-or-metoidioplasty
#3
REVIEW
Dmitriy Nikolavsky, Michael Hughes, Lee C Zhao
In the past decade, issues facing transgender individuals have come to the forefront of popular culture, political discourse, and medical study. The evaluating physician should have knowledge of the reconstructed anatomy, as well as potential postoperative complications. This knowledge will aid in providing appropriate care and recognizing issues that may require specialized urologic care. Transgender anatomic definitions and a synopsis of common urologic complications specific to transmen, including urethrocutaneous fistulae, neourethral strictures, and persistent vaginal cavities are discussed...
July 2018: Clinics in Plastic Surgery
https://www.readbyqxmd.com/read/29908631/phalloplasty-flap-related-complication
#4
REVIEW
Nick Esmonde, Rachel Bluebond-Langner, Jens U Berli
This article focuses on flap-related complications after creation of a neophallus for transgender individuals. It outlines the most frequently used flaps for this procedure and how flap-related complications can affect the overall outcome of the phalloplasty. With surgeons staging the procedure in different stages, it is important to understand the different strategies and the implication a flap-related complication can have on the end result and how it may be prevented.
July 2018: Clinics in Plastic Surgery
https://www.readbyqxmd.com/read/29908630/penile-prostheses
#5
REVIEW
Ervin Kocjancic, Valerio Iacovelli
Phalloplasty represents the most complete genitoperineal transformation for trans men. Although voiding while standing is a priority for most trans men, most patients want to use the neophallus for sexual experience after they are accustomed to their new voiding abilities. Different techniques have been used to obtain rigidity in the neophallus, often resulting in complications and failure. Implantation of an erectile prosthesis remains the best option for achieving sexual intercourse in trans men. This article discusses the current state of art of penile prostheses in trans men, including a description of the prostheses, techniques for implantation, and complications...
July 2018: Clinics in Plastic Surgery
https://www.readbyqxmd.com/read/29908629/the-pedicled-anterolateral-thigh-phalloplasty
#6
REVIEW
Kyle Y Xu, Andrew J Watt
The anterolateral thigh (ALT) flap is a viable and reliable option for phalloplasty. The primary advantages of the ALT flap remain an inconspicuous donor site and flexibility in phallus length. The disadvantages of the ALT flap are a higher incidence of both flap and urethral complications compared with a radial forearm phalloplasty. Although the ALT phalloplasty can achieve the primary goals of standing micturition, penetrative intercourse, and an aesthetic phallus, multiple stages and revisions are often necessary...
July 2018: Clinics in Plastic Surgery
https://www.readbyqxmd.com/read/29908628/radial-forearm
#7
REVIEW
Lawrence J Gottlieb
The radial forearm free flap phalloplasty provides a thin, potentially sensate, minimally hair-bearing cutaneous flap. Since its initial description, several modifications of the technique have emerged. The earliest dimensions described needed to be increased because of the increase amount of subcutaneous fat in the Western population. Incorporating a centrally placed neo-urethra with a distal extension that gets folded over to create a semblance of a neoglans eliminates the distal/meatal stenosis. Performing a urethral extension at a preliminary surgery and extending the neourethra proximally has improved the position of the neophallus and minimized proximal urethral strictures and fistulas in transgender men...
July 2018: Clinics in Plastic Surgery
https://www.readbyqxmd.com/read/29908627/introduction-to-phalloplasty
#8
REVIEW
Loren S Schechter, Bauback Safa
Phalloplasty represents the most complete genitoperineal transformation. Because it requires complex, staged procedures as well as the use of tissue from remote sites, patients must be well informed as to the nature of surgery. Surgical techniques for phalloplasty continue to evolve. Although many surgeons prefer the radial forearm free flap technique, a visible flap donor site makes this procedure less desirable for some patients. Other surgical options are available and include the anterolateral thigh flap, sometimes in conjunction with secondary flaps, and the musculocutaneous latissimus dorsi flap...
July 2018: Clinics in Plastic Surgery
https://www.readbyqxmd.com/read/29908626/metoidioplasty
#9
REVIEW
Rados P Djinovic
Transmasculine gender confirmation surgery remains challenging and demanding. As there is no perfect or standard procedure for creating male genitalia, practitioners continue to strive for better solutions. There are 2 goals in the surgical treatment of transgender persons: removal of the native genitalia and secondary sexual characteristics and creation of the desired genitalia and secondary sexual characteristics. In transmen, this often means removal of the uterus, fallopian tubes, ovaries, and vagina and creation of the external genitalia...
July 2018: Clinics in Plastic Surgery
https://www.readbyqxmd.com/read/29908625/chest-surgery-for-transgender-and-gender-nonconforming-individuals
#10
REVIEW
Karel E Y Claes, Salvatore D'Arpa, Stan J Monstrey
Chest surgery can greatly facilitate the experience of living in a gender role. For transfeminine chest surgery, most surgeons recommend a 12-month period of feminizing hormone therapy prior to breast augmentation. For those who already have some breast volume due to hormone treatment, lipofilling can be a good option. Transmasculine chest surgery includes mastectomy and creation of a male chest. Preoperative parameters to be evaluated include breast volume, degree of excess skin, nipple-areola complex size and position, and skin elasticity...
July 2018: Clinics in Plastic Surgery
https://www.readbyqxmd.com/read/29908624/vaginoplasty-complications
#11
REVIEW
Cecile A Ferrando
Complications after vaginoplasty surgery for the transgender woman exist. These adverse outcomes can be minor and easily treatable, whereas others are considered major events and require ongoing care. Adverse outcomes can be immediate or remote after surgery and include bleeding, hematoma, infection, delayed wound healing, neovaginal stenosis, visceral injury, and fistula. Patients may also experience pelvic floor disorders after surgery. Providers performing these surgeries and those providers caring for postoperative patients should be aware of the incidence of these complications and the treatment options that exist to manage them...
July 2018: Clinics in Plastic Surgery
https://www.readbyqxmd.com/read/29908623/male-to-female-gender-confirmation-surgery-intestinal-vaginoplasty
#12
REVIEW
Karel E Y Claes, Piet Pattyn, Salvatore D'Arpa, Cedric Robbens, Stan J Monstrey
The major steps in vaginoplasty are orchiectomy, penile amputation, creation of the neovaginal cavity with lining, and reconstruction of urethral meatus, labia, and clitoris. During pedicled intestinal transfer, an intestinal segment is transferred in a dissected cavity between the bladder and rectum. The bowel harvest is performed by a total laparoscopic technique. It is imperative to create the labia majora and minora, the clitoris, and a clitoral hood to achieve the physiologic and aesthetic equivalent of female external genitalia...
July 2018: Clinics in Plastic Surgery
https://www.readbyqxmd.com/read/29908622/gender-affirming-penile-inversion-vaginoplasty
#13
REVIEW
Ali Salim, Melissa Poh
In recent years, greater acceptance of transgender individuals in society and the inclusion of medical coverage for gender-affirmation surgeries has led to an increasing number of patients seeking gender-affirming vaginoplasty. Since the first descriptions of neovaginal reconstruction for gender affirmation were described in the early and mid-1900s, various techniques and revisions have been introduced. This article provides a brief historical perspective, defines the goals of surgical treatment within a multidisciplinary approach adhering to World Professional Association for Transgender Health standards, and focuses on issues related to what is currently the most common approach to primary neovaginal reconstruction, the penile inversion vaginoplasty...
July 2018: Clinics in Plastic Surgery
https://www.readbyqxmd.com/read/29908621/breast-and-body-contouring-for-transgender-and-gender-nonconforming-individuals
#14
REVIEW
Shane D Morrison, Stelios C Wilson, Scott W Mosser
Even after long-term hormone therapy, many transwomen still have challenges in the size and shape of their breasts and also of the contour of their trunk areas. Though distinct anthropomorphic differences in skeletal structure exist and pose limitations to an ideal result, considerable improvements can be obtained through breast augmentation and trunk feminization. There are challenges that are unique to the transfeminine chest and trunk, and important considerations for the priority of fat grafting to the buttocks and hips when grafted fat is in short supply...
July 2018: Clinics in Plastic Surgery
https://www.readbyqxmd.com/read/29908620/facial-gender-confirmation-surgery-facial-feminization-surgery-and-facial-masculinization-surgery
#15
REVIEW
Jordan C Deschamps-Braly
Facial feminization surgery was pioneered in the 1980s to provide options for trans women who were having difficulty with their outward appearance. This process presented a novel application of craniofacial surgery at the time. This text outlines the basic differences between male and female facial morphology, as well as the procedures we use to feminize the face.
July 2018: Clinics in Plastic Surgery
https://www.readbyqxmd.com/read/29908619/hormone-therapy-for-transgender-men
#16
REVIEW
Supraja Narasimhan, Joshua D Safer
This article provides an account of the current understanding of hormone therapy options for transgender men and emphasizes the importance of continued physician-supervised monitoring for long-term care.
July 2018: Clinics in Plastic Surgery
https://www.readbyqxmd.com/read/29908618/hormonal-management-for-transfeminine-individuals
#17
REVIEW
Jessica Abramowitz, Vin Tangpricha
Transfeminine individuals are treated with estradiol and anti-androgen agents to transition to a more feminine appearance. The physical changes that occur with estradiol therapy include breast development, body fat redistribution, and decreased muscle mass. Transfeminine treatment regimens require monitoring and dose adjustments to achieve appropriate physiologic targets to enhance feminization and decrease risk of adverse outcomes. Adverse effects associated with estradiol use include thromboembolic disease, macroprolactinoma, breast cancer, coronary artery disease, cerebrovascular disease, cholelithiasis, and hypertriglyceridemia...
July 2018: Clinics in Plastic Surgery
https://www.readbyqxmd.com/read/29908617/mental-health-evaluation-for-gender-confirmation-surgery
#18
REVIEW
Randi Ettner
The requests for medically necessary surgical interventions for transgender individuals have steadily increased over the past several years. So too has the recognition of the diverse nature of this population. The surgeon relies heavily on the mental health provider to assess the readiness and eligibility of the patient to undergo surgery, which the mental health provider documents in a referral letter to the surgeon. The mental health provider explores the individual's preparedness for surgery, expectations, and surgical goals and communicates with the surgeon and other providers to promote positive outcomes and inform multidisciplinary care...
July 2018: Clinics in Plastic Surgery
https://www.readbyqxmd.com/read/29908616/primary-care-for-the-transgender-and-gender-nonconforming-patient
#19
REVIEW
Frederic M Ettner
All physicians are likely to encounter gender diverse patients, and some of these patients require medically necessary surgical procedures. It is optimal for surgeons to collaborate with other providers who interact with this patient population. Primary care physicians initiate treatment with consultation from mental health professionals and refer to surgeons when necessary. Best practices consist of preventative care, hormone therapy induction when indicated, monitoring of all health parameters, and continuing care medically and postoperatively...
July 2018: Clinics in Plastic Surgery
https://www.readbyqxmd.com/read/29908615/multidisciplinary-care-and-the-standards-of-care-for-transgender-and-gender-nonconforming-individuals
#20
REVIEW
Dan H Karasic, Lin Fraser
In providing care to transgender patients, surgeons interact with health care providers of other disciplines, including medical and mental health providers. Mental health or medical providers often see a patient first, when hormones are initiated. The Standards of Care recommend that mental health professionals assess patients for surgery according to set criteria and send surgeons their evaluations prior to surgery. Open communication is essential between surgical, medical, and mental health providers as well as with patients, who must give informed consent...
July 2018: Clinics in Plastic Surgery
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