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transgender surgery

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
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
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
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
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
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
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
Miriam Hadj-Moussa, Dana A Ohl, William M Kuzon
BACKGROUND: Gender dysphoria is the experience of marked distress due to incongruence between genetically determined gender and experienced gender. Treatment of gender dysphoria should be individualized and multidisciplinary, involving a combination of psychotherapy, social gender transition, cross-sex hormone therapy, gender-affirming surgery, and/or ancillary procedures and services. The goal of all treatment modalities is to alleviate distress and affirm the patient's experienced gender identity...
June 8, 2018: Sexual Medicine Reviews
Shu Pan, Stanton C Honig
Gender-affirming surgeries (GASs), previously known as gender reassignment surgeries, are surgical procedures born from plastic and reconstructive surgery, colorectal surgery, urology, and gynecology. A multidisciplinary approach is essential for the care of transgender patients. The urologist plays a vital role, both in the perioperative period and as part of continued care. This publication will review the current concepts of genital GAS as it pertains to the practicing urologist. The most utilized surgical techniques will be described along with their notable complications and management options...
June 7, 2018: Current Urology Reports
Megan Lane, Graham C Ives, Emily C Sluiter, Jennifer F Waljee, Tsung-Hung Yao, Hsou Mei Hu, William M Kuzon
Background: An estimated 0.6% of the U.S. population identifies as transgender and an increasing number of patients are presenting for gender-related medical and surgical services. Utilization of health care services, especially surgical services, by transgender patients is poorly understood beyond survey-based studies. In this article, our aim is 2-fold; first, we intend to demonstrate the utilization of datasets generated by insurance claims data as a means of analyzing gender-related health services, and second, we use this modality to provide basic demographic, utilization, and outcomes data about the insured transgender population...
April 2018: Plastic and Reconstructive Surgery. Global Open
Kristin B de Haseth, Marlon E Buncamper, Müjde Özer, Lian Elfering, Jan Maerten Smit, Mark-Bram Bouman, Wouter B van der Sluis
Background: Vaginoplasty is performed as gender-affirming surgery in transgender women. While multiple surgical techniques exist for this goal, penile inversion vaginoplasty is performed most frequently. Neovaginal symptoms may impede sexual functioning after surgery. Methods: A total of five consecutive patients with symptoms and positive swabs for neovaginal candida infection were described. Results: All patients presented with white-colored neovaginal discharge and some with neovaginal itching and/or malodor...
2018: Transgender Health
Christopher J Salgado, Ajani Nugent, Joseph Kuhn, Meghan Janette, Heidi Bahna
Background: Many techniques have been described for reconstruction of the vaginal canal for oncologic, traumatic, and congenital indications. An increasing role exists for these procedures within the transgender community. Most often, inverted phallus skin is used to create the neovagina in transwomen. However, not all patients have sufficient tissue to achieve satisfactory depth and those that do must endure cumbersome postoperative dilation routines to prevent contracture. In selected patients, the sigmoid colon can be used to harvest ample tissue while avoiding the limitations of penile inversion techniques...
2018: BioMed Research International
Jonathan P Massie, Shane D Morrison, Judy Van Maasdam, Thomas Satterwhite
BACKGROUND: Penile inversion vaginoplasty is the current gold standard procedure for male-to-female transgender patients seeking gender-confirming genital surgery. Although complication data have been reported extensively in the literature, studies on patient-reported outcomes are sparse. This study aimed to report both postoperative complications and patient-reported outcomes from the largest cohort in the United States to date to undergo penile inversion vaginoplasty. Ultimately, the authors hoped to identify the predictors of postoperative complications and patient satisfaction...
June 2018: Plastic and Reconstructive Surgery
Jordan D Frey, Jessie Z Yu, Grace Poudrier, Catherine C Motosko, Whitney V Saia, Stelios C Wilson, Alexes Hazen
BACKGROUND: A primary goal in chest wall reconstruction ('top surgery') for trans men is achieving a symmetrical, aesthetically pleasing position of the reconstructed male NAC. In the context of existing surgical techniques for top surgery, the ability to achieve this goal is limited. METHODS: The senior author's technique for component NAC creation in chest wall reconstruction for trans men with a modified skate flap and free areolar graft, in conjunction with double-incision mastectomy, is described...
May 14, 2018: Plastic and Reconstructive Surgery
Benjamin B Massenburg, Shane D Morrison, Vania Rashidi, Craig Miller, David W Grant, Christopher S Crowe, Nathalia Velasquez, Justin R Shinn, Jacob E Kuperstock, Deepa J Galaiya, Scott R Chaiet, Amit D Bhrany
OBJECTIVE: Gender dysphoria is estimated to occur in over 1 million people in the United States. With decreasing stigma regarding the transgender population, it is likely more patients will seek medical and surgical gender transition as parts of their treatment. However, otolaryngologists may lack training in gender-confirming surgery. This study aims to determine the current state of transgender-related education in the United States otolaryngology training programs and to evaluate trainee perceptions regarding the importance of such training...
May 15, 2018: Journal of Craniofacial Surgery
Anna Zurada, Sonja Salandy, Wallisa Roberts, Jerzy Gielecki, Justine Schober, Marios Loukas
An estimated 1.4% of the population worldwide has been diagnosed with Gender Dysphoria, as defined by the Diagnostic and Statistical Manual of Mental Disorders. Gender reassignment, which holistically encompasses psychotherapy, hormonal therapy and genital and nongenital surgeries, is considered the most effective treatment for transgender non-conforming patients afflicted with gender dysphoria. Little research is currently available identifying the psychosocial needs of the transgender population and their access to preventative and primary care during this transitioning process...
May 7, 2018: Clinical Anatomy
Berna Özata Yıldızhan, Şahika Yüksel, Mirella Avayu, Handan Noyan, Eren Yıldızhan
OBJECTIVE: Our purpose was to compare the life style, family and social relationships (social adaptation) and the quality of life in people with gender dysphoria with and without history of sex reassignment surgery. METHOD: Twenty  individuals (SR group) who were earlier followed   in Istanbul University Psychiatry Department Psychoneurosis and Psychotherapy Unit with gender dysphoria diagnosis in  order  to  have confirmative reports for the sex reassignment (SR) surgery were interviewed at least one year after the surgery...
2018: Türk Psikiyatri Dergisi, Turkish Journal of Psychiatry
Yi-Le Lee, Teh-Fu Hsu, Ling-Yu Jiang, Hsiang-Tai Chao, Peng-Hui Wang, Yi-Jen Chen
STUDY OBJECTIVE: Previous studies suggest female-to-male transgender men tend to choose less invasive procedures, but the superior route of hysterectomy for them remains undetermined. DESIGN: Retrospective study (Canadian Task Force Classification II-3) SETTING: Academic tertiary hospital PATIENTS: Fifty-six female-to-male transsexuals received total vaginal hysterectomy (VH) with bilateral salpingo-oophorectomy (BSO) between April 2008 and August 2016 at Taipei Veterans General Hospital...
April 30, 2018: Journal of Minimally Invasive Gynecology
David Jiang, Jonathan Witten, Jens Berli, Daniel Dugi
BACKGROUND: Gender-affirming vaginoplasty aims to create the external female genitalia (vulva) as well as the internal vaginal canal; however, not all patients desire nor can safely undergo vaginal canal creation. AIM: Our objective is to describe the factors influencing patient choice or surgeon recommendation of vulvoplasty and to assess the patient's satisfaction with this choice. METHODS: Gender-affirming genital surgery consults were reviewed from March 2015 until December 2017, and patients scheduled for or who had completed vulvoplasty were interviewed by telephone...
April 26, 2018: Journal of Sexual Medicine
David Rabinerson, Tal Fortgang-Hershenhorn, Rinnat Gabbay-Benziv
The phenomenon of the discrepancy between a person's sexual self-perception and his/her genetic sex has been known to medicine since the mid-19th century. Initially, this discrepancy was considered to be a mental disorder. Over time, advances in medical abilities in surgery, hormonal treatment and infertility, have enabled physicians to help those who are affected to fulfill their wish. The present notion is that transsexualism is a solvable problem (whether the desired wish is for a man to become a woman or vice versa)...
April 2018: Harefuah
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