Search Results (53)

Background/Objectives: Gender-affirming surgery (GAS) has become more accessible in recent years. It aims to align the physical characteristics of transgender individuals with their gender identity to alleviate distress associated with gender dysphoria. This may involve procedures such as genital reconstruction, breast augmentation or removal, and voice modification surgeries. However, the associations of these treatments on long-term mental health outcomes remain debated. This paper aims to review and synthesize current research on the associations of GAS on psychiatric outcomes and quality of life in transgender individuals. Methods: In accordance with the PRISMA statement, a search on PubMed, PsychInfo, and Embase yielded 867 articles, of which 14 studies of 3023 participants met the full inclusion criteria. Results: There is an initial improvement in psychological well-being and quality of life within the first year post-GAS, followed by subsequent plateau or decline thereafter. Factors such as younger age, higher levels of education, noticeable improvement in secondary sexual characteristics, and a supportive social environment have been identified as predictors of positive outcomes. Conversely, non-homosexual orientation and higher levels of pre-GAS psychopathology have been associated with poorer outcomes, highlighting the importance of tailored support and pre-operative mental health care to optimize long-term success. Conclusions: This study underscores the need for further research into long-term outcomes and tailored support strategies to optimize the mental health and well-being of transgender individuals undergoing GAS. Full article

Facial gender-affirming surgery (FGAS) is a transformative step for transgender individuals in their gender care journey. Even so, the way outcomes are measured and reported is highly inconsistent and unstudied. This limits the ability to compare studies or develop clear, patient-centered benchmarks for success. We systematically assess how current research defines FGAS outcomes and lay the groundwork for a unified Core Outcome Set (COS). A systematic review was conducted following the PRISMA 2020 guidelines. PubMed was searched up to 15 March 2025; we identified 334 studies, and four reviewers independently screened the studies. After screening, 207 studies met the inclusion criteria, encompassing 30,937 patients. Data on study characteristics, surgical procedures, outcome domains, measurement tools, and follow-up duration were extracted. Descriptive statistics and chi-square analyses were used to evaluate reporting trends. Most studies emphasized aesthetic outcomes (60.56%) and complications (62.44%); fewer addressed psychosocial well-being (43.19%), quality of life (35.21%), or reoperation rates (21.60%). Only 26 of the 207 studies used validated outcome instruments, such as FACE-Q or PROMIS (p < 0.001). Among studies that reported satisfaction, only 41.2% provided numerical or stratified scores. Outcome reporting in FGAS research is fragmented and dominated by subjective or unvalidated assessments. A standardized COS is needed to unify research practices, facilitate meaningful comparisons, and ensure that outcomes align with patient-defined measures of surgical success. Full article

Background and Objectives: With the increasing demand for gender-affirming procedures, facial feminization surgery (FFS) has become an essential component in the management of patients with gender dysphoria. In this study, ‘male’ and ‘female’ refer to biological sex as recorded in the medical record; gender identity was not assessed. The mandible is widely recognized as one of the most sexually dimorphic facial bones and plays a critical role in defining masculine and feminine facial contours. However, quantitative mandibular data directly applicable to surgical planning for FFS, particularly in Asian populations, remain limited. The purpose of this study was to analyze gender differences in mandibular morphology using three-dimensional (3D) computed tomography (CT) images and to provide clinically relevant anatomic data applicable to mandibular contouring in FFS. Materials and Methods: In this single-center retrospective study, 275 Korean patients who underwent facial CT between January 2017 and December 2019 were enrolled. Three-dimensional cephalometric analysis was performed to obtain surgically relevant mandibular measurements, including angular, linear, and transverse parameters, as well as non-metric characteristics such as chin shape and inferior mandibular border contour. Statistical comparisons were conducted to evaluate gender differences. Results: Significant gender differences were observed in mandibular angle (p < 0.001), mandible length (p < 0.001), antegonial notch distance (p < 0.001), intercondylar width (p < 0.001), and intergonial width (p < 0.001). Ramus length and chin width did not demonstrate statistically significant differences. Non-metric analysis revealed significant gender differences in chin morphology and inferior mandibular border contour (p < 0.01). Males predominantly exhibited a round or square chin (79.5%) and a rocker-shaped inferior border, whereas females commonly demonstrated a pointed chin (82.3%) and a straight inferior mandibular border (94.4%). Conclusions: The sexual dimorphism of the mandible in the Korean population is characterized by differences in angularity, transverse width, antegonial morphology, and inferior border contour. These findings provide population-specific morphological reference ranges that may support individualized preoperative assessment for mandibular contouring in facial feminization surgery. Full article

Aesthetic Medicine is advanced as an integrated, evidence-based framework for patient-centered care that unites physical, psychological, social, and aesthetic dimensions of health. Drawing on Clinical Health Psychology, the paper introduces Aesthetic Health Psychology as a specialization that embeds psychological theory, assessment, and intervention within aesthetic medicine and surgery, emphasizing interdisciplinary collaboration rather than professional mistrust. The paper argues that integrating Aesthetic Health Psychology into aesthetic medicine can enhance ethical practice, improve patient-reported outcomes, and support equity-focused implementation across diverse procedures and settings. It further suggests a practical framework for implementation. Three interrelated models are proposed: the Aesthetic Biopsychosocial Model, which conceptualizes aesthetics as a distinct health domain alongside biological, psychological, and social factors; the Aesthetic Health Care Process Model, which structures care as a five-stage journey supported by systematic screening for body dysmorphic disorder and the routine use of patient-reported outcome measures; and the Aesthetic Health Systems Model, which situates aesthetic care within institutional, policy, and cultural contexts. Idealized but clinically grounded vignettes from elective cosmetic, reconstructive, and gender-affirming settings illustrate how these models address non-linear trajectories of adaptation, evolving expectations, complications, and stigma. These concepts jointly define both the motivation for Aesthetic Health Psychology and its practical implications, from the use of brief, selective aesthetic screening during primary health care visits to the design of equity-focused implementation strategies across aesthetic procedures and settings. Full article

Background/Objectives: Robotic technology has transformed several surgical specialties, offering enhanced precision, visualization, and dexterity. In plastic and reconstructive surgery, robotic systems are increasingly utilized across a range of procedures, though their applications remain in early development. Methods: A review of the literature was performed to identify studies reporting robot-assisted procedures in plastic and reconstructive surgery. The literature was synthesized thematically to characterize current procedural applications, emerging technologies, and areas of active clinical investigation. Results: Robotic systems have been reported in a broad range of plastic and reconstructive procedures, including flap harvest, microsurgery, breast reconstruction, craniofacial and head and neck reconstruction, esthetic surgery, and gender-affirming surgery. The existing studies primarily consist of case series and case reports with substantial variability in reported indications, techniques, and technological platforms. Comparative clinical outcomes and long-term data are limited. Conclusions: Robot-assisted reconstruction continues to expand across multiple procedural domains. However, current evidence remains largely descriptive, underscoring the need for standardized reporting and prospective studies to better define clinical value, safety, and appropriate indications. Full article

Background/Objectives: Assigned female at birth (AFAB) individuals who identify as transgender or gender-diverse (TGD) with concurrent breast cancer or high-risk genetic mutations represent a unique population, requiring consideration of oncologic and aesthetic goals. These patients sought chest masculinization with oncologic gender-affirming mastectomy (OGAM) or non-binary reconstruction to alleviate gender dysphoria and treat their breast cancer. There is limited literature on surgical techniques in this patient population. Methods: A retrospective chart review of AFAB TGD adults (>18 years of age) who underwent OGAM or non-binary reconstruction at the University of Washington between 2019 and 2023 was conducted. All patients had a consultation with a plastic surgeon for reconstruction and a minimum of one year follow-up. Demographic data, oncologic status, post-operative complications, and revision surgical history were collected. Results: Eight AFAB TGD individuals met the inclusion criteria. The mean age at the time of mastectomy was 35.13 years (SD = 8.04), and the mean BMI was 29.88 (SD = 6.40). Indications for mastectomy included a breast cancer diagnosis (N = 4) or a strong family history of breast cancer or genetic predisposition (N = 4). Two (25%) patients underwent nipple-sparing mastectomies (NSM), two patients (25%) underwent skin-sparing mastectomy with Goldilocks reconstruction, and four patients (50%) underwent simple mastectomy (oncologic gender-affirming mastectomy), flat closure with free nipple graft (FNG). Two patients had staged nipple mastectomy with secondary nipple reduction and fat grafting. Six patients had immediate reconstruction, four (50%) patients underwent immediate double-incision OGAM with FNG, and two (25%) patients underwent Goldilocks procedures—one with and one without FNG. One patient (12.5%) experienced a surgical site infection, and three patients (37.5%) underwent revision surgery. No patients had positive margins following their mastectomy. Conclusions: This case series highlights the importance of a multidisciplinary and highly personalized approach for AFAB and TGD individuals undergoing oncologic gender-affirming mastectomy or non-binary reconstruction. We reviewed reconstructive options performed at our institution, demonstrating safe oncologic and reconstructive techniques that emphasized collaboration between breast and plastic surgeons. Full article

Background and Objectives: There is a worldwide increase in the demand for gender-affirming surgical treatments among transgender and gender-diverse (TGD) adults and adolescents. In Poland, transgender people generally lack trust in healthcare providers, which makes it more difficult for them to begin their transition process. This patient population is not well understood by many of the specialists who may potentially be involved in their care, in some way, reinforcing their concerns. The aim of this study is to present the sociodemographic characteristics of a group of female-to-male transgender patients who were admitted to a privately based plastic surgery center to undergo chest wall reconstruction. Materials and Methods: This study comprises a statistical analysis of data retrospectively obtained from the medical records of 100 patients from across the country undergoing female-to-male transition, who were operated on between 2021 and 2025 at a specialized private clinic in Poland. All individuals had already started gender-affirming medical treatment with testosterone at the time of first consultation. Results: The results show a trend toward a decreasing age at the time of the decision to undergo gender-affirming surgery. In the study group, 100% of patients were already undergoing hormone therapy. In our group of transgender individuals, we did not observe a correlation between cultural or social background, religion, and gender dysphoria. It is encouraging that more than half of the patients reported no longer needing psychiatric support, and that those who were still under specialist supervision stated that they experienced a significant improvement in their overall well-being. Conclusions: The rising demand for transgender healthcare highlights the need for studying and analyzing this group of patients in order to provide the best patient-centered care throughout the gender transition process by all specialists involved. Gender-affirming mastectomy, when combined with testosterone therapy, has a positive mental health impact on transgender individuals. Full article

Intersex people continue to face barriers in healthcare. Despite notable ethical and legal advances, the role of socio-cognitive factors influencing clinical decision-making remains insufficiently understood. Critical perspectives call for revising the epistemological and normative foundations of medical practice, as clinical judgments may still be shaped by professionals’ beliefs and limited access to accurate information. Objective: This study examined how levels of knowledge, beliefs about gender determinism, and adherence to gender roles influence healthcare professionals’ attitudes toward intersex people. Methods: A total of 210 healthcare professionals from Spain participated in a cross-sectional survey. Participants completed the Intersex Knowledge Questionnaire, the short version of the Bem Sex-Role Inventory, and the Gender Determinism Scale. Data were analyzed using χ² tests, one-way ANOVA, and t-tests. Results: Higher levels of knowledge (conceptual, procedural, and legislative) were associated with more affirmative and non-normative attitudes toward intersex healthcare. Neither gender determinism nor adherence to traditional gender roles was associated with professionals’ attitudes. Participants with prior contact with intersex people demonstrated higher conceptual knowledge and lower support for corrective surgeries. Significant disciplinary differences were also found: physicians tended to display more corrective and ambivalent attitudes, whereas psychologists and social workers were more frequently aligned with affirmative and diversity-respectful perspectives. Conclusions: Intersex healthcare attitudes may be influenced by limited training opportunities and the low visibility of intersex topics in medical education. Knowledge appears to be an important factor associated with more affirmative professional attitudes. Future studies using larger samples are needed to confirm these associations and explore underlying causal mechanisms. Full article

Gender dysphoria stems from incongruence between gender identity and assigned sex, often causing significant distress related to breast anatomy in transmasculine individuals. Gender-affirming hormone therapy typically precedes mastectomy, which is a fundamental intervention in transgender healthcare. Surgical challenges arise in patients with large breasts on lean frames, requiring customized techniques to achieve a natural, proportional, androgynous chest. This case report describes a 23-year-old transmasculine patient with macromastia and a tall, lean build who underwent gender-affirming mastectomy with free nipple grafts and muscular sculpture aimed at an androgynous esthetic. Pre- and postoperative evaluations showed marked improvements in body image, physical strength performance, and emotional well-being. Psychological assessments revealed significant reductions in body uneasiness and gender dysphoria, while human figure drawings demonstrated increasing bodily integration and identity congruence. A general improvement in physical performance over time was reported, particularly in upper body strength, with minor fluctuations potentially related to the surgical intervention and recovery phase. The narrative literature review supports these outcomes, highlighting satisfaction rates above 90%, minimal regret, and consistent gains in psychosocial functioning and sexual and mental health, including reduced anxiety and depression. This evidence reinforces that gender-affirming mastectomy is medically necessary, particularly when tailored to individual anatomical and esthetic needs, affirming identity and alleviating distress. Full article

Background/Objectives: Gender-affirming care is a complex, multidisciplinary process that has gained increasing recognition worldwide. This practice report presents the unique clinical model developed at the Kocaeli University Hospital Gender Dysphoria Clinic, one of the pioneering centers in Türkiye. Methods: An experience-based descriptive approach was adopted to capture two decades of clinical experience, institutional processes, and socio-political challenges not fully reflected in systematic reviews. The article reflects on the authors’ direct practice in a university-based transgender health clinic in Türkiye, structured around the multidisciplinary team model, patient pathways, institutional processes, and the sociopolitical context of care. Results: The Kocaeli University model integrates psychiatry, endocrinology, surgery, nursing, social work, and legal consultation. Since 2004, the clinic has evaluated and treated hundreds of transgender individuals and produced numerous theses and peer-reviewed publications. Key strengths include a structured board system, the training of psychiatry residents, and close interdepartmental collaboration. Conclusions: This model illustrates how gender-affirming care can be effectively implemented in a challenging sociopolitical context. Sharing this experience may inform global practices and support the dissemination of multidisciplinary approaches to transgender health. Full article

Background/Objectives: Gender-affirming surgery (GAS) is associated with improved mental health outcomes in transgender and gender-diverse (TGD) individuals. However, TGD populations experience disproportionately high rates of substance use disorders (SUDs), which are established risk factors for surgical complications. Despite this, the relationship between preoperative SUDs and postoperative outcomes following GAS has not been studied. Our objective was to evaluate how specific SUD subtypes, including tobacco, alcohol, and cannabis, impact short- and medium-term postoperative complications following GAS. Methods: A retrospective cohort study was conducted using the TriNetX Research Network, which includes de-identified electronic health records from over 100 million U.S. patients. Adults with documented gender dysphoria who underwent GAS between April 2015 and April 2025 were included. Patients were divided into four groups: no SUD, tobacco use, alcohol use, and cannabis use. Propensity score matching was used to control for demographic variables. Postoperative complications were assessed at 30 days and 6 months. Results: Alcohol use was significantly associated with increased rates of delayed wound healing, wound dehiscence, gastrointestinal symptoms, and postoperative pain at both 30 days and 6 months. Cannabis use was linked to higher rates of wound dehiscence, infections, GI symptoms, and pain. Tobacco use showed the broadest impact, significantly associated with nearly all complications measured except pain at 30 days. These associations persisted at six months. Conclusions: This is the first study to quantify the relationship between substance use and GAS outcomes. Preoperative use of tobacco, alcohol, and cannabis was independently associated with increased postoperative complications. These findings underscore the need for systematic preoperative screening and the development of SUD-specific perioperative care pathways to improve outcomes and advance equity in surgical care for TGD patients. Full article

Background: Gender dysphoria refers to the psychological distress arising from a mismatch between an individual’s physical embodiment and their internal sense of gender. Gender-affirming mastectomies can be a pivotal component of gender affirmation for transgender, non-binary, and gender expansive individuals assigned female at birth. The impact of obesity on the outcomes of gender-affirming mastectomies has yet to be fully defined. Methods: A retrospective review of 205 gender-affirming mastectomies performed by the senior author was conducted. Patients were categorized into obese (BMI ≥ 30) and non-obese groups. Baseline characteristics, intraoperative variables, and complication rates were compared. Univariate and multivariate models were performed to evaluate the association between obesity and postoperative complications. Results: Obese patients had higher mean resection weights and liposuction volumes (p < 0.001). Significant differences were observed in the prevalence of fibromyalgia, prior chest surgeries, and hormone therapy usage (p = 0.002, 0.002, and 0.03, respectively). However, no statistically significant differences were found in overall complication rates between obese and non-obese groups in the univariate or multivariate analyses. Conclusions: Our study suggests that obesity is not a significant risk factor for complications in gender-affirming mastectomies patients. The varying impact of high BMI and obesity on surgical outcomes in different surgical fields highlights the importance of patient-centered care and a holistic and individual approach for each patient. Full article

Objectives: Health disparities among transgender and gender-diverse individuals are partly attributed to the limited knowledge and preparedness of healthcare providers. This study aims to assess the level of knowledge of transgender health among residents in obstetrics and gynecology and family medicine. Methods: A multicenter, cross-sectional study was conducted with obstetrics and gynecology (OBGYN) and family medicine (FM) residents from two different centers. Data were collected using a 21-item questionnaire. The questionnaire assessed participants’ demographic information, knowledge of sexual orientation and gender identity, clinical and anatomical effects of gender-affirming hormone therapy, knowledge of gender-affirming surgery, and knowledge of risk-based screening for TGD individuals. Results: The study, which included 85 residents (62 FM, 23 OBGYN), found that 76.6% of respondents indicated that SOGI should be routinely assessed. However, 68.3% of the participants reported inadequate knowledge regarding the clinical implications of gender-affirming hormone therapy, and 74.1% reported insufficient knowledge about gender-affirming surgeries. Furthermore, 62.4% of the participants indicated that they had not received any health education specifically tailored to address the needs of transgender individuals. Only 23.5% reported receiving training during their residency programs. Notably, 84.7% of the participants expressed a desire for formal education in this area. Conclusions: FM and OBGYN residents have significant knowledge gaps regarding TGD health. The integration of TGD health topics into the curricula of medical schools and residency programs is needed to improve access to healthcare for individuals with TGD. Full article

Background/Objectives: Gender-affirming mastectomies are a pivotal step in the gender-affirmation process. These procedures represent the concordance between an individual’s appearance, as seen by the environment, and his/her perception of themselves. Hematomas are a growing concern in gender-affirming mastectomies, as they carry the risk for reoperation, increased length of hospital stay, and sub-par aesthetic outcomes. Recognition of factors contributing to the development of hematomas in gender-affirming mastectomies can improve surgical outcomes and patient satisfaction. In this study, we hope to shed light on variables potentially contributing to the development of post-operative hematomas in our experience with 267 gender-affirming mastectomies. Methods: Medical records of 267 consecutive gender-affirming mastectomies performed by the senior author were included in this study. Relevant demographic, clinical, and surgical characteristics were collected from patients’ medical files. The patients were stratified based on whether they developed post-operative hematomas. Univariate and multivariate analyses were performed to determine the impact of various factors on the risk of the development of post-operative hematomas. Results: The study groups were found to be similar in most baseline demographic and surgical characteristics. Statistically significant differences were seen regarding mean BMI, use of combined TRT and estrogen blockers, surgical technique, previous reduction mammaplasty, and intra-operative tissue resection weight (p-value = 0.007, 0.03, <0.001, 0.02, <0.001). Multivariate logistic regression was performed to predict post-operative hematomas. The covariates in question were statistically significant variables that differed between the groups. Previous reduction mammaplasty was found to be a statistically significant independent predictor of post-operative hematomas, with an OR of 41.55 (95% CI 4.2–408.3), and the “free NAC” surgical technique was found to decrease the incidence of post-operative hematomas, with an OR of 0.015 (95% CI 0.003–0.064). Conclusions: A history of reduction mammaplasty is a substantial risk factor for the development of post-operative hematomas in gender-affirming mastectomies. Of the various surgical techniques, the use of the “free NAC” technique can, to some degree, reduce the risk of hematoma development. Full article

Background and Objectives: Gender affirmation surgery significantly improves the quality of life and psychological well-being of transgender women. Among various techniques, sigmoid vaginoplasty is widely performed due to its ability to provide adequate vaginal depth and intrinsic lubrication. However, it carries risks, with neovaginal perforation being a serious yet underreported complication. Materials and Methods: This review examines the etiology, clinical manifestations, diagnosis, and management of neovaginal perforation. A literature review was conducted to analyze reported cases and treatment strategies. Additionally, we present a case from our institution to highlight diagnostic and therapeutic challenges. Results: Neovaginal perforation arises from mechanical trauma, ischemia, infection, or structural weaknesses in the sigmoid segment. Common risk factors include improper dilation, introital stenosis, and vascular compromise. Symptoms range from mild pelvic discomfort to peritonitis and sepsis. Computed tomography (CT) is the gold standard for diagnosis. Conservative management is effective in mild cases, whereas severe cases require surgical repair. Conclusions: Neovaginal perforation is rare but potentially life-threatening. Future research should refine surgical techniques, dilation protocols, and tissue engineering solutions. Standardized guidelines and patient education are essential for prevention and improved outcomes. Full article