Corral, Gabriel Del

ABSTRACTBackgroundTactile sensory recovery in autologous breast reconstruction (ABR) has been shown to prevent injuries and improve quality of life. However, the studies comparing neurotized versus non‐neurotized outcomes are still controversial due to methodological heterogeneity. This review uses consistent and objective outcomes to evaluate the current evidence's qualitative characteristics and quantitative tactile sensory recovery.MethodsWe conducted a systematic electronic literature search from database inception through 10 February 2024, of the following databases: PubMed, Ovid MEDLINE, Embase, SCOPUS, and CINAHL to identify all studies reporting outcomes of tactile sensory recovery using the Semmes‐Weinstein Measuring scale in free‐flap ABR comparing neurotization versus non‐neurotization. The SWM scale score, demographic characteristics, and surgical features were extracted from each study. Due to the data heterogeneity within the studies, we transformed the data into means and pooled the qualitative information.ResultsWe identified 264 articles. After thorough screening, 12 fulfilled the inclusion criteria and were included in the qualitative synthesis. Finally, 7 were quantitatively analyzed with a total of 251 breasts that underwent ABR with free flap neurotization and 244 breasts without neurotization. This revealed a mean SWM score difference of −0.67 and a significant p‐value < 0.05. A subgroup DIEP flap analysis performed for 177 neurotized compared to 175 non‐eurotized flaps yielded a significant mean difference of −0.86 p < 0.05. There were no significant differences between groups in age (48.8 vs. 49.8, p = 0.5), history of chemotherapy (72 vs. 74, p = 0.91), radiotherapy (61 vs. 56, p = 0.84), or follow‐up time (21.85 vs. 25.09 months, p = < 0.05) that could have influenced tactile sensory recovery.ConclusionNeurotization in free‐flap ABR could allow better tactile sensory recovery than the spontaneous sensation gained without it. The additional surgical time required for coaptation is short, and no studies have reported associated complications, making it a safe procedure that can potentially improve patients´ quality of life. Nonetheless, higher‐quality studies, such as randomized control trials with standardized sensation testing and more rigorous methodologies, are needed before making final clinical recommendations.

Background: There is an increasing demand for body contouring and gender-affirming surgeries, and so is the need to compare outcomes between techniques. Gender dysphoria is a discrepancy between gender identity and the sex assigned at birth. One way to address this is to perform procedures to enable patients to look according to their desired gender identity. Gaps in knowledge regarding the best approaches and which surgical techniques yield the most patient satisfaction remain. This article summarizes up-to-date studies, including upper and lower body contouring procedures. Methods: A systematic review was performed using terms related to body contouring in gender-affirming surgery for transgender patients. All articles included surgical and patient-reported outcomes following either chest or lower body contouring procedures. Results: 15 studies, including trans male chest wall contouring, trans female breast augmentation, and lower body contouring, with 1811 patients, fulfilled the inclusion criteria. The double incision (DI) techniques consistently resected more tissue and had better BODY Q scores than non-overweight patients. Bleeding was increased in periareolar, semicircular, and obese patients with DI techniques. Nipple depigmentation and sensation loss were more common with double-incision-free nipple graft techniques (DIFNG). Lower body contouring patients had average implant sizes bigger than 200 mL and reported 2 gluteal implant displacements, 1 exposure, and one rupture. Eight percent of patients who underwent large-volume fat grafting reported dissatisfaction due to fat reabsorption. Conclusions: The debate between the double incision and periareolar techniques continues. Variations of the DIFNG technique continue to be the most common approach; however, nipple depigmentation and loss of sensation are also more common with it. Regarding increased bleeding with periareolar techniques, there is still no evidence that hormonal therapy may be playing a role in it. For lower-body trans female contouring, implants could help with the longevity of contouring results in patients needing large-volume fat grafting. There is an increasing evaluation of gender-affirming body contouring patient-reported outcomes; however, there is still a need for a validated way to report satisfaction scores in lower body contouring. Validated surveys could help identify surgical candidates based on satisfaction patterns, specifically for transgender and non-binary patients.

Purpose : There is an unknown percentage of transgender and gender non-confirming individuals who undergo gender affirmation surgeries (GAS) that experiences regret. Regret could lead to physical and mental morbidity, also questioning the appropriateness of these procedures in selected patients. The aim of this study is to evaluate the prevalence of regret in transgender individuals who underwent GAS and evaluate associated factors. Methods : A systematic review was conducted following the PRISMA guidelines. A comprehensive research strategy was performed including the following databases: Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. Random-effects meta-analysis of proportions, subgroup analysis, meta-regression, publication bias, and sensitivity analyses were performed. Results: A total of 27 studies, pooling 7,928 transgender patients that underwent any type of GAS were included in this review. The pooled prevalence of regret after GAS was 1% (95% Confidence interval [CI] <1-2%). Overall, 33% underwent transmasculine surgical procedures and 67% transfeminine procedures. The prevalence of regrets among patients undergoing transmasculine and transfeminine surgeries was <1% (IC<1-<1%) and 1% (CI<1-2%), respectively. A total of 77 patients regretted having had GAS. Of them, 28 had minor and 34 had major regrets based on Pfäfflin’s regret classification. The majority of these had “clear regret” based on Kuiper and Cohen Kettenis’ classification. Conclusion: Based on this review, there is an extremely low prevalence of regret in transgender patients after GAS. We believe this study corroborates the improvements made in regard to selection criteria for GAS. However, there is high subjectivity in the assessment of regret and lack of standardized questionnaires, which highlight the importance of developing validated questionnaires in this population.

Background: Every day, we see more patients present to hospitals and clinics seeking gender-affirmation care to ameliorate the symptoms of gender dysphoria. However, to provide a multidisciplinary approach, it is important to offer an integrated clinical program that provides mental health assessment, endocrine therapy, physical therapy, research, and the full spectrum of surgical services devoted to transgender patients. This article describes our experience on building a specialized, multidisciplinary, academic state-of-the-art gender-affirmation program. Methods: Herein, we describe the main and critical components on how to build a multidisciplinary academic gender-affirmation program. We share our lessons learned from this experience and describe how to overcome some of the obstacles during the process. Results: Building a multidisciplinary academic gender-affirmation program requires an invested team, as each and every member is essential for feedback, referrals, and to improve patient’s experience. Institutional support is essential and by far the most important component to overcome some of the obstacles during the process. Having all team members working under the same institution provides all the critical components needed to improve outcomes and patient satisfaction. In addition, the collection of prospective data with a well-structured research team will provide information needed to improve clinical services and standardize clinical protocols, while leaving space for innovation. Conclusions: This article describes the steps and experience needed to build a multidisciplinary holistic academic gender-affirmation program. We provide our lessons learned during the process that will help guide those who intend to start an academic gender-affirmation program.

Background: There is an unknown percentage of transgender and gender non-confirming individuals who undergo gender-affirmation surgeries (GAS) that experiences regret. Regret could lead to physical and mental morbidity and questions the appropriateness of these procedures in selected patients. The aim of this study was to evaluate the prevalence of regret in transgender individuals who underwent GAS and evaluate associated factors. Methods: A systematic review of several databases was conducted. Random-effects meta-analysis, meta-regression, and subgroup and sensitivity analyses were performed. Results: A total of 27 studies, pooling 7928 transgender patients who underwent any type of GAS, were included. The pooled prevalence of regret after GAS was 1% (95% CI <1%–2%). Overall, 33% underwent transmasculine procedures and 67% transfemenine procedures. The prevalence of regret among patients undergoing transmasculine and transfemenine surgeries was <1% (IC <1%–<1%) and 1% (CI <1%–2%), respectively. A total of 77 patients regretted having had GAS. Twenty-eight had minor and 34 had major regret based on Pfäfflin’s regret classification. The majority had clear regret based on Kuiper and Cohen-Kettenis classification. Conclusions: Based on this review, there is an extremely low prevalence of regret in transgender patients after GAS. We believe this study corroborates the improvements made in regard to selection criteria for GAS. However, there is high subjectivity in the assessment of regret and lack of standardized questionnaires, which highlight the importance of developing validated questionnaires in this population.

Background:Transmasculine chest surgery is the most common surgery performed in transmasculine patients, with high overall acceptance and low postoperative complication rates. Trends have shown clear improvement in quality of life and satisfaction. However, to the best of our knowledge, overall patient satisfaction after transmasculine chest surgery and associated factors are largely unknown. The aim of this study is to estimate the overall patient satisfaction in transgender men and nonbinary population after transmasculine chest surgery and to assess associated factors.Methods:A systematic review was conducted by searching literature in several databases. Meta-analyses of prevalence with a random-effect model for overall and subgroup prevalence were performed. Meta-regression, publication bias, and sensitivity analyses were conducted.Results:A total of 1052 transmasculine patients underwent any type of transmasculine chest surgery. The pooled overall postoperative satisfaction was 92% [95% confidence interval (CI) 88–96%]. In the subgroup metanalysis, patient satisfaction after periareolar mastectomy was 93% (CI 88%–97%) and after mastectomy with or without free nipple grafting was 90% (CI 84%–95%). Patient satisfaction for studies with mean follow-up >1 year was 91% (CI 83%–97%) and for mean follow-up of 1 year or less was 93% (CI 89%–96%).Conclusions:This study shows a high level of satisfaction in transmasculine chest surgery for both techniques, which remain stable over time. Also, our results show that this procedure impacts patient satisfaction beyond chest appearance and surgical outcomes. This corroborates its broad acceptance and the improvements in the standard of care, and decision-making approach.

Background: Vaginoplasty aims to create a functional feminine vagina, sensate clitoris, and labia minora and majora with acceptable cosmesis. The upward trend in the number of transfemale vaginoplasties has impacted the number of published articles on this topic. Herein, we conducted an updated systematic review on complications and patient-reported outcomes. Methods: A update on our previous systematic review was conducted. Several databases including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus were assessed. Random effects meta-analysis and subgroup analyses were performed. Results: After compiling the results of the update with the previous systematic review, a total of 57 studies pooling 4680 cases were included in the systematic review, and 52 studies were used in the meta-analysis. Overall pooled data including any surgical technique showed rates of 1% [95% confidence interval (CI) <0.1%–2%] of fistula, 11% (95% CI 8%–14%) of stenosis and/or strictures, 4% (95% CI 1%–9%) of tissue necrosis, and 3% (95% CI 1%–4%) of prolapse. Overall satisfaction was 91% (81%–98%). Regret rate was 2% (95% CI <1%–3%). Average neovaginal depth was 9.4 cm (7.9–10.9 cm) for the penile skin inversion and 15.3 cm (13.8–16.7 cm) for the intestinal vaginoplasty. Conclusions: Transfemale vaginoplasty is a key component of the comprehensive surgical treatment of transfemale patients with gender dysphoria. Over time, we will see an increased demand for these procedures, so adequate surgical training, clinical/surgical experience, and research outcomes are required, as we continue to strive to provide the best care possible for a population in need.