Figueroa, Nicole Sanchez

Background: Penile inversion vaginoplasty (PIV) is a common gender-affirming procedure for transgender women, but validated, transgender-specific patient-reported outcomes remain limited. This study evaluated long-term outcomes after PIV using the Post-Affirming Surgery Form and Function Individual Reporting Measure (AFFIRM), a validated instrument assessing appearance, urologic, and gynecologic domains. Methods: We conducted a single-institution retrospective cohort with a cross-sectional, anonymous AFFIRM survey distributed in 2024. Demographics, perioperative outcomes, and complications were obtained by chart review. AFFIRM domain scores, reported on a 0–200 scale with lower scores indicating better outcomes, were analyzed descriptively. Results: Of 193 eligible patients who underwent PIV between 2017 and 2023, surveys were delivered to 186 patients, and 47.8% responded. Median age at surgery was 34.3 years (interquartile range 26.1–49.1), with a median follow-up time of 50.0 months. Most respondents reported high satisfaction with genital appearance, and 90% strongly agreed their anatomy aligned with gender identity. Clitoral sensation was reported by 93%, most commonly as pleasurable. Urologic symptoms were generally minimally bothersome; although 59% reported a misdirected urine stream, mean bother score was low (1.64 ± 1.77). Vaginal dryness and dyspareunia were reported by 43% and 44%, respectively, with 27% describing symptoms as bothersome. Major complications occurred in 13.9% and revision surgery in 34.2%, most commonly for stenosis or depth concerns (13.5%). Conclusions: AFFIRM captured meaningful, transgender-specific, long-term outcomes after PIV, complementing traditional surgical metrics and identifying opportunities to improve preoperative counseling, surgical refinement, and postoperative management of vaginal dryness and urinary symptoms.

Purpose: To determine current dacryocystorhinostomy (DCR) practice patterns of American Society of Ophthalmic Plastic and Reconstructive Surgery members and identify surgeon and case-related factors impacting preference for endoscopic versus external DCR and the use of preoperative imaging. Methods: A cross-sectional web-based anonymous 16-question survey was distributed to 277 American Society of Ophthalmic Plastic and Reconstructive Surgery members enrolled in survey-based research. The survey assessed surgeons’ demographics, practice settings, surgical preferences, and imaging practices. Responses were summarized and compared using statistical tests for frequency distribution. Results: A total of 111 surgeons (40.0%) responded to the survey. Utilization of endoscopic DCR (endoDCR) was highly variable, with 57% of junior surgeons (<5 years in practice) using it for >66% of their cases, compared with only 18.3% of surgeons with >15 years postfellowship experience. High utilization of endoDCR (>66% of cases) was more common in academic surgeons compared with private practice (48.4% vs. 19.6%, p < 0.01). The most cited reasons for endoDCR were scar avoidance and revision surgery. For external DCR, anatomical barriers and concern for mass/need for biopsy were common indications. Most surgeons only order imaging for certain indications, such as prior sinonasal surgery, facial trauma, suspected tumor, or atypical presentation. Conclusion: Utilization of endoDCR was correlated with years in practice, with younger surgeons preferring the endoscopic technique. A large majority felt that the relevance of imaging is low in most patients. Future research is needed to standardize case-based indications for endoscopic versus external approaches and preoperative imaging.

Introduction Hypergranulation tissue (excess granulation tissue) is a common complication following penile inversion vaginoplasty (PIV). It often requires repeated treatment with silver nitrate using a speculum to access the neovagina. This study evaluates whether adding betamethasone suppositories to silver nitrate treatment improves the resolution of hypergranulation tissue after PIV. Methods A retrospective chart review was conducted on patients who received supplemental betamethasone suppositories in addition to silver nitrate treatment (betamethasone group) between 01/2023 and 12/2024 and matched to a cohort of patients treated with silver nitrate alone (silver nitrate group). Outcomes, number of treatments, and severity of hypergranulation tissue were compared using t tests for continuous variables and Fisher's exact tests for categorical variables. Results There were 16 patients in each group, with similar average follow-up times: 8.5 ± 5.5 months (silver nitrate group) and 7.8 ± 4.7 months (betamethasone group) ( P = 0.70). At the most recent follow-up, moderate and severe hypergranulation resolved more often in the betamethasone group (86%, 50%) than in the silver nitrate group (60%, 25%). Patients in the betamethasone group with moderate or severe hypergranulation tissue required fewer median treatments for resolution (2 vs 3.5 and 4 vs 5, respectively). After excluding cases that required cauterization under anesthesia, patients in the betamethasone group were significantly more likely to have resolution of their hypergranulation tissue compared to patients in the silver nitrate group ( P = 0.035). Conclusions Betamethasone is an effective addition to silver nitrate for the treatment of hypergranulation tissue, with our results indicating it can improve resolution and lessen treatment burden in patients' post-PIV.

Background: Development of ectropion is a frequently reported complication after reconstruction of infraorbital Mohs defects. This study aimed to characterize preoperative and surgical factors contributing to ectropion development in patients undergoing reconstruction after Mohs micrographic surgery. Methods: We conducted a retrospective single-center case-control study on patients undergoing reconstruction of Mohs micrographic surgery defects involving the nonmarginal lower eyelid and upper cheek from 2011 to 2023. Pre- and postoperative photographs were reviewed to confirm defect location and postreconstructive eyelid malposition. Ectropion risk factors were determined with uni- and multivariate odds ratio analyses. Results: A total of 202 patients were included, 45 cases in the ectropion group and 157 in the control group. Negative orbital vector (P = 0.02), recurrent disease (P = 0.01), and greater defects size (P = 0.007) were associated with postreconstructive ectropion. Ectropion was more likely after multidisciplinary reconstruction (13.3% versus 1.4%, P < 0.001) and reconstruction with cervicofacial flaps (28.9% versus 4.2%, P < 0.0005); and less likely after primary closure (8.9% versus 28.5%, P < 0.001). Multivariate assessment (odds ratio [95% confidence interval], P value) revealed that combined cheek and eyelid defect involvement (4.32 [1.36–13.6], P = 0.01), larger size (1.07 [1.03–1.13], P < 0.001), and negative orbital vector (12.11 [2.65–65.42], P = 0.002) were independent risk factors for ectropion development. Conclusions: Combined cheek/lower eyelid defects and negative orbital vector increase the risk of postreconstructive ectropion. These findings can be used to optimize surgical technique and counsel patients on increased likelihood of this complication with possible need for revision surgery.

Background: Penile inversion vaginoplasty (PIV) entails considerable soft-tissue dissection to the perineal region and involves complex tissue rearrangement. This study examines the role of an enhanced recovery after surgery (ERAS) pathway after PIV in reducing opioid use and controlling postoperative pain. Methods: A retrospective study of 50 transfemale patients who underwent PIV at a single institution from June 2021 to January 2023 was completed. The study compared 2 groups of patients who were given different postoperative pain management regimens: group A received standard postoperative analgesics and group B received ERAS. Variables such as postoperative pain scores on the numeric pain rating scale (0–10), use of opioid medication, length of hospital stay, and patient comorbidities were recorded and compared across the 2 groups. Results: The average hospital stay length was 4.92 (±0.85) days. Group A had a slightly longer average stay compared with group B. The average pain level in both groups was 4.25 (SD ±1.51). Group A exhibited a slightly higher average pain level of 4.31 (±1.53), whereas group B exhibited 4.16 (SD±1.51) (P = 0.77). Although pain levels did not significantly vary between the 2 groups, there was a statistically significant decrease in the amount of opioid medication used in group B with a P value of 0.009. Conclusions: ERAS protocol is effective in decreasing opioid usage in the immediate postoperative setting after PIV.

Abstract Background Implant-based breast augmentation is a gold standard procedure for transfeminine patients to create a more feminine-appearing chest. In many cases, ancillary procedures are performed simultaneously to achieve an optimal aesthetic result. Objectives To determine the clinical outcomes of patients undergoing feminizing gender-affirming breast surgery in a single academic institution. Methods A retrospective electronic chart review of feminizing gender-affirming breast surgery patients at Mayo Clinic, Rochester from 2017 to 2022 was conducted. Patients demographics and surgical outcomes were gathered. A survival analysis was performed to obtain the time-to-event complication rate. Results Over 5 years, 46 patients (92 breasts) were included. The mean age was 39 years (SD ±15), and most had an above-normal Body Mass Index (58.7%). Thirty (65%) had previous gender-affirming surgeries. The mean implant volume was 289 ml (SD ±95; 140 - 520). Most implants were placed in a subglandular plane (81%) with an inframammary fold incision (91.3%). All implants used were smooth round cohesive silicone gel implants. Ancillary procedures were performed in thirty-two patients (69.57%). Eight patients presented complications (4 major vs 4 minor) in a median postoperative follow-up of 372 vs 392 days; at 1-month follow-up, the probability of a complication to have occurred is 2.17% (95% CI: 0–6.3%) vs 5% (95% CI: 0–11.5%) and at 1 year is 10.21% (95% CI: 0–20.9%) vs 12.5% (95% CI: 0–23.4%) ​which remain the same up to 4 years. Conclusions Breast augmentation with implants is a safe procedure to achieve feminization of the breast with a low rate of complications.