Few Complications, 100% Satisfaction Reported in Female-to-Male Top Surgery

By Rob Goodier

March 06, 2020

NEW YORK (Reuters Health) - Chest reconstruction had no major complications for patients transitioning from female to male, and all of the patients reported satisfaction with the surgery, according to a review of 22 cases.

The findings appear to confirm the limited data from previous research, according to a presentation February 27 at the meeting of the American Academy of Cosmetic Surgery in Las Vegas, Nevada.

"This study was performed to validate existing data, and to educate the range of involved care providers about the potentially life-saving surgical options for care in this underserved population," the study's lead author, Dr. Courtney Caplin of Cosmetic Surgery Affiliates in Oklahoma City, told Reuters Health by email.

The patients ranged in age from 15 to 52 years, with an average of 27.8 years. More than 80% were on testosterone before surgery, and this was the first gender-transitioning surgery for all of them.

No major complications occurred and no revisions were requested. Pain was minimal, according to the researchers. There were two minor complications: a case of hypertrophic scarring and a case of hypo-pigmentation of the nipple.

Patients appeared to enter the procedure in high hopes. Most had pre-operative mental health counseling and the support of friends and family. Pre-operative surveys suggested "extreme optimism and hope for self-improvement," Dr. Caplin said. That optimism apparently was maintained after surgery, as all of the patients reported satisfaction and increased confidence.

"Universally, patients were highly appreciative and felt the surgery was life-changing as well as potentially life-saving," Dr. Caplin said.

The procedure is rewarding to patients and also to providers, she added. But it requires a multi-disciplinary team to care for the psychological and physical challenges of the transition.

Half of the patients said they would undergo a second gender-transitioning surgery. Cost appears to be an issue, however. More than one-third of the patients reported cost as a barrier to undergoing new procedures.

"I absolutely agree with the authors' conclusions that top surgery improves quality of life and has high satisfaction rates. Unfortunately, as the authors point out, there are still many barriers to care and surgery and this is a problem that needs to be addressed," Dr. Alexes Hazen, a reconstructive plastic surgeon at New York University's Langone Medical Center in New York, who was not involved in the research, told Reuters Health by email.

SOURCE: https://bit.ly/2wqX5u8 American Academy of Cosmetic Surgery, February 2020 and American Journal of Cosmetic Surgery, online December 24, 2019.

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