A review of gender affirmation surgery: What we know, and what we need to know

Akhavan, Arya A.; Sandhu, S. S.; Ndem, Idorenyin; Ogunleye, Adeyemi A.

doi:10.1016/j.surg.2021.02.013

Cited by 62 publications

(49 citation statements)

References 42 publications

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“…FFS is very safe and has low complication rates, as delineated by this review. 4 While most studies described high satisfaction among patients, only half used validated PROMs, and overall data from these assessments was limited in detail. PROMs are crucial assessments of patient QOL, satisfaction, function, and perceived value of treatment, and are indicators of the life-ability of a person, which with FFS includes gender conformity and improved dysphoria.…”

Section: Discussionmentioning

confidence: 99%

“… 2 , 3 In this marginalized patient population, GAS has been shown to reduce gender dysphoria, depression, and suicidality—highlighting its significant impact on patient well-being. 4 , 5 …”

Section: Introductionmentioning

confidence: 99%

“… 4 It includes procedures such as chondrolaryngoplasty to reduce thyroid cartilage prominence, mandibular setback, genioplasty, rhinoplasty, facial implants, forehead cranioplasty, hairline advancement, and fronto-orbital reshaping. 3 , 4 FFS is often a pivotal step in the surgical journey of nonbinary and transgender patients, critical to achieving congruence between a person’s facial features and the physical expression of their gender identity. 3 As a highly visible area, facial misgendering is an exceedingly common problem with devastating impacts on a person’s daily experience.…”

Section: Introductionmentioning

confidence: 99%

“…GAS has been shown to significantly improve quality of life (QOL); however, there are disparities in how patient-reported outcomes are measured, and therefore it is difficult to understand which methods of FFS have high patient satisfaction and improve dysphoria. 4 , 8 …”

Section: Introductionmentioning

confidence: 99%

“…4,5 FFS describes craniomaxillofacial procedures that transform masculine-appearing features into more feminine-appearing structures. 4 It includes procedures such as chondrolaryngoplasty to reduce thyroid cartilage prominence, mandibular setback, genioplasty, rhinoplasty, facial implants, forehead cranioplasty, hairline advancement, and fronto-orbital reshaping. 3,4 FFS is often a pivotal step in the surgical journey of nonbinary and transgender patients, critical to achieving congruence between a person's facial features and the physical expression of their gender identity.…”

Section: Introductionmentioning

confidence: 99%

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Facial Feminization Surgery: A Systematic Review of Perioperative Surgical Planning and Outcomes

Tirrell

Hawa

Bekeny

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: Facial feminization is a critical step in a transfeminine patient's surgical transition. However, the existing literature on the various types of feminization surgeries suffers from inadequate reporting on perioperative aspects of care, such as preoperative evaluation and postoperative outcomes. The aim of this study is to evaluate facial feminization surgery (FFS), preoperative planning, and patient reported outcomes after various types of procedures. Methods: An electronic database search of Ovid MEDLINE was completed according to PRISMA guidelines for articles pertaining to FFS. Study characteristics, operative information, and patient demographics were collected. Data concerning preoperative imaging, virtual simulation, postoperative complications, and patientreported outcome measures (PROMs) were collected and analyzed for patterns. Results: A total of 22 papers representing 1302 patients were included for analysis. The most commonly discussed operations included upper face procedures, particularly of the forehead (17 studies, 77%). When discussed, preoperative planning for FFS included standard photography in 19 (86%) studies, advanced imaging, such as cephalometry or computed tomography, in 12 (55%) studies, and virtual simulation of surgical outcomes in four (18%) studies. Patient-centered outcomes, such as postoperative satisfaction, were described in 17 (77%) studies. Standardized PROMs were heterogenous across included studies with only 11 (50%) including at least one PROM. Conclusions: FFS is common, safe, and highly satisfying for transfeminine patients seeking surgical intervention for identity actualization. Future research concerning transgender care must evaluate advanced surgical planning and 3D simulation combined with more standardized assessment of PROMs to ensure high-quality analysis of patient satisfaction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Facial Feminization Surgery: A Systematic Review of Perioperative Surgical Planning and Outcomes

Tirrell

Hawa

Bekeny

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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National Estimates of Gender-Affirming Surgery in the US

Wright,

Chen,

Suzuki

et al. 2023

JAMA Netw Open

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ImportanceWhile changes in federal and state laws mandating coverage of gender-affirming surgery (GAS) may have led to an increase in the number of annual cases, comprehensive data describing trends in both inpatient and outpatient procedures are limited.ObjectiveTo examine trends in inpatient and outpatient GAS procedures in the US and to explore the temporal trends in the types of GAS performed across age groups.Design, Setting, and ParticipantsThis cohort study includes data from 2016 to 2020 in the Nationwide Ambulatory Surgery Sample and the National Inpatient Sample. Patients with diagnosis codes for gender identity disorder, transsexualism, or a personal history of sex reassignment were identified, and the performance of GAS, including breast and chest procedures, genital reconstructive procedures, and other facial and cosmetic surgical procedures, were identified.Main Outcome MeasuresWeighted estimates of the annual number of inpatient and outpatient procedures performed and the distribution of each class of procedure overall and by age were analyzed.ResultsA total of 48 019 patients who underwent GAS were identified, including 25 099 (52.3%) who were aged 19 to 30 years. The most common procedures were breast and chest procedures, which occurred in 27 187 patients (56.6%), followed by genital reconstruction (16 872 [35.1%]) and other facial and cosmetic procedures (6669 [13.9%]). The absolute number of GAS procedures rose from 4552 in 2016 to a peak of 13 011 in 2019 and then declined slightly to 12 818 in 2020. Overall, 25 099 patients (52.3%) were aged 19 to 30 years, 10 476 (21.8%) were aged 31 to 40, and 3678 (7.7%) were aged12 to 18 years. When stratified by the type of procedure performed, breast and chest procedures made up a greater percentage of the surgical interventions in younger patients, while genital surgical procedures were greater in older patients.Conclusions and RelevancePerformance of GAS has increased substantially in the US. Breast and chest surgery was the most common group of procedures performed. The number of genital surgical procedures performed increased with increasing age.

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Implementation of Patient-Reported Outcome Measures for Gender-Affirming Care Worldwide

et al. 2023

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ImportanceGender-affirming care is a key clinical area that can benefit from implementation of patient-reported outcome measures (PROMs). Identifying barriers to and enablers of PROM implementation is needed to develop an evidence-based implementation strategy.ObjectiveTo identify (1) PROMs previously implemented for gender-affirming care and constructs measured, (2) how patients completed PROMs and how results were reported and used, and (3) barriers to and enablers of PROM implementation.Evidence ReviewIn this systematic review, PubMed, Embase, MEDLINE, PsycINFO, CINAHL, and Web of Science were searched from inception to October 25, 2021, and updated on December 16, 2022. Gray literature was searched through gray literature database, online search engine, and targeted website searching. Inclusion criteria were (1) original articles of (2) a formally developed PROM or ad hoc instrument administered for gender-affirming care to (3) patients accessing gender-affirming care. The Critical Appraisal Skills Programme tool was used to evaluate quality of included studies. This review was registered on PROSPERO (CRD42021233080).FindingsIn total, 286 studies were included, representing 85 395 transgender and nonbinary patients from more than 30 countries. A total of 205 different PROMs were used in gender-affirming care. No studies described using an implementation science theory, model, or framework to support PROM deployment. Key barriers to PROM implementation included issues with evidence strength and quality of the PROM, engaging participants, and PROM complexity. Key enablers of PROM implementation included using PROMs validated for gender-affirming care, implementing PROMs able to be deployed online or in person, implementing PROMs that are shorter and reduce patient burden, engaging key stakeholders and participants as part of developing an implementation plan, and organizational climate.Conclusions and RelevanceIn this systematic review of barriers to and enablers of PROM implementation in gender-affirming care, PROM implementation was inconsistent and did not follow evidence-based approaches in implementation science. There was also a lack of patient input in creating implementation strategies, suggesting a need for patient-centered approaches to PROM implementation. Frameworks created from these results can be used to develop evidence-based PROM implementation initiatives for gender-affirming care and have potential generalizability for other clinical areas interested in implementing PROMs.

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A review of gender affirmation surgery: What we know, and what we need to know

Cited by 62 publications

References 42 publications

Facial Feminization Surgery: A Systematic Review of Perioperative Surgical Planning and Outcomes

Facial Feminization Surgery: A Systematic Review of Perioperative Surgical Planning and Outcomes

National Estimates of Gender-Affirming Surgery in the US

Implementation of Patient-Reported Outcome Measures for Gender-Affirming Care Worldwide

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