Imaging in Gender Affirmation Surgery

Hassan, Omar; Sun, Derek; Jha, Priyanka

doi:10.1007/s11934-020-01029-3

Cited by 8 publications

(14 citation statements)

References 32 publications

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“…Many respondents admitted to knowledge gaps regarding gender affirming surgery. 12,13 Radiologists and radiation oncologists need a basic understanding of potential complications for persons who have had breast augmentation, chest masculinization, metoidioplasty, phalloplasty, or neovaginal surgery--specifically, that postoperative complications may include hematomas, seromas, abscesses or fistulas, arterial or venous thrombosis, potential haemorrhage, strictures, stenosis, and diverticula and that MRI is preferred over CT for breast complications. 14 Breast hematoma, seroma, and abscess can be diagnosed through ultrasound and managed with percutaneous drainage.…”

Section: Discussionmentioning

confidence: 99%

Radiology and radiation oncology considerations for transgender and intersex patients: A qualitative study

et al. 2023

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Introduction:In this qualitative study, we explored experiences of radiologists and radiation oncologists in providing clinical care to transgender, gender diverse (TGD), and intersex patients by asking about comfort level, relevant past training and training gaps, and clinical recommendations for TGD and intersex patient care. Methods: A purposive sample of radiology and radiation oncology professionals (n = 16) from diverse practice settings were interviewed on a videoconferencing platform. Transcripts were auto-populated and checked manually for accuracy. Two coders used a mix of deductive and inductive coding to identify key themes. Member checking was conducted with interviewees. Results: Participants reported major gaps in training, knowledge, and confidence related to all aspects of TGD and intersex patient care. Recommendations for improvements included training that encompassed key terminology, how to conduct a physical exam on TGD and intersex patients, radiology and radiation oncology adaptations for TGD and intersex patients, and care coordination among multi-disciplinary oncology team members and gender affirming care providers. Exposure to diverse TGD and intersex persons in personal and professional life contributed to higher levels of comfort among providers in caring for TGD and intersex patients. Conclusion: Gaps in knowledge and limited confidence characterized the sample. Training at all levels is needed to improve radiology and radiation oncology care for TGD and intersex patients.

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Section: Discussionmentioning

confidence: 99%

Radiology and radiation oncology considerations for transgender and intersex patients: A qualitative study

et al. 2023

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“…Some articles have suggested the use of stretched penile length of 7–12 cm to determine the need of full‐thickness skin grafting 8,26 . Others report a goal‐oriented approach to achieve neovaginal length of about 8 cm 27 . In any case, the surgeon should assess the quality of the genital skin pre‐operatively to be used for reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Gender‐affirming vaginoplasty: Technical considerations in patients with genital skin deficiency

Huang

Lai

Morgantini

et al. 2022

Neurourology and Urodynamics

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Introduction: Gender dysphoria affects over 1 million American adults. Vaginoplasty is a critical step in gender affirmation, and many patients have insufficient genital skin for full-depth penile inversion vaginoplasty (PIV). We reviewed the literature for technical considerations addressing this and present our data supporting the use of peritoneal flaps (Davydov technique). Materials and Methods:A comprehensive review of modern literature was conducted. Second, we present a retrospective case review of our experience with PIV, including data from procedures utilizing peritoneal flaps. Results: We identified 20 original articles, including retrospective and prospective case and cohort studies. Approaches included the application of local soft tissue grafts and flaps, peritoneal flaps, and intestinal segments. Between June 2018 and February 2021, 47 patients at our institution, underwent PIV for the treatment of gender dysphoria. Nineteen of those patients underwent robotic-assisted peritoneal flap procedure in addition to PIV. In this cohort, the mean follow-up was 200.6 ± 124.8 days. Mean neovaginal depth was 13.1 ± 3.0 cm intra-operatively and 11.0 cm at the last follow-up. Twenty-six percent of complications were Clavien Grade 1 or 2; others included wound dehiscence (30.4%), perianal and urethral fistula (13.0%), and neovaginal stenosis (8.7%). The majority of patients reported satisfactory results in terms of sexual function with intact tactile and erogenous sensation. Almost half were able to have penetrative vaginal intercourse at the last follow-up. We did not aim to perform statistical calculations to compare the outcomes of PIV with and without robotic-assisted peritoneal flap augmentation, as the groups were not constructed in that manner. However, it is evident that anatomical and functional results as well as the distribution of postoperative complications seem similar. Conclusion:Vaginoplasty is indicated in a growing population of patients with a wide range of medical histories and anatomic variations. Genitourinary reconstructive surgeons must have several methods to achieve full-depth Neurourol Urodyn.

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“…Breast and chest reconstructions are also crucial components of an individual's treatment for gender dysphoria [12]. Nevertheless, insurance coverage for such procedures is insufficient.…”

Section: Chest Reconstructionmentioning

confidence: 99%

“…Nevertheless, insurance coverage for such procedures is insufficient. In 2020, Blasdel et al analyzed 150 insurance companies in the United States and determined that chest masculinization, chest feminization, and nipple-areola complex reconstruction were covered by 98%, 29%, and 20% of the companies, respectively [12]. The lower coverage rate for chest feminization procedures is because about 75% of health insurers do not deem the procedure to be medically necessary [12].…”

Section: Chest Reconstructionmentioning

confidence: 99%

“…In 2020, Blasdel et al analyzed 150 insurance companies in the United States and determined that chest masculinization, chest feminization, and nipple-areola complex reconstruction were covered by 98%, 29%, and 20% of the companies, respectively [12]. The lower coverage rate for chest feminization procedures is because about 75% of health insurers do not deem the procedure to be medically necessary [12]. Insurance companies have also asserted this procedure to be the equivalent of cosmetic breast enlargement procedures in cisgender women and thus continue to deny coverage for transgender patients [2].…”

Section: Chest Reconstructionmentioning

confidence: 99%

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Journeying Through the Hurdles of Gender-Affirming Care Insurance: A Literature Analysis

Patel¹,

Camacho²,

Salehi³

et al. 2023

Cureus

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Gender-affirming surgery (GAS) has been proven to be successful in the treatment of gender dysphoria. The benefits of providing insurance coverage for transition-related surgeries far surpass the costs of suffering from persistent gender dysphoria, including many positive health outcomes such as decreased rates of substance use, psychiatric illness, and suicide. Despite being deemed a medical necessity, discrepancies in access to treatment and insurance coverage for GAS persist. The purpose of this review is to understand the impact of limited insurance coverage on the well-being of transgender patients. A comprehensive search was conducted utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in SCOPUS and PubMed databases using the terms "insurance" AND "gender affirming surgery." Articles in non-English languages were excluded. Data related to variations in insurance coverage for GAS in the United States were collected. Of the 67 articles reviewed, 29 met the inclusion criteria. When compared to the general population, individuals who identify as transgender have higher rates of being uninsured as of 2020, with only 30 states in the United States providing insurance coverage for transgender and gender nonbinary people. Of the 30 states, only 18 provide coverage for GAS, with chondrolaryngoplasty having the highest prevalence of coverage. As evidenced in our review, the persistence of complex insurance regulations impedes transgender individuals' access to equitable care. Overall, this literature review elucidates the variability in insurance coverage as it relates to gender-affirming care. Furthermore, this review highlights the need for additional health policy reforms, in addition to improving physician awareness regarding the hurdles of navigating the insurance world as a transgender patient.

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Imaging in Gender Affirmation Surgery

Cited by 8 publications

References 32 publications

Radiology and radiation oncology considerations for transgender and intersex patients: A qualitative study

Radiology and radiation oncology considerations for transgender and intersex patients: A qualitative study

Gender‐affirming vaginoplasty: Technical considerations in patients with genital skin deficiency

Journeying Through the Hurdles of Gender-Affirming Care Insurance: A Literature Analysis

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