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[PMID]:28841608
[Au] Autor:van de Grift TC; Elfering L; Bouman MB; Buncamper ME; Mullender MG
[Ad] Endereço:Amsterdam, The Netherlands From the Department of Plastic, Reconstructive, and Hand Surgery and the Department of Medical Psychology, Center of Expertise on Gender Dysphoria, VU University Medical Center.
[Ti] Título:Surgical Indications and Outcomes of Mastectomy in Transmen: A Prospective Study of Technical and Self-Reported Measures.
[So] Source:Plast Reconstr Surg;140(3):415e-424e, 2017 Sep.
[Is] ISSN:1529-4242
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Although transgender surgery constitutes a growing field within plastic surgery, prospective studies on masculinizing mastectomies are lacking. The objectives of the present study were to prospectively follow a cohort of transmen undergoing mastectomy to assess technical and self-reported outcomes and to evaluate surgical decision-making. METHODS: Fifty-four transmen were recruited during a 10-month period at the Department of Plastic Surgery of the Centre of Expertise on Gender Dysphoria. Preoperative assessment included standardized chest examination. Six months postoperatively, participants rated their satisfaction with surgery, and 12-month postoperative surgical outcomes were reviewed independently. Surgical decision-making was evaluated by comparing indications and outcomes per technique, and assessing the clinical validity of the most-used decision aid (using the Cohen's kappa statistic). RESULTS: One periareolar mastectomy, 26 concentric circular mastectomies, and 22 inframammary skin resections with free nipple graft were performed in the authors' cohort. Five participants were still to be operated on. Concentric circular mastectomy was performed in smaller or medium-size breasts with low ptosis grade and good elasticity, whereas the inframammary skin resection group showed a wider range of physical characteristics. Despite being performed in better quality breasts, concentric circular mastectomy was associated with more secondary corrections (38.5 percent), dehiscence, seroma, and lower postoperative satisfaction compared with inframammary skin resections. Clinical decision-making was generally in line with the published decision aid. CONCLUSIONS: Compared with inframammary skin resections, concentric circular mastectomy-despite being performed in favorable breast types-appears to produce poorer technical and self-reported outcomes. Surgical indications and preoperative counseling regarding secondary corrections may therefore be subject to improvement. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
[Mh] Termos MeSH primário: Mastectomia/métodos
Cirurgia de Readequação Sexual/métodos
Transexualismo
[Mh] Termos MeSH secundário: Adolescente
Adulto
Feminino
Seres Humanos
Masculino
Meia-Idade
Satisfação do Paciente
Estudos Prospectivos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170918
[Lr] Data última revisão:
170918
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170826
[St] Status:MEDLINE
[do] DOI:10.1097/PRS.0000000000003607


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[PMID]:28641936
[Au] Autor:Papadopulos NA; Zavlin D; Lellé JD; Herschbach P; Henrich G; Kovacs L; Ehrenberger B; Machens HG; Schaff J
[Ad] Endereço:Department of Plastic and Hand Surgery, University Hospital Rechts der Isar, Munich Technical University, Munich, Germany; Department of Plastic Surgery and Burns, Alexandroupoli University Hospital, Democritus University of Thrace, School of Medicine, Alexandroupoli, Greece. Electronic address: nik
[Ti] Título:Combined vaginoplasty technique for male-to-female sex reassignment surgery: Operative approach and outcomes.
[So] Source:J Plast Reconstr Aesthet Surg;70(10):1483-1492, 2017 Oct.
[Is] ISSN:1878-0539
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Several therapy options exist for male-to-female (MTF) transgenders desiring sex reassignment. Surgery includes numerous different procedures. Of those, vaginoplasty is predominant and aims at providing attractive esthetics and fully functional genitals. This study aimed to present the surgical results of our modified combined vaginoplasty technique in a consecutive patient cohort. METHODS: We included 40 MTF transgender patients who underwent a two-stage sex reassignment surgery (SRS) in an observational prospective study between September 2012 and January 2014. Demographic characteristics, medical and surgical history, operative details, and outcomes after surgery were documented. Postoperatively, 23 patients received a pelvic examination following the standardized protocol. RESULTS: Measured vaginal depth was 11.77-14.99 cm depending on the size of the dilator used (25-40 mm). Vaginal, clitoral, and labial sensitivities were intact and favorable in all examined patients. Nineteen women (47.5%) opted for breast augmentations to achieve a feminine cosmesis, making it the most common nongenital operation. Complications were mostly minor and temporary. Severe adverse events, such as wound infections (n = 3), colon injuries (3), short (1) or narrow (1) vaginas, or partial clitoral necroses (1), were rare and immediately addressed by the surgical team. No vaginal construction was lost, and no secondary reconstructive approaches were required. CONCLUSION: Satisfactory physical results and favorable low rates of complications endorse our combined technique for MTF SRS. These findings, however, need to be confirmed by other research groups as well. Therefore, in our opinion, MTF SRS remains an evolving area of development, whose research is aiming to establish a state-of-the-art surgical technique.
[Mh] Termos MeSH primário: Complicações Pós-Operatórias
Procedimentos Cirúrgicos Reconstrutivos
Cirurgia de Readequação Sexual
Vagina/cirurgia
[Mh] Termos MeSH secundário: Adulto
Estudos de Coortes
Demografia
Estética
Feminino
Seres Humanos
Masculino
Avaliação de Resultados da Assistência ao Paciente
Complicações Pós-Operatórias/classificação
Complicações Pós-Operatórias/diagnóstico
Complicações Pós-Operatórias/epidemiologia
Estudos Prospectivos
Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos
Procedimentos Cirúrgicos Reconstrutivos/métodos
Cirurgia de Readequação Sexual/efeitos adversos
Cirurgia de Readequação Sexual/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170928
[Lr] Data última revisão:
170928
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170624
[St] Status:MEDLINE


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[PMID]:28587891
[Au] Autor:Vargas CR; Ricci JA; Lee M; Tobias AM; Medalie DA; Lee BT
[Ad] Endereço:Department of Plastic Surgery, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio.
[Ti] Título:The accessibility, readability, and quality of online resources for gender affirming surgery.
[So] Source:J Surg Res;217:198-206, 2017 Sep.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The transgender population is disproportionally affected by health disparities related to access to care. In many communities, transgender specialists are geographically distant and locally available medical professionals may be unfamiliar with unique needs of transgender patients. As a result, use of Internet resources for information about gender affirming surgery is particularly important. This study simulates a patient search for online educational material about gender affirming surgery and evaluates the accessibility, readability, and quality of the information. METHODS: An Internet search for the term "transgender surgery" was performed, and the first 10 relevant hits were identified. Readability was assessed using 10 established tests: Coleman-Liau, Flesch-Kincaid, FORCAST, Fry, Gunning Fog, New Dale-Chall, New Fog Count, Raygor Estimate, Simple Measure of Gobbledygook, and Flesch Reading Ease. Quality was assessed using Journal of the American Medical Association criteria and the DISCERN instrument. RESULTS: Review of 69 results was required to identify 10 sites with relevant patient information. There were 97 articles collected; overall mean reading level was 14.7. Individual Web site reading levels ranged from 12.0 to 17.5. All articles and Web sites exceeded the recommended sixth grade level. Quality ranged from 0 to 4 (Journal of the American Medical Association) and 35 to 79 (DISCERN) across Web sites. CONCLUSIONS: Web sites with relevant patient information about gender affirming surgery were difficult to identify from search results. The content of these sites universally exceeded the recommended reading level. A wide range of Web site quality was noted, and this may further complicate successful navigation. Barriers in access to appropriately written patient information on the Internet may contribute to disparities in referral, involvement, satisfaction, and outcomes.
[Mh] Termos MeSH primário: Internet/estatística & dados numéricos
Cirurgia de Readequação Sexual
[Mh] Termos MeSH secundário: Acesso à Informação
Compreensão
Feminino
Seres Humanos
Masculino
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171003
[Lr] Data última revisão:
171003
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170608
[St] Status:MEDLINE


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[PMID]:28499524
[Au] Autor:Stojanovic B; Bizic M; Bencic M; Kojovic V; Majstorovic M; Jeftovic M; Stanojevic D; Djordjevic ML
[Ad] Endereço:University Children's Hospital, Belgrade, Belgrade, Serbia.
[Ti] Título:One-Stage Gender-Confirmation Surgery as a Viable Surgical Procedure for Female-to-Male Transsexuals.
[So] Source:J Sex Med;14(5):741-746, 2017 May.
[Is] ISSN:1743-6109
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Female-to-male gender-confirmation surgery (GCS) includes removal of breasts and female genitalia and complete genital and urethral reconstruction. With a multidisciplinary approach, these procedures can be performed in one stage, avoiding multistage operations. AIM: To present our results of one-stage sex-reassignment surgery in female-to-male transsexuals and to emphasize the advantages of single-stage over multistage surgery. METHODS: During a period of 9 years (2007-2016), 473 patients (mean age = 31.5 years) underwent metoidioplasty. Of these, 137 (29%) underwent simultaneous hysterectomy, and 79 (16.7%) underwent one-stage GCS consisting of chest masculinization, total transvaginal hysterectomy with bilateral adnexectomy, vaginectomy, metoidioplasty, urethral lengthening, scrotoplasty, and implantation of bilateral testicular prostheses. All surgeries were performed simultaneously by teams of experienced gynecologic and gender surgeons. OUTCOMES: Primary outcome measurements were surgical time, length of hospital stay, and complication and reoperation rates compared with other published data and in relation to the number of stages needed to complete GCS. RESULTS: Mean follow-up was 44 months (range = 10-92). Mean surgery time was 270 minutes (range = 215-325). Postoperative hospital stay was 3 to 6 days (mean = 4). Complications occurred in 20 patients (25.3%). Six patients (7.6%) had complications related to mastectomy, and one patient underwent revision surgery because of a breast hematoma. Two patients underwent conversion of transvaginal hysterectomy to an abdominal approach, and subcutaneous perineal cyst, as a consequence of colpocleisis, occurred in nine patients. There were eight complications (10%) from urethroplasty, including four fistulas, three strictures, and one diverticulum. Testicular implant rejection occurred in two patients and testicular implant displacement occurred in one patient. CLINICAL IMPLICATIONS: Female-to-male transsexuals can undergo complete GCS, including mastectomy, hysterectomy, oophorectomy, vaginectomy, and metoidioplasty with urethral reconstruction as a one-stage procedure without increased surgical risks and complication rates. STRENGTHS AND LIMITATIONS: To our knowledge, this is the largest cohort on this topic so far, with good surgical outcomes. Limitations include lack of selection or exclusion criteria and lack of other studies with a simple approach. For this reason, the technique should be studied further and compared with other techniques for female-to-male surgery before it can be recommended as an alternative procedure. CONCLUSIONS: Through a multidisciplinary approach of experienced teams, one-stage GCS presents a safe, viable, and time- and cost-saving procedure. Complication rates do not differ from reported rates in multistage surgeries. Stojanovic B, Bizic M, Bencic M, et al. One-Stage Gender-Confirmation Surgery as a Viable Surgical Procedure for Female-to-Male Transsexuals. J Sex Med 2017;14:741-746.
[Mh] Termos MeSH primário: Complicações Pós-Operatórias/epidemiologia
Cirurgia de Readequação Sexual/efeitos adversos
Transexualismo/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Feminino
Seres Humanos
Tempo de Internação
Masculino
Duração da Cirurgia
Reoperação/estatística & dados numéricos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171023
[Lr] Data última revisão:
171023
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170514
[St] Status:MEDLINE


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[PMID]:28403322
[Au] Autor:Schneider MA; Andreazza T; Fontanari AM; Costa AB; Silva DC; Aguiar BW; Massuda R; Pedrini M; Gama CS; Schwarz K; Kauer-Sant'Anna M; Lobato MI
[Ad] Endereço:Programa de Identidade de Gênero (Protig), Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
[Ti] Título:Serum concentrations of brain-derived neurotrophic factor in patients diagnosed with gender dysphoria undergoing sex reassignment surgery.
[So] Source:Trends Psychiatry Psychother;39(1):43-47, 2017 Jan-Mar.
[Is] ISSN:2238-0019
[Cp] País de publicação:Portugal
[La] Idioma:eng
[Ab] Resumo:Introduction:: Transsexualism (ICD-10) is a condition characterized by a strong and persistent dissociation with one's assigned gender. Sex reassignment surgery (SRS) and hormone therapy provide a means of allowing transsexual individuals to feel more congruent with their gender and have played a major role in treatment over the past 70 years. Brain-derived neurotrophic factor (BDNF) appears to play a key role in recovery from acute surgical trauma and environmentally mediated vulnerability to psychopathology. We hypothesize that BDNF may be a biomarker of alleviation of gender incongruence suffering. Objectives:: To measure preoperative and postoperative serum BDNF levels in transsexual individuals as a biomarker of alleviation of stress related to gender incongruence after SRS. Methods:: Thirty-two male-to-female transsexual people who underwent both surgery and hormonal treatment were selected from our initial sample. BDNF serum levels were assessed before and after SRS with sandwich enzyme linked immunosorbent assay (ELISA). The time elapsed between the pre-SRS and post-SRS blood collections was also measured. Results:: No significant difference was found in pre-SRS or post-SRS BDNF levels or with relation to the time elapsed after SRS when BDNF levels were measured. Conclusion:: Alleviation of the suffering related to gender incongruence after SRS cannot be assessed by BDNF alone. Surgical solutions may not provide a quick fix for psychological distress associated with transsexualism and SRS may serve as one step toward, rather than as the conclusion of, construction of a person's gender identity.
[Mh] Termos MeSH primário: Fator Neurotrófico Derivado do Encéfalo/sangue
Disforia de Gênero/sangue
Cirurgia de Readequação Sexual
Estresse Psicológico/sangue
Transexualismo/sangue
[Mh] Termos MeSH secundário: Adulto
Biomarcadores/sangue
Análise Química do Sangue
Ensaio de Imunoadsorção Enzimática
Feminino
Disforia de Gênero/tratamento farmacológico
Disforia de Gênero/psicologia
Disforia de Gênero/cirurgia
Infecções por HIV/sangue
Infecções por HIV/complicações
Terapia de Reposição Hormonal
Seres Humanos
Masculino
Período Pós-Operatório
Período Pré-Operatório
Estudos Prospectivos
Estresse Psicológico/etiologia
Pessoas Transgênero/psicologia
Transexualismo/tratamento farmacológico
Transexualismo/psicologia
Transexualismo/cirurgia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); 0 (Brain-Derived Neurotrophic Factor); 0 (brain-derived neurotrophic factor, human)
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170419
[Lr] Data última revisão:
170419
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170414
[St] Status:MEDLINE


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[PMID]:28402247
[Au] Autor:Baker KE
[Ad] Endereço:From the Johns Hopkins Bloomberg School of Public Health, Baltimore; and the Center for American Progress, Washington, DC.
[Ti] Título:The Future of Transgender Coverage.
[So] Source:N Engl J Med;376(19):1801-1804, 2017 May 11.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Cobertura do Seguro/legislação & jurisprudência
Seguro Saúde/legislação & jurisprudência
Procedimentos de Readequação Sexual/economia
Pessoas Transgênero
[Mh] Termos MeSH secundário: Feminino
Disforia de Gênero/economia
Disforia de Gênero/psicologia
Disforia de Gênero/terapia
Seres Humanos
Cobertura do Seguro/economia
Masculino
Cirurgia de Readequação Sexual/economia
Cirurgia de Readequação Sexual/legislação & jurisprudência
Sexismo/legislação & jurisprudência
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170601
[Lr] Data última revisão:
170601
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170413
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMp1702427


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[PMID]:28366591
[Au] Autor:Papadopulos NA; Lellé JD; Zavlin D; Herschbach P; Henrich G; Kovacs L; Ehrenberger B; Kluger AK; Machens HG; Schaff J
[Ad] Endereço:Department of Plastic and Hand Surgery, University Hospital Rechts der Isar, Munich Technical University, Munich, Germany; Department of Plastic Surgery and Burns, Alexandroupoli University General Hospital, Democritus University of Thrace, Alexandroupoli, Greece. Electronic address: nikolaos.papado
[Ti] Título:Quality of Life and Patient Satisfaction Following Male-to-Female Sex Reassignment Surgery.
[So] Source:J Sex Med;14(5):721-730, 2017 May.
[Is] ISSN:1743-6109
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Surveys on quality of life (QOL) of male-to-female (MTF) transsexuals have found low QOL scores before and increased satisfaction scores after sex-reassignment surgery (SRS). To our knowledge, many of them lack standardized questionnaires and comparisons with normative data to evaluate different vaginoplasty techniques. AIM: To analyze patient satisfaction and QOL after SRS. METHODS: Forty-seven patients participated in this study. All patients had surgery with our self-developed combined technique on average 19 months before the survey. They completed a self-developed indication-specific questionnaire concerning demographic and socioeconomic issues and postoperative satisfaction. Furthermore, a standardized self-assessment questionnaire on satisfaction and QOL (Fragen zur Lebenszufriedenheit [FLZ ]; Questions on Life Satisfaction ) was used. The FLZ consists of three modules (general life satisfaction, satisfaction with health, and satisfaction with body image) with scores of weighted satisfaction for each item. Results of the general and health modules were compared with normative data. OUTCOMES: Demographics, QOL, general life satisfaction, satisfaction with health, and satisfaction with body image. RESULTS: The self-developed indication-specific questionnaire showed that 91% experienced an improvement of QOL. All patients stated they would undergo SRS again and did not regret it at all. Patients stated their femininity significantly increased. For the FLZ , the sum score for general life satisfaction (P < .001) was significantly lower than the normative data, whereas the sum score of the satisfaction with health module (P = .038) did not reach statistical significance. The two modules also showed positive trends for different items. Values of the body image module showed a significant increase in satisfaction with breasts (P < .001) and genitals (P = .002). CLINICAL IMPLICATIONS: The findings of this survey emphasize the importance of SRS in the interdisciplinary gender-reassignment process. The detailed description of our combined technique could help to improve the surgical outcome and patient satisfaction of this complex and non-standardized surgery. STRENGTHS AND LIMITATIONS: This is the first description of a new surgical technique (combined technique) for MTF SRS. QOL was assessed by a large number of patients by standardized questionnaires and could be compared with normative data. Because this is a retrospective study, we can draw only careful conclusions for pre- and postoperative changes. CONCLUSION: Our self-developed combined surgical technique seemed to have a positive influence on QOL after SRS. Satisfaction with breasts, genitals, and femininity increased significantly and show the importance of surgical treatment as a key therapeutic option for MTF transsexuals. Papadopulos NA, Lellé J-D, Zavlin D, et al. Quality of Life and Patient Satisfaction Following Male-to-Female Sex Reassignment Surgery. J Sex Med 2017;14:721-730.
[Mh] Termos MeSH primário: Satisfação do Paciente
Qualidade de Vida/psicologia
Cirurgia de Readequação Sexual/psicologia
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
Fatores Socioeconômicos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171023
[Lr] Data última revisão:
171023
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170404
[St] Status:MEDLINE


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[PMID]:28350659
[Au] Autor:Deschamps-Braly JC; Sacher CL; Fick J; Ousterhout DK
[Ad] Endereço:San Francisco, Calif. From private practice, California Pacific Medical Center, University of California, San Francisco Benioff Children's Hospital Oakland, and the University of California, San Francisco Center for Craniofacial Anomalies.
[Ti] Título:First Female-to-Male Facial Confirmation Surgery with Description of a New Procedure for Masculinization of the Thyroid Cartilage (Adam's Apple).
[So] Source:Plast Reconstr Surg;139(4):883e-887e, 2017 Apr.
[Is] ISSN:1529-4242
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Although male-to-female transgender patients commonly seek facial feminization surgery, facial masculinization surgery in the female-to-male transgender population is unreported in the literature. This report documents the first known female-to-male facial masculinization surgery, including a new technique for creating an "Adam's apple" to enhance the facial masculine appearance of a natal female. The authors "reversed" the methods typically used to feminize male facial features, and modified the forehead, nose, and chin to masculinize the patient's natal female facial features. The authors devised a novel technique to augment the thyroid cartilage using autologous rib cartilage to create a visible Adam's apple. Initially, masculinization of the chin was accomplished with a multisegment chin osteotomy with grafts to vertically expand and widen the chin along with correcting pronounced microgenia. Subsequently, a second facial masculinization procedure was performed to masculinize the forehead, nose, and thyroid cartilage. Rib cartilage was harvested and carved into an appropriately shaped thyroid cartilage onlay graft and then attached and integrated with the native thyroid cartilage, creating a fully mobile cartilage that translocates up and down with swallowing and a visible Adam's apple. Previously described techniques to masculinize the facial features of natal male patients were adapted to masculinize the female-to-male patient. Those procedures were combined with the novel technique to create a visually perceptible and naturally mobile Adam's apple in the female-to-male transsexual patient. Collectively, these described procedures can now provide most female-to-male transsexual patients with a satisfying transformation of their facial features. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
[Mh] Termos MeSH primário: Cartilagem Costal/transplante
Face/cirurgia
Procedimentos Cirúrgicos Reconstrutivos/métodos
Cirurgia de Readequação Sexual/métodos
Cartilagem Tireóidea/cirurgia
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170601
[Lr] Data última revisão:
170601
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170329
[St] Status:MEDLINE
[do] DOI:10.1097/PRS.0000000000003185


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[PMID]:28350658
[Au] Autor:Bluebond-Langner R; Berli JU; Sabino J; Chopra K; Singh D; Fischer B
[Ad] Endereço:Baltimore, Annapolis, and Timonium, Md.; and Portland, Ore. From the Division of Plastic Surgery, University of Maryland School of Medicine; Anne Arundel Medical Center; Advanced Center for Plastic Surgery; and Oregon Health & Science University.
[Ti] Título:Top Surgery in Transgender Men: How Far Can You Push the Envelope?
[So] Source:Plast Reconstr Surg;139(4):873e-882e, 2017 Apr.
[Is] ISSN:1529-4242
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The authors present their grading scale and the outcomes of the largest cohort of top surgery published to date. Application of this grading system can help determine which patients will benefit from a subcutaneous mastectomy with free nipple graft versus a circumareolar technique, with the primary endpoint being need for aesthetic revisions. METHODS: The authors reviewed their database of transgender males who underwent bilateral mastectomy between 2006 and 2015. Data collected included age, body mass index, American Society of Anesthesiologists class, smoking, diabetes, testosterone use, months of social transition, technique used, postoperative complications, and need for revision. Two techniques were used, circumareolar incision and free nipple graft technique. RESULTS: Between 2006 and 2015, 1686 consecutive mastectomies were performed on 843 patients. Of those, 548 patients were excluded because of inadequate follow-up. Of the 295 included, 109 were treated using a circumareolar incision and 186 were treated using a free nipple graft technique. There was no statistically significant difference in complications between the two groups; however, there was a statistically significant difference in the rate of aesthetic revisions in the grade 2B circumareolar incision group (34 percent versus 8.8 percent). CONCLUSIONS: The authors' outcomes are comparable to the literature, and demonstrate that these procedures can safely be performed in an outpatient setting. The authors' grading scale classifies patients and helps the surgeon select a surgical technique. The authors show a statistical difference in rates of aesthetic revisions in Fischer grade 2B patients when a circumareolar incision is selected over a free nipple graft technique. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
[Mh] Termos MeSH primário: Mastectomia/métodos
Mamilos/transplante
Cirurgia de Readequação Sexual/métodos
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Masculino
Complicações Pós-Operatórias/epidemiologia
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170601
[Lr] Data última revisão:
170601
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170329
[St] Status:MEDLINE
[do] DOI:10.1097/PRS.0000000000003225


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[PMID]:28272274
[Au] Autor:Buncamper ME; Van der Sluis WB; Bouman MB; Smit JM; Ozer M; Mullender MG
[Ad] Endereço:Department of Plastic, Reconstructive, and Hand Surgery, VU Medical Centre, Amsterdam, The Netherlands.
[Ti] Título:Reply: Surgical Outcome after Penile Inversion Vaginoplasty: A Retrospective Study of 475 Transgender Women.
[So] Source:Plast Reconstr Surg;140(1):237e, 2017 07.
[Is] ISSN:1529-4242
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos em Ginecologia
Pessoas Transgênero
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Masculino
Pênis/cirurgia
Estudos Retrospectivos
Cirurgia de Readequação Sexual
Vagina/cirurgia
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170810
[Lr] Data última revisão:
170810
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170309
[St] Status:MEDLINE
[do] DOI:10.1097/PRS.0000000000003487



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