Reconstructive Surgery

Long-term Outcomes After Gender-Affirming Surgery

40-Year Follow-up Study

Park, Rachel H. MD^a; Liu, Yi-Ting BA^b; Samuel, Ankhita MD^a; Gurganus, Margot MD^c; Gampper, Thomas J. MD^a; Corbett, Sean T. MD^d; Shahane, Amit PhD^e; Stranix, John T. MD^a

Author Information

From the ^aDepartment of Plastic and Reconstructive Surgery

^bSchool of Medicine

^cDepartment of Obstetrics and Gynecology

^dDepartment of Urology

^eDepartment of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA.

Received December 6, 2021, and accepted for publication, after revision March 27, 2022.

Conflicts of interest and sources of funding: none declared.

Submitted for 2022 Plastic Surgery Research Council Meeting, decision pending.

Reprints: John T. Stranix, MD, Department of Plastic Surgery, UVA Health, 1300 Jefferson Park Ave, 4th Floor, Charlottesville, VA 22903. E-mail: [email protected].

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.annalsplasticsurgery.com).

Annals of Plastic Surgery 89(4):p 431-436, October 2022. | DOI: 10.1097/SAP.0000000000003233

Abstract

Background

Gender dysphoria is a condition that often leads to significant patient morbidity and mortality. Although gender-affirming surgery (GAS) has been offered for more than half a century with clear significant short-term improvement in patient well-being, few studies have evaluated the long-term durability of these outcomes.

Methods

Chart review identified 97 patients who were seen for gender dysphoria at a tertiary care center from 1970 to 1990 with comprehensive preoperative evaluations. These evaluations were used to generate a matched follow-up survey regarding their GAS, appearance, and mental/social health for standardized outcome measures. Of 97 patients, 15 agreed to participate in the phone interview and survey. Preoperative and postoperative body congruency score, mental health status, surgical outcomes, and patient satisfaction were compared.

Results

Both transmasculine and transfeminine groups were more satisfied with their body postoperatively with significantly less dysphoria. Body congruency score for chest, body hair, and voice improved significantly in 40 years' postoperative settings, with average scores ranging from 84.2 to 96.2. Body congruency scores for genitals ranged from 67.5 to 79 with free flap phalloplasty showing highest scores. Long-term overall body congruency score was 89.6. Improved mental health outcomes persisted following surgery with significantly reduced suicidal ideation and reported resolution of any mental health comorbidity secondary to gender dysphoria.

Conclusion

Gender-affirming surgery is a durable treatment that improves overall patient well-being. High patient satisfaction, improved dysphoria, and reduced mental health comorbidities persist decades after GAS without any reported patient regret.