Improving Gender-Affirming Surgery Terminology: A Multicenter Patient Survey : Annals of Plastic Surgery

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Improving Gender-Affirming Surgery Terminology

A Multicenter Patient Survey

Makhoul, Alan T. BAa; Morrison, Shane D. MD, MSb; Mundra, Leela S. MDc; Kaoutzanis, Christodoulos MDc; Satterwhite, Thomas MDd; Winocour, Julian S. MDe; Al Kassis, Salam MDe; Drolet, Brian C. MDe,f

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Annals of Plastic Surgery 88(5):p S478-S480, June 2022. | DOI: 10.1097/SAP.0000000000003122



To promote patient safety and build trust, plastic surgeons must use patient-centered language when discussing gender-affirming surgery. However, the existing terminology has not been evaluated from a patient perspective. This study sought to understand how gender-affirming surgery patients from 3 US geographic regions perceive common terminology.


An anonymous, 24-item electronic survey was distributed to gender-affirming surgery patients seen in Tennessee, Colorado, and California. After institutional review board exemption, the survey instrument was pretested and piloted with gender-affirming surgery patients. Internal consistency was assessed by computation of Cronbach α (0.87).


A total of 306 participants completed the survey: 68 from a Tennessee academic center (response rate, 56%), 131 from a California private practice (response rate, 8%), and 107 from a Colorado academic center (response rate, 53%). A greater proportion of respondents felt the terms “top surgery” and “bottom surgery” were appropriate (83% and 82%, respectively) relative to “chest surgery” and “genital surgery” (41% and 30%, respectively). More respondents favored the phrase “gender-affirming surgery” than “gender-confirming surgery” (86% vs 67%). Nearly half (43%) perceived the phrase “sex reassignment surgery” as inappropriate. Most respondents (80%) preferred their surgeon ask for their pronouns.


Optimizing communication is an actionable way for plastic surgeons to improve the healthcare experiences of gender-affirming surgery patients. “Top surgery” and “bottom surgery” are favored terms, and “gender-affirming surgery” is the preferred name for this discipline. Language preferences should be openly discussed with each patient to ensure professional communication.

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