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Outcomes and Predictors of Revision Labiaplasty and Clitoroplasty after Gender-Affirming Genital Surgery

Boas, Samuel R BS,*; Ascha, Mona MD MS,*; Morrison, Shane D MD; Massie, Jonathan P BM; Nolan, Ian T BA; Shen, Jacson K MD, PhD, MHS; Vyas, Krishna S MD; Satterwhite, Thomas MD

Plastic and Reconstructive Surgery: August 30, 2019 - Volume PRS Online First - Issue - p
doi: 10.1097/PRS.0000000000006282
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Background: Penile inversion vaginoplasty is the most common genital-affirming procedure for transfeminine patients. Patients undergoing this procedure may require revision labiaplasty and clitoroplasty. This study describes complications and outcomes from the largest reported cohort in the United States to undergo penile inversion vaginoplasty with subsequent revision labiaplasty and/or clitoroplasty.

Methods: A retrospective chart review was performed of a single surgeon’s experience with penile inversion vaginoplasty with or without revision labiaplasty and/or clitoroplasty between July 2014 and June 2016 in a cohort of gender diverse patients assigned male at birth. Patient demographic data, complications, and quality of life data were collected. Univariate and multivariate comparisons were completed.

Results: A total of 117 patients underwent penile inversion vaginoplasty. Of these, 28 (23.9%) patients underwent revision labiaplasty and/or clitoroplasty, with nine patients (7.7%) undergoing both procedures. Patients who underwent penile inversion vaginoplasty necessitating revision were significantly more likely to have granulation tissue (p=.006), intravaginal scarring (p<0.001), and complete vaginal stenosis (p=.008). The majority of patients who underwent revision labiaplasty and/or clitoroplasty reported satisfaction with their final surgical outcome (82.4%) and resolution of their genital related dysphoria (76.5%).

Conclusions: Patients who developed minor post-operative complications following penile inversion vaginoplasty were more likely to require revision surgeries to address functional and aesthetic concerns. Patients responded with high levels of satisfaction following revision procedures, with the majority of patients reporting resolution of genital related dysphoria. Transfeminine patients who undergo penile inversion vaginoplasty should be counseled on the possibility of revisions during their post-operative course.

Case Western Reserve University School of Medicine, Cleveland, OH.

Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH.

Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA.

Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.

New York University School of Medicine, New York, NY.

The University of Sydney School of Medicine, Sydney, Australia.

Department of Plastic Surgery, Mayo Clinic, Rochester, MN.

Brownstein and Crane Surgical Services, San Francisco, CA.

* Authors contributed equally to this work

Funding Sources: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. There are no funding sources to disclose.

Conflict of Interest: Samuel R Boas BS: The author has no significant conflicts of interest with any companies or organization whose products or services may be discussed in this article.

Mona Ascha MD: The author has no significant conflicts of interest with any companies or organization whose products or services may be discussed in this article.

Shane D Morrison MD MS: The author has no significant conflicts of interest with any companies or organization whose products or services may be discussed in this article.

Jonathan P Massie MD: The author has no significant conflicts of interest with any companies or organization whose products or services may be discussed in this article.

Ian T Nolan BM: The author has no significant conflicts of interest with any companies or organization whose products or services may be discussed in this article.

Jacson K Shen BA: The author has no significant conflicts of interest with any companies or organization whose products or services may be discussed in this article.

Krishna S Vyas MD, PhD, MHS: The author has no significant conflicts of interest with any companies or organization whose products or services may be discussed in this article.

Thomas Satterwhite MD: The author has no significant conflicts of interest with any companies or organization whose products or services may be discussed in this article.

Address for correspondence: Thomas Satterwhite, MD, Brownstein & Crane Surgical Services, 575 Sir Francis Drake Blvd, Suite 1, Greenbrae, CA 94904, tsatterwhite@gmail.com, (415) 625-3230

©2019American Society of Plastic Surgeons