No abstract

Summary: Gender incongruence describes a condition in which an individual’s gender identity does not align with their sex assigned at birth based on anatomic characteristics. Individuals with gender incongruence may request surgical interventions, and gender-affirmation surgery plays an important role for these individuals. The basis of care derives from principles elucidated in the Standards of Care, international guidelines that help inform clinical decision-making. Historically, mental health care professionals (MHCPs) and surgeons have worked collaboratively to select “appropriate” surgical candidates. However, as understanding of gender identity evolves, so does the relationship between the MHCP and the surgeon. The role of the MHCP has shifted from a requirement to verify an individual’s identity to that of supporting and participating in a shared decision-making process between the individual and the health care team. This article discusses the evolution of the relationship between the MHCP and the surgeon and provides insight into the history of this relationship.

No abstract

The flap success rate in the DIEP group was 100%. The alternative flap group had two partial flap failures, but none were total flap loss. The stacked flap group had only one total and one partial flap loss (success rate 97.7%). The overall complication rate was 19% in the DIEP group, 43% in the alternative flaps, and 13.6% for stacked flaps. The reconstruction flap method did have a significant difference in complication risk between the three groups (p-value 0.011). Compared to the DIEP flap group, alternative flaps (PAP or LAP) had a 3.107 higher risk of overall complication (p= 0.037). Stacked flaps, however, had a comparable risk for any complication to the DIEP flaps. There was no statistical difference in the number of secondary revisions needed or the total fat grafted between the three methods.Conclusions: Autologous breast reconstruction in low BMI patients yields successful and durable results in DIEP flap. This study shows that predictable results in the thin patient population can be obtained via alternate autologous methods beyond the gold standard DIEP flap.

Volume 150, Number 3 • Letters 705e policy would improve access to care for patients as well as promote innovation in surgical technique.As the popularity of phalloplasty procedures increases, surgeons new to the field must decide how to balance which methods to offer with unique patient desires. The review article by Berli et al. 1 offers a framework for these important considerations and must be built upon in the coming years to provide increased access, minimize complications, and offer care in line with individualized patient goals.