Atlas of Operative Techniques in Gender Affirmation Surgery

1st Edition - April 18, 2023
Editors: Rajveer S. Purohit, Miroslav L Djordjevic
Language: English
Paperback ISBN:
9 7 8 - 0 - 3 2 3 - 9 8 3 7 7 - 8
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 9 8 5 5 7 - 4

As transgender and gender non-binary individuals are a growing demographic, the number of patients seeking gender confirmation surgery is increasing. Atlas of Operative Te… Read more

Atlas of Operative Techniques in Gender Affirmation Surgery

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As transgender and gender non-binary individuals are a growing demographic, the number of patients seeking gender confirmation surgery is increasing. Atlas of Operative Techniques in Gender Affirmation Surgery is a highly illustrated and practical guide to the different types of gender affirmation surgery. Top and bottom surgeries are illustrated include facial feminization, mastectomy, techniques in phalloplasty, metoidioplasty, different approaches to vaginoplasty, management of complications of gender affirming surgery, and more.

This comprehensive textbook is a must-have guide for individuals interested in gender affirmation surgery to master the complex operative procedures that this field demands and to refine their techniques.

Cover
Title page
Table of Contents
Copyright
Dedication
Contributors
Acknowledgments
Chapter 1: Developing a transgender health center of excellence: The Mount Sinai model
Abstract
Introduction
Overview of services
Education
Research
References
Chapter 2: Satisfaction and outcomes after genitourinary gender affirmation surgery
Abstract
Introduction
Feminizing surgery
Masculinizing surgery
Scrotoplasty and testicular prosthesis
Conclusions
References
Chapter 3: Orchiectomy for transgender women
Abstract
Overview
Important anatomic considerations include
Preoperative work-up
OR equipment
Surgical technique
Postoperative management
Common problems
Tips and pitfalls
References
Chapter 4: Facial gender confirmation surgery
Abstract
Overview
Anatomical considerations
Preoperative work-up
OR equipment
Surgical technique: The upper third
Surgical technique: The lower third
Surgical technique: The neck
Postoperative management
Take home messages
References
Chapter 5: Transfeminine breast augmentation
Abstract
Overview
Anatomical considerations
Preoperative workup
Operating room equipment
Surgical technique
Postoperative management
Tips and pitfalls
Take-home messages
References
Chapter 6: Vaginoplasty: Bowers’ version
Abstract
Overview: A historical perspective
Preoperative workup and preparation for surgery
Surgical technique
References
Chapter 7: Vaginoplasty: The Ghent technique
Abstract
Overview
Anatomic considerations
Preoperative work-up
OR equipment
Surgical technique
Postoperative management
Tips and pitfalls
Take home message
References
Chapter 8: Vaginoplasty: The Swedish technique
Abstract
Introduction
Decisional algorithm
Preoperative preparation
Surgical techniques for vagino-clitoro-labioplasty and orchiectomy
Postoperative care
Results and complications
Queries for the future
References
Chapter 9: Intestinal vaginoplasty in transgender women
Abstract
Introduction
Surgical technique: Intestinal vaginoplasty in our center
Surgical outcomes and patient reported outcomes
Long-term health of the intestinal segment
Other techniques
References
Chapter 10: Robotic peritoneal flap vaginoplasty
Abstract
Introduction
History
Preoperative considerations and technique
Outcomes
Revision robotic peritoneal flap
Conclusion
References
Chapter 11: Complications after vaginoplasty
Abstract
Overview
Intraoperative complications
Intraoperative or immediate postoperative complications
Delayed complications
Tips and pitfalls
Take home message
References
Chapter 12: Facial features remodeling and affirming surgery (FFRS)
Abstract
Overview
Anatomical considerations
Preoperative workup
Surgical technique
Ancillary procedures
Masculinization
Postoperative care
References
Chapter 13: Mastectomy
Abstract
Financial disclosure statement
Introduction
Preoperative considerations
Technique selection
Periareolar technique
Circumareolar or extended circumareolar techniques
Double incision with free nipple grafts
Inferior pedicle technique
Ancillary procedures
Postoperative care and considerations
References
Chapter 14: Metoidioplasty and variants of technique
Abstract
Acknowledgments
Overview
Anatomic considerations
Preoperative work-up
OR equipment
Surgical technique
Postoperative management
Tips and pitfalls
Take home message
Comments
References
Chapter 15: Female-to-male gender-affirmation phalloplasty: Radial forearm free flap with urethral lengthening
Abstract
Justification for the radial forearm flap
Patient evaluation
Surgical technique
Postoperative sequelae/complications
Recent advances in phalloplasty
Conclusion
References
Chapter 16: Musculocutaneous latissimus dorsi phalloplasty
Abstract
Overview
Anatomic considerations
Preoperative work-up
OR equipment
Surgical technique
Postoperative management
Tips and pitfalls
Take home message
References
Chapter 17: ALT phalloplasty: The Ghent technique
Abstract
Overview
Anatomic considerations
Preoperative work-up
OR equipment
Surgical technique
Postoperative management
Surgical outcome
Tips and pitfalls
Take-home message
References
Chapter 18: Abdominal phalloplasty
Abstract
Overview
Anatomical considerations
Preoperative workup
OR equipment
Surgical techniques
Tips and pitfalls
Take-home message
References
Chapter 19: Scrotoplasty
Abstract
Overview
Anatomical considerations
Preoperative workup
OR equipment
Surgical technique
Our technique
Second-stage scrotoplasty after metoidioplasty
V-Y plasty with or without testicular prostheses
Autologous scrotal augmentation
Postoperative management
References
Chapter 20: Vaginectomy and hysterectomy
Abstract
Gender-affirming hysterectomies
Vaginectomy (also referred to as colpectomy/colpocleisis)
References
Chapter 21: Penile prosthesis after phalloplasty
Abstract
Overview
Anatomical considerations
Preoperative workup
OR equipment
Surgical technique
Postoperative management
Complications
Tips and pitfalls
Take-home message: Three points that surgeons must know
References
Chapter 22: Masculinizing top surgery complications
Abstract
Procedure overview
Choice of operative technique
Additional considerations
Anatomic considerations
Preoperative work-up
Breast cancer surveillance
Surgical technique
Postoperative management
Tips and pitfalls
Dog ears
Contour irregularities
Surgical scars
Hematoma
Seroma
NAC size, shape, and placement
Nipple necrosis
Postoperative pain
Take home messages
References
Chapter 23: Vaginal remnants, strictures, and fistula after masculinizing surgery
Abstract
Overview
Preoperative work-up
Unique anatomic and surgical considerations
OR equipment
Surgical techniques
Postoperative management
Tips and pitfalls
Take home message
References
Chapter 24: Therapeutic management of hormone-dependent cancers in transgender patients
Abstract
Introduction
Prostate cancer
Take-home message
References
Index

Rajveer S. Purohit

Dr. Purohit is the co-director of Reconstructive Urology at the Icahn School of Medicine at Mount Sinai Hospital and Associate Professor in its Department of Urology. In 2018, Mt. Sinai appointed him co-director of its first fellowship in Reconstructive Urology that trains methods of gender affirmation surgery including vaginoplasty, metoidioplasty and phalloplasty. His areas of research include reconstructive urology, voiding dysfunction, urethral strictures, gender affirmation surgery, mesh complications, reconstructive urology voiding dysfunction, minimally invasive urology, urogynecology, urologic oncology, treatment of complications of surgery and radiation therapy, and erectile dysfunction. His research in urethral strictures revealed that low-stage urethral strictures rarely progresses and does not require surgery.

Affiliations and expertise

Associate Professor, Icahn School of Medicine, Mount Sinai Hospital, USA

Miroslav L Djordjevic

Dr. Djordjevic is Professor of Surgery, PhD in Urology (Belgrad, 2003), currently practicing at: Belgrade Center for Genital Reconstructive Surgery, Belgrade; School of Medicine, University of Belgrade, Belgrade; Mount Sinai, New York, NY, USA. He published circa 141 titles in peer reviewed manuscripts, book chapters and books. Dr. Miroslav Djordjevic is a leader in the field of urogenital reconstructive surgery and one of the few urologists in the world to encompass treatment of all anomalies of the genital system regardless of gender or age, providing new knowledge of the surgical anatomy of the male and female genitalia. Dr. Djordjevic is the President of the Society for Genitourinary Reconstructive Surgeons (GURS). He is also a member of other urological and surgical associations, including the World Professional Association for Transgender Health (WPATH), the American Urological Association (AUA), and the American Academy of Pediatrics (AAP). He has also received numerous research awards and honors, including awards given by the European Association of Urology, the German Urological Association, and the European Society for Sexual Medicine.

Affiliations and expertise

Professor, Belgrade University School of Medicine, Serbia