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Maximizing Safety and Optimizing Outcomes of Labiaplasty: A Systematic Review and Meta-Analysis
Joseph M Escandón1, Daniela Duarte-Bateman1, Valeria P Bustos1
1From the Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center; Cleveland Clinic Lerner Research Institute; Division of Plastic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School; Universidad El Bosque, School of Medicine; Department of Plastic and Reconstructive Surgery, Children's National Hospital; Department of Plastic and Reconstructive Surgery, Cleveland Clinic Florida; and Department of Plastic, Reconstructive and Burn Surgery, Arzobispo Loayza National Hospital.
Background:
The considerable increase in labiaplasty requires plastic surgeons to be acquainted with the surgical techniques, their respective complications, and satisfaction rates. The authors conducted a systematic review of the available evidence on labia minoraplasty, looking at surgical techniques, clinical outcomes, and patient satisfaction.
Methods:
A comprehensive search across PubMed, Web of Science, SCOPUS, and CochraneCENTRAL was performed through October of 2020. A random-effects model meta-analysis was performed to assess satisfaction and complication rates.
Results:
Forty-six studies including 3804 patients fulfilled the inclusion criteria. The pooled satisfaction rate after labia minoraplasty was 99 percent (95 percent CI, 97 to 99 percent). Substantial heterogeneity was present across studies ( I2 = 63.09 percent; p < 0.001). The highest pooled incidence of dehiscence was reported for laser-assisted labiaplasty (5 percent; 95 percent CI, 2 to 8 percent) and wedge resection (3 percent; 95 percent CI, 1 to 5 perecent). The highest pooled incidence of hematoma formation (8 percent; 95 percent CI, <1 to 23 percent) and postoperative bleeding (2 percent; 95 percent CI, <1 to 15 percent) was reported for W-shape resection. The highest pooled incidence of transient pain or discomfort was reported for de-epithelialization (2 percent; 95 percent CI, <1 to 23 percent) and W-shape resection (2 percent; 95 percent CI, <1 to 15 percent). Three cases of flap necrosis were reported; two occurred using wedge resection labia minoraplasty and one was not specified. The most common causes for revision surgery ( n = 169) were dehiscence and aesthetic concerns.
Conclusions:
Labia minoraplasty is a safe procedure, but serious complications requiring surgical management have been reported. Surgical experience, knowledge of female genital anatomy, and thorough technique selection in accordance with the patient characteristics are mandatory.
