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Gender-affirming microvascular breast reconstruction.

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  • 1Division of Plastic and Reconstructive Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

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Summary

Gender-affirming surgery for transgender women, including breast feminization, is common. While implants are standard, autologous tissue reconstruction offers an alternative for specific cases, improving well-being.

Keywords:
Chest feminizationautologous breast reconstructiongender-affirming surgery (GAS)microvascular breast reconstructiontransgender surgery

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Area of Science:

  • Plastic Surgery
  • Gender Affirmation
  • Reconstructive Surgery

Background:

  • Gender-affirming surgery (GAS), particularly breast feminization, is increasingly sought by transgender women to alleviate gender dysphoria.
  • Hormone therapy often yields inadequate glandular breast development in adult transgender women.
  • Implant-based breast augmentation is the primary method for chest feminization.

Purpose of the Study:

  • To review autologous tissue breast reconstruction techniques for gender-affirming surgery.
  • To present the senior author's approach to autologous chest feminization.
  • To discuss factors influencing the choice between implant and autologous reconstruction.

Main Methods:

  • Literature review of autologous tissue breast reconstruction in gender-affirming cases.
  • Case review of two patients undergoing autologous chest feminization by the senior author.
  • Analysis of factors necessitating alternative reconstruction methods.

Main Results:

  • Implant-based breast augmentation is suitable for most patients seeking chest feminization.
  • Autologous reconstruction is a viable option when implants are contraindicated or yield suboptimal results.
  • Specific patient factors, such as congenital/acquired chest deformities, may necessitate autologous approaches.

Conclusions:

  • Implant-based breast feminization remains the default procedure for transgender women.
  • Autologous tissue reconstruction is a crucial alternative for select patients, especially those with anatomical challenges or implant complications.
  • Individualized assessment is key to determining the optimal breast feminization strategy.