Body Feminization Surgery 4.0: Do We Need a Safety Update?

Body feminization surgery (BFS) is an evolving component of gender-affirming care that increasingly incorporates hybrid approaches such as circumferential liposuction, gluteal augmentation, and minimally invasive rib remodeling. While these combinations yield favorable aesthetic outcomes, data regarding their thromboembolic safety profile remain limited.

To evaluate early thromboembolic events following hybrid body feminization surgery and to assess the potential value of scheduled postoperative Doppler ultrasound surveillance.

A retrospective review was performed of 52 transfeminine patients who underwent hybrid BFS between November 2023 and February 2025. All patients received standardized pharmacologic and mechanical thromboprophylaxis. Doppler ultrasound examinations were scheduled on postoperative days 1, 3, 7, and 10 to detect early thromboembolic events.

A significant improvement in waist-to-hip ratio was observed (mean reduction 32%, p < 0.001). Three thromboembolic events (5.7%) were identified: two asymptomatic deep vein thromboses (3.8%) detected during routine Doppler surveillance and one symptomatic pulmonary embolism (1.9%) occurring after unauthorized early long-haul travel. Doppler screening enabled detection of otherwise clinically silent events.

Hybrid BFS may be associated with a higher-than-expected incidence of early thromboembolic events in a moderate-risk population undergoing complex, multicomponent aesthetic surgery. Scheduled Doppler ultrasound surveillance may facilitate early detection of subclinical events and warrants further evaluation in this context.

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