Chirurgiczna korekta płci - przegląd trendów i wybranych technik

Autorzy

Zofia Graca
Studenckie Koło Naukowe im. Prof. Zbigniewa Religi przy Katedrze Biofizyki w Zabrzu, Wydział Nauk Medycznych w Zabrzu, Śląski Uniwersytet Medyczny w Katowicach
Martyna Żurek
Jakub Kołodziej

Słowa kluczowe:

dysforia płciowa, chirurgiczna korekta płci, transpłciowość, falloplastyka, waginoplastyka

Streszczenie

Na przestrzeni ostatnich lat znacznie wzrosła widoczność osób transpłciowych w przestrzeni publicznej. Coraz więcej osób borykających się z dysforią płciową decyduje się na czasochłonny proces tranzycji wymagający wsparcia ze strony różnych specjalistów. Niniejszy artykuł traktuje o nowoczesnych procedurach chirurgicznych mających na celu zmianę wyglądu pacjenta  w kierunku płci, z którą się utożsamia. Wiele spośród opisywanych technik jest bardzo skomplikowanych i ryzykownych, natomiast specjaliści stale dążą do ich udoskonalania i wzrostu poziomu satysfakcji pacjentów. Przeprowadzane operacje można podzielić na te, które dążą do feminizacji wyglądu oraz te, których celem jest maskulinizacja. Obejmują one przede wszystkim zabiegi w obrębie klatki piersiowej, twarzy oraz genitaliów. Te ostatnie stanowią największe wyzwanie dla chirurgów i są stale modyfikowane. Warunkiem niezbędnym do przystąpienia do opisywanych zabiegów jest przejście terapii hormonalnej. Istotne jest bardzo indywidualne podejście do pacjenta i zrozumienie jego potrzeb. Dla wielu osób transpłciowych poddanie się inwazyjnym procedurom jest jedyną drogą do pełnej ekspresji płciowej.

Bibliografia

Brown GR. A review of clinical approaches to gender dysphoria. J Clin Psychiatry. 1990;51(2):57-64.

Zurada A, Salandy S, Roberts W, Gielecki J, Schober J, Loukas M. The evolution of transgender surgery. Clin Anat. 2018;31(6):878-886. doi:10.1002/ca.23206

Berli JU, Knudson G, Fraser L, et al. What Surgeons Need to Know About Gender Confirmation Surgery When Providing Care for Transgender Individuals: A Review. JAMA Surg. 2017;152(4):394-400. doi:10.1001/jamasurg.2016.5549

Arcelus J, Bouman WP, Van Den Noortgate W, Claes L, Witcomb G, Fernandez-Aranda F. Systematic review and meta-analysis of prevalence studies in transsexualism. Eur Psychiatry. 2015;30(6):807-815. doi:10.1016/j.eurpsy.2015.04.005

Rudin J, Yang Y, Ross LW, Farro A, Billing TK. Are FTM and MTF Transgender Employees Equally Transgressive? AMPROC. 2015;2015(1):15725. doi:10.5465/ambpp.2015.15725abstract

Pan S, Honig SC. Gender-Affirming Surgery: Current Concepts. Curr Urol Rep. 2018;19(8):62. Published 2018 Jun 7. doi:10.1007/s11934-018-0809-9

Siringo NV, Berman ZP, Boczar D, et al. Techniques and Trends of Facial Feminization Surgery. Ann Plast Surg. 2022;88(6):704-711. doi:10.1097/sap.0000000000002952

Selvaggi G. Discussion: Breast Augmentation in the Transfemale Patient: Comprehensive Principles for Planning and Obtaining Ideal Results. Plast Reconstr Surg. 2020;145(6):1354-1355. doi:10.1097/PRS.0000000000006820

American Urological Association. Update Series (2017) Lesson 5: Genital Gender Affirming Surgery for Transgender Patients | AUA University. https://auau.auanet.org/content/update-series-2017-lesson-5-genital-gender-affirming-surgery-transgender-patients. Published January 1, 2017. Accessed February 5, 2023.

Deschamps-Braly JC. Facial Gender Confirmation Surgery: Facial Feminization Surgery and Facial Masculinization Surgery. Clin Plast Surg. 2018;45(3):323-331. doi:10.1016/j.cps.2018.03.005

Bruce MK, Joseph WJ, Grunwaldt L, Nguyen VT, De La Cruz C. Transgender Mastectomy: Incidence of High-Risk Pathologic Findings and the Need for Postoperative Cancer Surveillance. Ann Plast Surg. 2022;88(3 Suppl 3):S148-S151. doi:10.1097/SAP.0000000000003175

Rooker SA, Vyas KS, DiFilippo EC, Nolan IT, Morrison SD, Santucci RA. The Rise of the Neophallus: A Systematic Review of Penile Prosthetic Outcomes and Complications in Gender-Affirming Surgery. J Sex Med. 2019;16(5):661-672. doi:10.1016/j.jsxm.2019.03.009

Marfori CQ, Wu CZ, Katler Q, Kotzen M, Samimi P, Siedhoff MT. Hysterectomy for the Transgendered Male: Review of Perioperative Considerations and Surgical Techniques with Description of a Novel 2-Port Laparoscopic Approach. Journal of Minimally Invasive Gynecology. 2018;25(7):1149-1156. doi:10.1016/j.jmig.2017.09.008

Altman K. Facial feminization surgery: current state of the art. International Journal of Oral and Maxillofacial Surgery. 2012;41(8):885-894. doi:10.1016/j.ijom.2012.04.024

Siringo NV, Berman ZP, Boczar D, et al. Techniques and Trends of Facial Feminization Surgery: A Systematic Review and Representative Case Report. Ann Plast Surg. 2022;88(6):704-711. doi:10.1097/SAP.0000000000002952

Morrison SD, Vyas KS, Motakef S, et al. Facial Feminization: Systematic Review of the Literature. Plast Reconstr Surg. 2016;137(6):1759-1770. doi:10.1097/PRS.0000000000002171

Ferretti C, Reyneke JP. Genioplasty. Atlas Oral Maxillofac Surg Clin North Am. 2016;24(1):79-85. doi:10.1016/j.cxom.2015.10.008

Becking AG, Tuinzing DB, Hage JJ, Gooren LJ. Transgender feminization of the facial skeleton. Clin Plast Surg. 2007;34(3):557-564. doi:10.1016/j.cps.2007.04.009

Lundgren KC, Koudstaal MJ. Midfacial Bony Remodeling. Facial Plastic Surgery Clinics of North America. 2019;27(2):221-226. doi:10.1016/j.fsc.2018.12.004

Berli JU, Loyo M. Gender-confirming Rhinoplasty. Facial Plast Surg Clin North Am. 2019;27(2):251-260. doi:10.1016/j.fsc.2019.01.003

Hohman MH, Teixeira J. Transgender Surgery of the Head and Neck. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 29, 2022.

Sayegh F, Ludwig DC, Ascha M, et al. Facial Masculinization Surgery and its Role in the Treatment of Gender Dysphoria. Journal of Craniofacial Surgery. 2019;30(5):1339-1346. doi:10.1097/scs.0000000000005101

Safa B, Lin WC, Salim AM, Deschamps-Braly JC, Poh MM. Current Concepts in Masculinizing Gender Surgery. Plastic and Reconstructive Surgery. 2019;143(4):857e-871e. doi:10.1097/prs.0000000000005453

Deschamps-Braly JC, Sacher CL, Fick J, Ousterhout DK. First Female-to-Male Facial Confirmation Surgery with Description of a New Procedure for Masculinization of the Thyroid Cartilage (Adam's Apple). Plast Reconstr Surg. 2017;139(4):883e-887e. doi:10.1097/PRS.0000000000003185

Harris J, Premaratne ID, Spector JA. Facial Masculinization from Procedures to Payment: A Review. LGBT Health. 2021;8(7):444-453. doi:10.1089/lgbt.2020.0128

Bared A, Epstein JS. Hair Transplantation Techniques for the Transgender Patient. Facial Plast Surg Clin North Am. 2019;27(2):227-232. doi:10.1016/j.fsc.2018.12.005

Bared A. What's New in Facial Hair Transplantation?: Effective Techniques for Beard and Eyebrow Transplantation. Facial Plast Surg Clin North Am. 2019;27(3):379-384. doi:10.1016/j.fsc.2019.04.003

Bekeny JC, Zolper EG, Manrique OJ, Fan KL, Del Corral G. Breast augmentation in the transgender patient: narrative review of current techniques and complications. Ann Transl Med. 2021;9(7):611. doi:10.21037/atm-20-5087

Nauta AC, Baltrusch KM, Heston AL, et al. Differences in Chest Measurements between the Cis-female and Trans-female Chest Exposed to Estrogen and Its Implications for Breast Augmentation. Plast Reconstr Surg Glob Open. 2019;7(3):e2167. Published 2019 Mar 13. doi:10.1097/GOX.0000000000002167

Weigert R, Frison E, Sessiecq Q, Al Mutairi K, Casoli V. Patient satisfaction with breasts and psychosocial, sexual, and physical well-being after breast augmentation in male-to-female transsexuals. Plast Reconstr Surg. 2013;132(6):1421-1429. doi:10.1097/01.prs.0000434415.70711.49

Zhu A, Callori S, Boonipat T, Hebel N, Jorge-Martinez J. Examining the Impact of Breast Augmentation vs Hormone Therapy on Chest Femininity of Transgender Women. Aesthet Surg J. 2023;43(2):NP114-NP121. doi:10.1093/asj/sjac288

Morrison SD, Chong HJ, Dy GW, et al. Educational Exposure to Transgender Patient Care in Plastic Surgery Training. Plast Reconstr Surg. 2016;138(4):944-953. doi:10.1097/PRS.0000000000002559

Miller TJ, Wilson SC, Massie JP, Morrison SD, Satterwhite T. Breast augmentation in male-to-female transgender patients: Technical considerations and outcomes. JPRAS Open. 2019;21:63-74. doi:10.1016/j.jpra.2019.03.003

Morrison SD, Massie JP, Crowe CS, Smith JR. Patient-Reported Outcomes Needed for Chest Masculinization. Ann Plast Surg. 2018;80(1):90-91. doi:10.1097/SAP.0000000000001130

Massie JP, Morrison SD, Smith JR, Wilson SC, Satterwhite T. Patient-Reported Outcomes in Gender Confirming Surgery. Plast Reconstr Surg. 2017;140(1):236e-237e. doi:10.1097/PRS.0000000000003479

Coon D, Lee E, Fischer B, Darrach H, Landford WN. Breast Augmentation in the Transfemale Patient: Comprehensive Principles for Planning and Obtaining Ideal Results. Plastic & Reconstructive Surgery. 2020;145(6):1343-1353. doi:10.1097/prs.0000000000006819

Bruce MK, Joseph WJ, Grunwaldt L, Nguyen VT, De La Cruz C. Transgender Mastectomy. Ann Plast Surg. 2022;88(3):S148-S151. doi:10.1097/sap.0000000000003175

Piette E, Jaumotte M, Gilon Y, Nizet JL. Mastectomie, procédure chirurgicale initiale chez les patients transgenres [Mastectomy, the initial surgical procedure in transgender patients]. Rev Med Liege. 2022;77(2):118-123.

Monstrey S, Selvaggi G, Ceulemans P, et al. Chest-wall contouring surgery in female-to-male transsexuals: a new algorithm. Plast Reconstr Surg. 2008;121(3):849-859. doi:10.1097/01.prs.0000299921.15447.b2

Hoevenaren IA, Schott DA, Otten BJ, Kroese-Deutman HC. Prepubertal unilateral gynecomastia: a report of two cases. Eur J Plast Surg. 2011;34(5):395-398. doi:10.1007/s00238-010-0469-6

Monstrey SJ, Ceulemans P, Hoebeke P. Sex Reassignment Surgery in the Female-to-Male Transsexual. Semin Plast Surg. 2011;25(3):229-244. doi:10.1055/s-0031-1281493

Perez MM, Stoehr JR, Chwa E, Connor L, Gosain AK. Dog Ears in Wound Closure: Can They Be Minimized?. Ann Plast Surg. 2022;89(5):581-590. doi:10.1097/SAP.0000000000003229

Rifkin WJ, Robinson IS, Kloer C, et al. Gender-affirming Mastectomy: Comparison of Periareolar and Double Incision Patterns. Plast Reconstr Surg Glob Open. 2022;10(5):e4356. Published 2022 May 25. doi:10.1097/GOX.0000000000004356

Kamali A, Sigurjónsson H, Gran I, et al. Improved Surgical Outcome with Double Incision and Free Nipple Graft in Gender Confirmation Mastectomy. Plast Reconstr Surg Glob Open. 2021;9(7):e3628. Published 2021 Jul 13.

Etemad SA, Furuyama WM, Winocour JS. Double Incision Mastectomy with Free Nipple Graft for Masculinizing Chest Wall Surgery. Plast Reconstr Surg Glob Open. 2020;8(11):e3184. Published 2020 Nov 30. doi:10.1097/GOX.0000000000003184

Horbach SE, Bouman MB, Smit JM, Özer M, Buncamper ME, Mullender MG. Outcome of Vaginoplasty in Male-to-Female Transgenders: A Systematic Review of Surgical Techniques. J Sex Med. 2015;12(6):1499-1512. doi:10.1111/jsm.12868

Zhang WR, Garrett GL, Arron ST, Garcia MM. Laser hair removal for genital gender affirming surgery. Transl Androl Urol. 2016;5(3):381-387. doi:10.21037/tau.2016.03.27

Tchaikovski SN, Rosing J. Mechanisms of estrogen-induced venous thromboembolism. Thromb Res. 2010;126(1):5-11. doi:10.1016/j.thromres.2010.01.045

Pariser JJ, Kim N. Transgender vaginoplasty: techniques and outcomes. Transl Androl Urol. 2019;8(3):241-247. doi:10.21037/tau.2019.06.03

Raigosa M, Avvedimento S, Yoon TS, Cruz-Gimeno J, Rodriguez G, Fontdevila J. Male-to-Female Genital Reassignment Surgery: A Retrospective Review of Surgical Technique and Complications in 60 Patients. J Sex Med. 2015;12(8):1837-1845. doi:10.1111/jsm.12936

Wangjiraniran B, Selvaggi G, Chokrungvaranont P, Jindarak S, Khobunsongserm S, Tiewtranon P. Male-to-female vaginoplasty: Preecha's surgical technique. J Plast Surg Hand Surg. 2015;49(3):153-159. doi:10.3109/2000656X.2014.967253

Shoureshi P, Dugi D 3rd. Penile Inversion Vaginoplasty Technique. Urol Clin North Am. 2019;46(4):511-525. doi:10.1016/j.ucl.2019.07.006

Grimstad F, McLaren H, Gray M. The gynecologic examination of the transfeminine person after penile inversion vaginoplasty. Am J Obstet Gynecol. 2021;224(3):266-273. doi:10.1016/j.ajog.2020.10.002

Ferrando CA. Vaginoplasty Complications. Clin Plast Surg. 2018;45(3):361-368. doi:10.1016/j.cps.2018.03.007

Heston AL, Esmonde NO, Dugi III DD, Berli JU. Phalloplasty: techniques and outcomes. Transl Androl Urol. 2019;8(3):254-265. doi:10.21037/tau.2019.05.05

Salgado CJ, Fein LA, Chim J, Medina CA, Demaso S, Gomez C. Prelamination of Neourethra with Uterine Mucosa in Radial Forearm Osteocutaneous Free Flap Phalloplasty in the Female-to-Male Transgender Patient. Case Rep Urol. 2016;2016:8742531. doi:10.1155/2016/8742531

Doornaert M, Hoebeke P, Ceulemans P, T'Sjoen G, Heylens G, Monstrey S. Penile reconstruction with the radial forearm flap: an update. Handchir Mikrochir Plast Chir. 2011;43(4):208-214. doi:10.1055/s-0030-1267215

Perovic SV, Djinovic R, Bumbasirevic M, Djordjevic M, Vukovic P. Total phalloplasty using a musculocutaneous latissimus dorsi flap. BJU Int. 2007;100(4):899-905. doi:10.1111/j.1464-410X.2007.07084.x

Morrison SD, Shakir A, Vyas KS, Kirby J, Crane CN, Lee GK. Phalloplasty. Plastic and Reconstructive Surgery. 2016;138(3):594-615. doi:10.1097/prs.0000000000002518

Mueller SC, De Cuypere G, T'Sjoen G. Transgender Research in the 21st Century: A Selective Critical Review From a Neurocognitive Perspective. Am J Psychiatry. 2017;174(12):1155-1162. doi:10.1176/appi.ajp.2017.17060626

Tollinche LE, Walters CB, Radix A, et al. The Perioperative Care of the Transgender Patient. Anesth Analg. 2018;127(2):359-366. doi:10.1213/ANE.0000000000003371

Transgender Day of Visibility: Representation matters. Cell Rep Med. 2022;3(4):100599. Published 2022 Mar 30. doi:10.1016/j.xcrm.2022.100599

Patel V, Nolan IT, Card E, Morrison SD, Bared A. Facial Hair Transplantation for Transgender Patients: A Literature Review and Guidelines for Practice. Aesthet Surg J. 2021;41(3):NP42-NP51. doi:10.1093/asj/sjaa430

Carter EE, Saade DS, Vashi NA. Presurgical Laser Hair Removal: Protocoling a Safe and Effective Procedure for Transgender Patients. Transgend Health. 2021;6(4):201-206. Published 2021 Jul 30. doi:10.1089/trgh.2020.0015

Li VY, Demzik A, Snyder L, Ogunleye AA, Wang A, Figler BD. Genital Gender Affirming Surgery. Am Surg. 2022;88(12):2817-2822. doi:10.1177/00031348221109479

Chen ML, Safa B. Single-Stage Phalloplasty. Urol Clin North Am. 2019;46(4):567-580. doi:10.1016/j.ucl.2019.07.010

Opublikowane

9 maja 2023