Revision Surgery Rates in Gender-Affirming Surgeries

Revision surgeries are a notable aspect of gender-affirming surgical procedures, as they address functional issues, complications, or dissatisfaction with aesthetic outcomes.

The rate of revision surgeries can vary depending on the specific type of gender-affirmation surgery, surgical technique used, individual patient factors, and the experience of the surgical team.

1. Vaginoplasty (Male-to-Female Surgery)

• Estimated Revision Rates: Studies indicate that the revision rate for vaginoplasty can range from 20% to 30%. However, this rate may vary depending on the surgical technique, surgeon experience, and the criteria used to define a “revision.”
• Common Reasons for Revision:
  • Vaginal Stenosis: Narrowing of the neovagina, which may occur due to insufficient dilation, scar tissue formation, or technical issues during surgery. Revision surgery may involve re-dilation or additional grafting to restore vaginal depth and width.
  • Urethral Complications: Urethral stricture or fistula (an abnormal connection between the urethra and the neovagina) may necessitate surgical correction.
  • Aesthetic Adjustments: Patients may seek revisions to address concerns related to the appearance of the labia or clitoral area.
• Functional Revisions: In some cases, revisions are performed to improve sexual function or to address issues with lubrication or sensation.

2. Phalloplasty (Female-to-Male Surgery)

Phalloplasty is one of the most complex gender-affirming surgeries, involving the creation of a neophallus using tissue grafts from donor sites such as the forearm, thigh, or abdomen. Due to its complexity, phalloplasty has a relatively high rate of revisions.

• Estimated Revision Rates: The revision rate for phalloplasty can range from 25% to 50%, with some studies reporting even higher rates depending on the specific techniques and patient populations studied.
• Common Reasons for Revision:
  • Urethral Complications: Urethral strictures (narrowing) and fistulas (abnormal connections) are among the most common complications, often requiring surgical intervention to correct. These issues can lead to difficulties with urination and increase the risk of infections.
  • Aesthetic Revisions: Some individuals may seek revisions to address aesthetic concerns, such as the size, shape, or positioning of the neophallus. This can involve additional procedures to refine the appearance or symmetry.
  • Implant-Related Issues: For those who opt for erectile implants, complications such as implant malfunction, infection, or erosion can occur, necessitating revision or replacement of the implant.
• Scarring and Donor Site Concerns: Revisions may also address issues related to scarring at donor graft sites (such as the forearm) or address concerns about the texture and appearance of the grafted tissue.

3. Metoidioplasty (Female-to-Male Surgery)

Metoidioplasty involves releasing the hormonally enlarged clitoris to create a neophallus. It is generally considered less complex than phalloplasty, with a correspondingly lower rate of complications and revisions.

• Estimated Revision Rates: The revision rate for metoidioplasty is generally lower than that for phalloplasty, typically estimated to be around 15% to 25%.
• Common Reasons for Revision:
  • Urethral Complications: Similar to phalloplasty, urethral complications such as fistulas and strictures can occur, though they are less common and often less severe.
  • Aesthetic Revisions: Some patients may seek revisions to modify the appearance of the neophallus or to adjust the position of the urethral opening.

4. Mastectomy (Chest Masculinization Surgery)

Chest masculinization surgery, or mastectomy, involves the removal of breast tissue to create a more masculine chest contour. This procedure is generally associated with lower complication and revision rates compared to genital surgeries.

• Estimated Revision Rates: Revision rates for mastectomy range from 5% to 10%.
• Common Reasons for Revision:
  • Scar Revisions: Scarring is a common concern, and some individuals may seek additional surgery to minimize the appearance of scars or to correct hypertrophic (raised) scars.
  • Contour Adjustments: Some patients may require revisions to address issues such as residual breast tissue, uneven chest contour, or asymmetry of the nipples.
  • Nipple Placement: Revisions may also be performed to reposition the nipples or to address issues related to nipple graft survival or sensation.

5. Facial Feminization Surgery (FFS)

Facial feminization surgery encompasses a range of procedures designed to feminize facial features. The revision rates for FFS vary depending on the specific procedures performed, such as rhinoplasty, jaw contouring, brow reduction, and tracheal shave.

• Estimated Revision Rates: The revision rate for FFS is typically reported to be around 10% to 20%.
• Common Reasons for Revision:
  • Aesthetic Dissatisfaction: Patients may seek revisions to enhance facial symmetry, refine certain features, or achieve a more feminine appearance.
  • Functional Issues: In some cases, revisions are necessary to address functional concerns, such as breathing difficulties following rhinoplasty or issues related to tracheal shave.

6. Factors Influencing Revision Surgery Rates

The likelihood of requiring revision surgery can be influenced by several factors:

• Surgeon Experience and Technique: Higher rates of revision are often seen in surgeries performed by less experienced surgeons or with older techniques. Choosing a surgeon with extensive experience in gender-affirming surgeries can reduce the risk of complications and the need for revisions.
• Patient Health and Anatomy: Individual health conditions (e.g., diabetes, smoking status) and anatomical variations can impact surgical outcomes and the potential need for revisions.
• Postoperative Care: Proper postoperative care, including adherence to dilation schedules (for vaginoplasty) or careful monitoring for signs of complications, can play a crucial role in minimizing the need for revisions.
• Realistic Expectations: Patients with a clear understanding of the potential outcomes and limitations of surgery are often more satisfied, which may decrease the demand for aesthetic revisions.

Conclusion

Revision surgeries are a relatively common aspect of the journey for individuals undergoing gender-affirming surgeries, especially for complex procedures like vaginoplasty and phalloplasty. The revision rates vary depending on the type of surgery, individual patient factors, surgical technique, and the skill of the surgical team.

Proper preoperative counseling, setting realistic expectations, and ensuring comprehensive postoperative care are key strategies in minimizing the need for revision surgeries and optimizing patient satisfaction with gender-affirming procedures.