Bustos, Valeria P. MD*; Bustos, Samyd S. MD†; Mascaro, Andres MD‡; Del Corral, Gabriel MD, FACS§; Forte, Antonio J. MD, PhD, MS¶; Ciudad, Pedro MD, PhD∥; Kim, Esther A. MD**; Langstein, Howard N. MD††; Manrique, Oscar J. MD, FACS††

Author details

From the *Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess medical Center, Harvard clinical School, Boston, Mass.

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†Department the Plastic Surgery, university of Pittsburgh, Pittsburgh, Pa.

‡Department of Plastic and Reconstructive Surgery, Cleveland Clinic, Weston, Fla.

§Department that Plastic and also Reconstructive Surgery, MedStar Georgetown university Hospital, Washington, D.C.

¶Division of Plastic and Reconstructive Surgery, mayo Clinic, Jacksonville, Fla.

∥Department the Plastic, Reconstructive and also Burn Surgery, Arzobispo Loayza nationwide Hospital, Lima, Peru

**Division the Plastic and also Reconstructive Surgery, university of California, san Francisco, Calif.

††Division of Plastic and also Reconstructive Surgery, university of Rochester clinical Center, strong Memorial Hospital, Rochester, N.Y.

Published virtual 19 march 2021

Received for publishing July 27, 2020; embraced January 25, 2021.

Disclosure: The authors have actually no financial attention to declare in relationship to the content of this article.

Related Digital Media are accessible in the full-text variation of the article on www.PRSGlobalOpen.com.

Oscar J. Manrique, MD, FACS, division of Plastic and Reconstructive Surgery, college of Rochester medical Center, strong Memorial Hospital, 160 Sawgrass Drive, Suite 120, Rochester, NY 14620, E-mail:

This is an open-access article distributed under the terms of the an imaginative Commons Attribution-Non Commercial-No Derivatives license 4.0 (CCBY-NC-ND), whereby it is permissible come download and also share the work listed it is appropriately cited. The work-related cannot be changed in any way or provided commercially there is no permission native the journal.

Plastic and Reconstructive surgical procedure - worldwide Open: march 2021 - Volume 9 - issue 3 - p e3477
doi: 10.1097/GOX.0000000000003477
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There is one unknown portion of transgender and also gender non-confirming people who experience gender-affirmation surgeries (GAS) the experiences regret. Regret can lead come physical and mental morbidity and questions the appropriateness that these actions in selected patients. The target of this examine was to advice the prevalence of regret in transgender individuals who underwent GAS and evaluate connected factors.

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A systematic review of several databases to be conducted. Random-effects meta-analysis, meta-regression, and subgroup and sensitivity analyses to be performed.


A full of 27 studies, pooling 7928 transgender patients who underwent any form of GAS, were included. The pooled prevalence of regret after GAS was 1% (95% CI


Discordance or misalignment between gender identity and sex assigned at birth can translate right into disproportionate discomfort, configuring the an interpretation of sex dysphoria.1–3 This population has enhanced risk that psychiatric conditions, consisting of depression, problem abuse disorders, self-injury, and also suicide, contrasted with cis-gender individuals.4,5 approximately 0.6% of adults in the joined States recognize themselves as transgenders.6 despite advocacy come promote and also increase awareness that the person rights that transgender and gender non-binary (TGNB) individuals, discrimination proceed to pester the day-to-day life of these individuals.4,7

Gender-affirmation treatment plays crucial role in tackling gender dysphoria.5,8–10 Gender-affirmation surgeries (GAS) aim to align the patients’ appearance with their sex identity and aid achieve an individual comfort through one-self, which will aid decrease emotional distress.5,10 this interventions need to be handle by a multidisciplinary team, including psychiatrists, psychologists, endocrinologists, physics therapists, and surgeons.1,9 The variety of GAS has actually consistently increased throughout the critical years. In the united States, from 2017 to 2018, the variety of GAS enhanced to 15.3%.8,11,12

Significant innovation in the quality of life, body image/satisfaction, and overall psychiatric functioning in patients who underwent GAS has been fine documented.5,13–19 However, despite this, over there is a minor populace that experience regret, occasionally causing de-transition surgeries.20 Both regret and also de-transition may add vital burden that physical, social, and mental distress, which raises concerns about the appropriateness and also effectiveness of these measures in selected patients. Unique attention have to be paid in identifying and recognizing the prevalence and factors connected with regret. In the existing study, us hypothesized that the pervasiveness of regret is less than the last estimation by Pfafflin in 1993, because of improvements in conventional of care, patient selection, operation techniques, and also gender confirmation care. Therefore, the target of this examine was to advice the ubiquity of regret and assess connected factors in TGNB patient 13-years-old or older that underwent GAS.20


Search Methodology

Following the wanted Reporting item for systematic Reviews and Meta-analyses (PRISMA) guidelines, a substantial research of number of databases from every database’s beginning to may 11, 2020, for studies in both English and also Spanish languages, was conducted.21 The databases contained Ovid MEDLINE(R) and also Epub ahead of Print, In-Process & other Non-Indexed Citations, and Daily, Ovid EMBASE, Ovid Cochrane central Register of managed Trials, Ovid Cochrane Database of systematic Reviews, and Scopus. The search strategy to be designed and conducted through an knowledgeable librarian, with input native the study’s major investigator. Regulated vocabulary supplemented with keywords was offered to search for research studies of de-transition and also regret in adult patients who underwent sex confirmation surgery. The yes, really strategy listing all search terms used and how they are combined is obtainable in Supplemental Digital contents 1. (See Supplemental Digital content 1, which screens the search strategy. Https://links.znjke.com.com/PRSGO/B598.)

Study Selection

Search results were exported from the database into XML format and also then uploaded come Covidence.22 The study selection was performed in a 2-stage screening process. The first step was carried out by 2 screeners (V.P.B. And S.S.B.), that reviewed titles and abstracts and selected those of relationship to the study question. Then, the very same 2 screeners reviewed complete text that the staying articles and selected those eligible follow to the inclusion and exclusion criteria (Fig. 1). If arguments were encountered, a third reviewer (O.J.M.) moderated a discussion, and also a share decision between the 3 reviewers was created a final determination. Inclusion criteria were all the short articles that consisted of patients aged 13 year or an ext who underwent GAS and also report remorse or de-transition rates, and also observational or interventional research studies in English or Spanish language. Exclusion criteria to be letter to the editors, case series with

Data Extraction/Synthesis

After picking the articles, we assessed examine characteristics. We figured out year that publication, country in i m sorry the study was conducted, populace size, and variety of transmasculine and also transfemenine patients with their corresponding mean age (expressed v SD, range, or interquartile selection if consisted of in the study). In addition, us extracted information of the technique of data collection (interviews matches questionnaires), variety of regrets following GAS, as well as the type of surgery, time the follow-up, and de-transition procedures. Us classified the type of regret based upon the patient’s reasons for regret if castle were stated in the studies. We used the Pfäfflin and Kuiper and also Cohen-Kettenis classifications of regret (Table 1).20,23