An external validation of a novel predictive algorithm for male nipple areolar positioning: an improvement to current practice through a multicenter endeavor

[Gender-Affirming Top Surgery for Gender Incongruence/Dysphoria: A Literature Review and Alignment with the New German S2k Guidelines on Mastectomy and Breast Augmentation]

"Top surgery", which refers to gender-affirming chest procedures, is one of the most common surgeries for individuals with gender incongruence (GI). These surgeries include breast augmentation or mastectomy and aim to align the physical appearance with gender identity. This review is based on the newly published German S2k guideline "Surgical Measures for Gender Incongruence" and offers a comprehensive overview of current breast surgery techniques and relevant literature.A literature analysis was conducted based on data from PubMed from 1973 to July 2024. The analysis included 122 studies on gender-affirming chest surgeries for individuals with GI. The core statements were extracted and summarized.Gender-affirming chest surgeries, including both breast augmentation and mastectomy, generally lead to significant improvements in the well-being of individuals. Breast augmentations often involve silicone implants or autologous fat grafting. Mastectomies for chest flattening aim to create a smooth, masculine-contoured or neutral chest while preserving nipple sensation. The choice of surgical technique largely depends on breast size, the degree of ptosis, and skin elasticity. Patient satisfaction with the surgical outcomes is consistently high, underscoring the importance of these procedures.This review provides a comprehensive overview of current surgical techniques for chest surgeries in individuals with gender incongruence. With the growing number of transgender and non-binary patients, clear surgical guidelines are increasingly important to meet the high demands and address complex anatomical challenges. The new German S2k guideline, developed by German experts from various participating disciplines, supports this need. The high patient satisfaction with surgical outcomes underscores the significance of these procedures for improving quality of life.

Masculinizing and defeminizing gender-affirming surgery

Transmasculine transgender and gender-diverse individuals may request gender-affirming surgery, standalone or in addition to other interventions. The choices and preferred outcomes of surgery can be highly individual. Besides surgeons' technical skills and patient physique, professionals in this field should be able to cooperate with other disciplines and with patients. The most requested surgery is masculinizing chest surgery, aiming to create a masculine chest with minimal scarring. For genital surgery, metoidioplasty refers to the procedure where the hypertrophic clitoris is released and possibly a scrotum is created from local labia flaps, whereas phalloplasty refers to a procedure in which a neophallus is created from a flap. Possible other surgeries include hysterectomy/oophorectomy, colpectomy, and the implants of scrotal or erection prostheses. In order to guide patients and clinicians, standardized outcome measures as well as evidence-based decision aids have been developed. Such aids, in combination with collaborative medical and psychosocial care, may further leverage the long-term outcomes of these surgeries.