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Ross MB, Jahouh H, Mullender MG, Kreukels BPC, van de Grift TC. Voices from a Multidisciplinary Healthcare Center: Understanding Barriers in Gender-Affirming Care-A Qualitative Exploration. Int J Environ Res Public Health 2023; 20:6367. [PMID: 37510602 PMCID: PMC10379025 DOI: 10.3390/ijerph20146367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/17/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023]
Abstract
When seeking gender-affirming care, trans* and gender-diverse individuals often describe experiencing barriers. However, a deeper understanding of what constitutes such barriers is generally lacking. The present research sought to better understand the barriers trans* and gender-diverse individuals experienced, and their effects, when seeking gender-affirming care in the Netherlands. Qualitative interviews were conducted with trans* and gender-diverse individuals who sought care at a Dutch multidisciplinary medical center. Twenty-one participants were included, of which 12 identified as (trans) male, six identified as (trans) female, one as trans*, and one as gender-nonconforming (GNC)/non-binary. The interviews were mostly conducted at the homes of the participants and lasted between 55 min and 156 min (mean = 85 min). Following data collection and transcription, the interviews were analyzed using axial coding and thematic analysis. A total of 1361 codes were extracted, which could be classified into four themes describing barriers: lack of continuity: organizational and institutional factors (ncodes = 546), patient-staff dynamics (ncodes = 480), inadequate information and support (ncodes = 210), and lack of autonomy in decision making (ncodes = 125). Within our study, trans* and gender-diverse individuals described encountering multiple and diverse barriers when seeking gender-affirming care in the Netherlands. Future studies are needed to evaluate whether individualized care, the decentralization of care, and the use of decision aids can improve the experienced barriers of trans* and gender-diverse individuals seeking gender-affirming care within the Dutch healthcare system.
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Affiliation(s)
- Maeghan B Ross
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health Institute, 1081 BT Amsterdam, The Netherlands
| | - Hiba Jahouh
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Margriet G Mullender
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health Institute, 1081 BT Amsterdam, The Netherlands
| | - Baudewijntje P C Kreukels
- Amsterdam Public Health Institute, 1081 BT Amsterdam, The Netherlands
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Tim C van de Grift
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health Institute, 1081 BT Amsterdam, The Netherlands
- Department of Medical Psychology and Psychiatry, Zaans Medisch Centrum, 1502 DV Zaandam, The Netherlands
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2
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Özer M, de Kruif AJTCM, Gijs LACL, Kreukels BPC, Mullender MG. Sexual Wellbeing according to Transgender Individuals. Int J Sex Health 2023; 35:608-624. [PMID: 38601805 PMCID: PMC10903571 DOI: 10.1080/19317611.2023.2227172] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 06/14/2023] [Indexed: 04/12/2024]
Abstract
Objective Sexual wellbeing is an important aspect of quality-of-life. In transgender individuals who seek gender affirming treatment, various aspects of sexuality have been assessed. However, not much is known on how transgender individuals themselves perceive sexual wellbeing. This study aims to explore the perception of sexual wellbeing in transgender-individuals (an emic-perspective). Methods To explore sexual wellbeing from an emic perspective, qualitative interviews with transgender individuals were conducted, recorded and transcribed verbatim. Inductive coding and thematic analysis were used to assess topics and themes pertaining to sexual wellbeing. Results Based on interviews wih15 participants (19-74 years) with diverse self-identified genders, four main themes, relating to sexual wellbeing were derived: (1) given description of sexual wellbeing, (2) conditions for sexual wellbeing, (3) factors affecting sexual wellbeing, and (4) experienced sexual wellbeing. Conclusion Positive experiences, feeling comfortable with body/self, intimacy, acceptation and communication with partner appeared helpful to overcome hurdles and experience sexual wellbeing.
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Affiliation(s)
- Müjde Özer
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
| | - Anja J. T. C. M. de Kruif
- Department of Epidemiology and Biostatistics, Amsterdam UMC location VUmc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Nutrition, Dietetics and Lifestyle, School of Allied Health, HAN University of Applied Sciences Nijmegen, The Netherlands
| | - Luk A. C. L. Gijs
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
- Department of Neurosciences, Institute for Family and Sexuality Studies, KU Leuven, Leuven, Belgium
| | - Baudewijntje P. C. Kreukels
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
| | - Margriet G. Mullender
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
- Amsterdam Public Health research institute, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
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Heijsters FACJ, van Loon GAP, Santema JMM, Mullender MG, Bouman M, de Bruijne MC, van Nassau F. A usability evaluation of the perceived user friendliness, accessibility, and inclusiveness of a personalized digital care pathway tool. Int J Med Inform 2023; 175:105070. [PMID: 37121138 DOI: 10.1016/j.ijmedinf.2023.105070] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE This study aimed to acquire insight into the perceived user friendliness, accessibility and inclusiveness of a personalized digital care pathway. MATERIALS & METHODS Usability of the tool was tested in an experimental setting. Mixed methods data collection consisted of scenario-based eye tracking tests in a web- or mobile-based prototype of the tool, followed by a questionnaire assessing user friendliness (System Usability Scale; SUS) and a structured interview. Inclusiveness was assessed by subgroup comparisons based on language proficiency, age and education level. Via purposive sampling a heterogeneous population of users (N = 24) was recruited. Eye tracking was used to measure gaze behavior. RESULTS Overall, participants were satisfied with the tool (scale 0-10, 7.5; SD = 1.29). User friendliness of the mobile version (68.3; SD = 21.6) was higher than the web version (50.9; SD = 17.3) measured by SUS score (0-100). With regard to accessibility, eye tracking scenarios showed that the menu bar was hard to find (17% mobile, 55% web). In all scenario's, information was found faster in the mobile version than the web version. Attention was easily drawn to images. Regarding inclusiveness of the tool, we found significantly longer completing time of the scenario tasks for low language proficiency (p-value = 0.029) and higher age subgroups (p-value = 0.049). Lower language proficiency scored a significant lower SUS score (p-value = 0.012). CONCLUSIONS Overall, user friendliness and accessibility were positively evaluated. Assessment of inclusiveness emphasized the need for tailoring digital tools to those with low language proficiency and/or an older age. Co-creation of digital care tools with users is therefore important to match users' needs, make tools easily understandable and accessible to all users, and ultimately result in better uptake and impact.
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Affiliation(s)
- F A C J Heijsters
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Strategy and Innovation, De Boelelaan 1117, Amsterdam, the Netherlands.
| | | | - J M M Santema
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - M G Mullender
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - M Bouman
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Plastic, Reconstructive and Hand Surgery, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - M C de Bruijne
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands.
| | - F van Nassau
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Health Behaviors and Chronic Diseases, Amsterdam, the Netherlands.
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Timmermans FW, Ruyssinck L, Mokken SE, Buncamper M, Veen KM, Mullender MG, Claes KEY, Bouman MB, Monstrey S, van de Grift TC. An external validation of a novel predictive algorithm for male nipple areolar positioning: an improvement to current practice through a multicenter endeavor. J Plast Surg Hand Surg 2023; 57:103-108. [PMID: 34743656 DOI: 10.1080/2000656x.2021.1994982] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The correct positioning of nipple-areolar complexes (NAC) during gender-affirming mastectomies remains a particular challenge. Recently, a Dutch two-step algorithm was proposed predicting the most ideal NAC-position derived from a large cisgender male cohort. We aimed to externally validate this algorithm in a Belgian cohort. The Belgian validation cohort consisted of cisgender men. Based on patient-specific anthropometry, the algorithm predicts nipple-nipple distance (NN) and sternal-notch-to-nipple distance (SNN). Predictions were externally validated using the performance measures: R2-value, means squared error (MSE) and mean absolute percentage error (MAPE). Additionally, data were collected from a Belgian and Dutch cohort of transgender men having undergone mastectomy with free nipple grafts. The observed and predicted NN and SNN were compared and the inter-center variability was assessed. A total of 51 Belgian cisgender and 25 transgender men were included, as well as 150 Dutch cisgender and 96 transgender men. Respectively, the performance measures (R2-value, MSE and MAPE) for NN were 0.315, 2.35 (95%CI:0-6.9), 4.9% (95%CI:3.8-6.1) and 0.423, 1.51 (95%CI:0-4.02), 4.73%(95%CI:3.7-5.7) for SNN. When applying the algorithm to both transgender cohorts, the predicted SNN was larger in both Dutch (17.1measured(±1.7) vs. 18.7predicted(±1.4), p= <0.001) and Belgian (16.2measured(±1.8) vs. 18.4predicted(±1.5), p= <0.001) cohorts, whereas NN was too long in the Belgian (22.0measured(±2.6) vs. 21.2predicted(±1.6), p = 0.025) and too short in the Dutch cohort (19.8measured(±1.8) vs. 20.7predicted(±1.9), p = 0.001). Both models performed well in external validation. This indicates that this two-step algorithm provides a reproducible and accurate clinical tool in determining the most ideal patient-tailored NAC-position in transgender men seeking gender-affirming chest surgery.
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Affiliation(s)
- Floyd W Timmermans
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands.,Center of Expertise on Gender Dysphoria, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands
| | - Laure Ruyssinck
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Sterre E Mokken
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Public Health Institute, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands
| | - Marlon Buncamper
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Kevin M Veen
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Margriet G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands.,Center of Expertise on Gender Dysphoria, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Public Health Institute, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands
| | - Karel E Y Claes
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Mark-Bram Bouman
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands.,Center of Expertise on Gender Dysphoria, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Public Health Institute, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands
| | - Stanislas Monstrey
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Timotheus C van de Grift
- Center of Expertise on Gender Dysphoria, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Public Health Institute, Amsterdam UMC - location VUMC, Amsterdam, The Netherlands
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5
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Oorthuys AOJ, Ross M, Kreukels BPC, Mullender MG, van de Grift TC. Identifying Coping Strategies Used by Transgender Individuals in Response to Stressors during and after Gender-Affirming Treatments-An Explorative Study. Healthcare (Basel) 2022; 11:healthcare11010089. [PMID: 36611552 PMCID: PMC9818796 DOI: 10.3390/healthcare11010089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/09/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Gender-affirming treatments are reported to improve mental health significantly. However, a substantial number of transgender individuals report a relapse in, or persistence of, mental health problems following gender-affirming treatments. This is due to multiple stressors occurring during this period, and in general as a consequence of widespread stigma and minority stress. AIM The aim of this pilot study was to identify different coping strategies that transgender individuals use in response to stressors prior to and following gender-affirming treatments, as mediator of mental health. METHODS Qualitative interviews were conducted to better understand the treatment outcomes and healthcare experiences of Dutch transgender individuals who had received gender-affirming treatments. Nineteen participants were included, of which 12 identified as (transgender) male, six as (transgender) female and one as transgender. OUTCOMES Inductive coding and theory-informed thematic analysis were used to assess stressors (ncodes = 335) and coping strategies (ncodes = 869). RESULTS Four stressor domains were identified, including lack of support system, stressors related to transition, and physical and psychosocial stressors post-transition. We identified six adaptive coping strategies of which acceptance, help seeking and adaptive cognitions concerning gender and transition were reported most frequently. Of the seven maladaptive strategies that we identified, social isolation and maladaptive cognitions concerning gender and transition were the most-reported maladaptive coping strategies Clinical implications: The results indicated that transgender individuals may experience significant stress, both transgender-specific and non-specific, prior to and following gender-affirming treatments and, as a result, use many coping strategies to adapt. Increased awareness of stressors and (mal)adaptive coping strategies may help to improve mental healthcare and overall support for transgender individuals. Strengths and Limitations: This is the first (pilot) study to provide insight into the range of stressors that transgender individuals experience during and after gender-affirming treatments, as well as the variety of coping strategies that are used to adapt. However, since this was a pilot study assumptions and generalizations of the evidence should be made cautiously. CONCLUSION Results of this pilot study showed that transgender individuals may undergo significant stress during and after gender-affirming medical treatment related to the treatments and the social experiences that occur during this period, and as a result, use a range of coping strategies to adapt to the stress.
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Affiliation(s)
- Anna O. J. Oorthuys
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Maeghan Ross
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health Institute, 1081 BT Amsterdam, The Netherlands
| | - Baudewijntje P. C. Kreukels
- Amsterdam Public Health Institute, 1081 BT Amsterdam, The Netherlands
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Margriet G. Mullender
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health Institute, 1081 BT Amsterdam, The Netherlands
| | - Tim C. van de Grift
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health Institute, 1081 BT Amsterdam, The Netherlands
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
- Correspondence: ; Tel.: +31-204443520
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6
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Heijsters FACJ, van Breda FGF, van Nassau F, van der Steen MKJ, Ter Wee PM, Mullender MG, de Bruijne MC. A pragmatic approach for implementation of value-based healthcare in Amsterdam UMC, the Netherlands. BMC Health Serv Res 2022; 22:550. [PMID: 35468765 PMCID: PMC9040233 DOI: 10.1186/s12913-022-07919-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/05/2022] [Indexed: 11/26/2022] Open
Abstract
Background The emphasis on implementation of value-based healthcare (VBHC) has increased in the Dutch healthcare system. Yet, the translation of the theoretical principles of VBHC towards actual implementation in daily practice has been rarely described. Our aim is to present a pragmatic step-by-step approach for VBHC implementation, developed and applied in Amsterdam UMC, to share our key elements. The approach may inspire others and can be used as a template for implementing VBHC principles in other hospitals. Methods The local approach is developed in a major academic hospital in the Netherlands, based at two locations with 15,000 employees in total. Experience-based co-design is used, building on our learning experiences from implementing VBHC for 14 specific patient groups. The described steps and activities devolved from iterative and participative co-design sessions with various experienced stakeholders involved in the implementation of one or more VBHC pathways. Results The approach includes five phases; preparation, design (team introduction, outcome selection, action agenda), building (outcome set integration in daily practice), implementation (training, outcome registration and implementation) and the continuous improvement cycle. We described two cases for illustration of the approach; the Cleft Lip and Palate and the Chronic Kidney Disease patient groups. For a good start, involvement of a clinical leader as driving force, ensuring participation of patient representatives and sufficient resources are needed. Conclusion We have experienced that several defining features of the development and implementation of this approach may have contributed to its completeness and applicability. Key elements for success have been organisational readiness and clinical leadership. In conclusion, the approach has provided a first step towards VBHC in our hospital. Further research is needed for evaluation of its effectiveness including impact on value for patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07919-1.
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Affiliation(s)
- Florence A C J Heijsters
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan, 1117, Amsterdam, Netherlands. .,Department of Strategy and Innovation, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan, 1117, Amsterdam, Netherlands.
| | - Fenna G F van Breda
- Department of Nephrology, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan, 1117, Amsterdam, Netherlands
| | - Femke van Nassau
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Boelelaan, 1117, Amsterdam, Netherlands
| | - Marije K J van der Steen
- Department of Strategy and Innovation, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan, 1117, Amsterdam, Netherlands
| | - Piet M Ter Wee
- Department of Strategy and Innovation, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan, 1117, Amsterdam, Netherlands.,Department of Nephrology, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan, 1117, Amsterdam, Netherlands
| | - Margriet G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan, 1117, Amsterdam, Netherlands
| | - Martine C de Bruijne
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Boelelaan, 1117, Amsterdam, Netherlands
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Timmermans FW, Mokken SE, Smit JM, Bouman MB, van de Grift TC, Mullender MG, Middelkoop E. The Impact of Incisional Negative Pressure Wound on Scar Quality and Patient Reported Outcomes: a Within-Patient Controlled, Randomized Trial. Wound Repair Regen 2022; 30:210-221. [PMID: 35146830 PMCID: PMC9306814 DOI: 10.1111/wrr.13001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/04/2022] [Accepted: 01/09/2022] [Indexed: 11/28/2022]
Abstract
Literature provides a moderate level of evidence for the beneficial effects of incisional negative pressure wound therapy (iNPWT) on scar quality. The purpose of this study was to establish if iNPWT results in improved scar outcomes in comparison to the standard of care. Therefore, a within‐patient randomised controlled, open‐label trial was conducted in transgender men undergoing gender‐affirming mastectomies. A unilateral side was randomised to receive iNPWT (PICO™, Smith&Nephew) without suction drains and contrastingly the standard dressing (Steri‐Strips™) with suction drain. Scar quality and questionnaires were bilaterally measured by means of objective assessments and patient‐reported outcome measures (PROM) at 1, 3 and 12 months. Objective scar outcomes were scar pliability (Cutometer®), colouration (DSM‐II) and scar width (3‐D imaging). PROM outcomes were related to scars (POSAS and SCAR‐Q) and body satisfaction (BODY‐Q). From 85 included patients, 80 were included for analyses. No significant difference between treatments was seen in the quantitative outcomes of scar pliability, colour, and width. For qualitative scar outcomes, several significant findings for iNPWT were found for several subscales of the POSAS, SCAR‐Q, and BODY‐Q. These effects could not be substantiated with linear mixed‐model regression, signifying no statically more favourable outcome for either treatment option. In conclusion, this study demonstrated that some PROM outcomes were more favourable for the iNPWT compared to standard treatment. In contrast, the quantitative outcomes showed no beneficial effects of iNPWT on scar outcomes. This suggests that iNPWT is of little benefit as a scar‐improving therapy.
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Affiliation(s)
- F W Timmermans
- Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Amsterdam UMC, location VUmc, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands
| | - S E Mokken
- Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Amsterdam UMC, location VUmc, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands
| | - J M Smit
- Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Amsterdam UMC, location VUmc, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands
| | - M B Bouman
- Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Amsterdam UMC, location VUmc, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands.,Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Public Health, Amsterdam, the Netherlands
| | - T C van de Grift
- Amsterdam UMC, location VUmc, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands.,Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Public Health, Amsterdam, the Netherlands
| | - M G Mullender
- Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Amsterdam UMC, location VUmc, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands.,Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Public Health, Amsterdam, the Netherlands
| | - E Middelkoop
- Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Amsterdam UMC, location VUmc, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands.,Association of Dutch Burn Centers, Red Cross Hospital, Vondellaan 13, Beverwijk, the Netherlands
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8
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Elfering L, van de Grift TC, Al-Tamimi M, Timmermans FW, de Haseth KB, Pigot GLS, Lissenberg-Witte BI, Bouman MB, Mullender MG. How Sensitive Is the Neophallus? Postphalloplasty Experienced and Objective Sensitivity in Transmasculine Persons. Sex Med 2021; 9:100413. [PMID: 34425361 PMCID: PMC8498953 DOI: 10.1016/j.esxm.2021.100413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/10/2021] [Accepted: 06/17/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Tactile and erogenous sensitivity of the neophallus after phalloplasty is assumed to affect the sexual well-being of transmasculine persons and, ultimately, their quality of life. The experienced and objective sensation of the neophallus and their association are largely unknown. AIM This study evaluated experienced tactile and erotic sensation of the neophallus in transmasculine persons and investigated how this was related to objective tactile sensitivity. METHODS Between August 2017 and January 2020, 59 transmasculine persons who underwent phalloplasty were recruited to participate in a prospective follow-up study. Tactile sensitivity of the neophallus and donor-site was measured (Semmes-Weinstein Monofilament test) and compared, and participants were asked to fill out a questionnaire about experienced sensation of the neophallus and sexual wellbeing. MAIN OUTCOME MEASURES Experienced and objective sensation of the neophallus were measured by using a questionnaire and Semmes-Weinstein Monofilament scores. RESULTS Neophallic tactile sensitivity was significantly reduced compared to the donor-site (n = 44), with the proximal part being more sensitive than the distal part (median follow-up of 1.8 years, range 1.0-7.2)). Sensitivity of the neophallus was not significantly associated with the surgical flap used, yet increased significantly with follow-up time. The questionnaire was completed by 26 participants of which 24 (92.3%) experienced (some degree of) tactile sensitivity in their neophallus. Erogenous sensation was experienced by 23 (88.5%). Experienced and objectified tactile sensitivity were not significantly correlated (Spearmans's rho = 0.23, P = .26). Answers to open-ended questions showed that results often do not match expectations. CONCLUSION Tactile sensation of the neophallus was reduced in most transmasculine persons and improved slowly over time. A significant association between subjective and objective measures could not be detected. Although experienced sensitivity varied between individuals, the vast majority reported to have tactile and erotic sensitivity in the neophallus.Transmasculine persons should be informed that sensitivity of the neophallus will likely be reduced. Elfering L, van de Grift TC, Al-Tamimi M, et al. How Sensitive Is the Neophallus? Postphalloplasty Experienced and Objective Sensitivity in Transmasculine Persons. Sex Med 2021;9:100413.
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Affiliation(s)
- Lian Elfering
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Tim C van de Grift
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands; Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam UMC, Amsterdam, The Netherlands
| | - Muhammed Al-Tamimi
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Floyd W Timmermans
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Kristin B de Haseth
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Garry L S Pigot
- Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands; Department of Urology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - Mark-Bram Bouman
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Margriet G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
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9
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Timmermans FW, Mokken SE, Smit JM, Zwanenburg PR, van Hout N, Bouman MB, Middelkoop E, Mullender MG. Within-patient randomized clinical trial comparing incisional negative-pressure wound therapy with suction drains in gender-affirming mastectomies. Br J Surg 2021; 108:925-933. [PMID: 34244715 PMCID: PMC10364878 DOI: 10.1093/bjs/znab204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/06/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Incisional negative-pressure wound therapy (iNPWT) is widely adopted by different disciplines for multiple indications. Questions about the most appropriate uses and value of iNPWT have been raised. METHODS An open-label within-patient RCT was conducted in transgender men undergoing gender-affirming mastectomies. The objective was to determine the effect of iNPWT as a substitute for standard dressing and suction drains on wound healing complications. One chest side was randomized to receive the iNPWT intervention, and the other to standard dressing with suction drain. The primary endpoints were wound healing complications (haematoma, seroma, infection, and dehiscence) after three months. Additional outcomes were pain according to a numerical rating scale and patient satisfaction one week after surgery. RESULTS Eighty-five patients were included, of whom 81 received both the iNPWT and standard treatment. Drain removal criteria were met within 24 h in 95 per cent of the patients. No significant decrease in wound healing complications was registered on the iNPWT side, but the seroma rate was significantly increased. In contrast, patients experienced both significantly less pain and increased comfort on the iNPWT side. No medical device-related adverse events were registered. CONCLUSION Substituting short-term suction drains with iNPWT in gender-affirming mastectomies increased the seroma rates and did not decrease the amount of wound healing complications. Registration number: NTR7412 (Netherlands Trial Register).
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Affiliation(s)
- F W Timmermans
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Centre of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - S E Mokken
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Centre of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands
| | - J M Smit
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Centre of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, the Netherlands
| | - P R Zwanenburg
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, the Netherlands
| | - N van Hout
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Centre of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, the Netherlands
| | - M B Bouman
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Centre of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, the Netherlands
| | - E Middelkoop
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, the Netherlands
| | - M G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Centre of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, the Netherlands
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10
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Hendriks TCC, Botman M, Binnerts JJ, Mtui GS, Nuwass EQ, Niemeijer AS, Mullender MG, Winters HAH, Nieuwenhuis MK, van Zuijlen PPM. The development of burn scar contractures and impact on joint function, disability and quality of life in low- and middle-income countries: A prospective cohort study with one-year follow-up. Burns 2021; 48:215-227. [PMID: 34716045 DOI: 10.1016/j.burns.2021.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/04/2021] [Accepted: 04/23/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The aim of this study was to assess the development of burn scar contractures and their impact on joint function, disability and quality of life in a low-income country. METHODS Patients with severe burns were eligible. Passive range of motion (ROM) was assessed using lateral goniometry. To assess the development of contractures, the measured ROM was compared to the normal ROM. To determine joint function, the normal ROM was compared to the functional ROM. In addition, disability and quality of life (QoL) were assessed. Assessments were from admission up to 12 months after injury. RESULTS Thirty-six patients were enrolled, with a total of 124 affected joints. The follow-up rate was 83%. Limited ROM compared to normal ROM values was observed in 26/104 joints (25%) at 12 months. Limited functional ROM was observed in 55/115 joints (48%) at discharge and decreased to 22/98 joints (22%) at 12 months. Patients who had a contracture at 12 months reported more disability and lower QoL, compared to patients without a contracture (median disability 0.28 versus 0.17 (p = 0.01); QoL median 0.60 versus 0.76 (p = 0.001)). Significant predictors of developing joint contractures were patient delay and the percentage of TBSA deep burns. CONCLUSION The prevalence of burn scar contractures was high in a low-income country. The joints with burn scar contracture were frequently limited in function. Patients who developed a contracture reported significantly more disability and lower QoL. To limit the development of burn scar contractures, timely access to safe burn care should be improved in low-income countries.
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Affiliation(s)
- T C C Hendriks
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (Location VU), Amsterdam, The Netherlands; Haydom Lutheran Hospital, Haydom, Tanzania; Global Surgery Amsterdam, The Netherlands; Doctors of the World, The Netherlands.
| | - M Botman
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (Location VU), Amsterdam, The Netherlands; Global Surgery Amsterdam, The Netherlands; Doctors of the World, The Netherlands
| | | | - G S Mtui
- Haydom Lutheran Hospital, Haydom, Tanzania; Global Surgery Amsterdam, The Netherlands
| | - E Q Nuwass
- Haydom Lutheran Hospital, Haydom, Tanzania; Global Surgery Amsterdam, The Netherlands
| | - A S Niemeijer
- Association of Dutch Burn Centers, Burn Center, The Netherlands; Burn Center, Martini Hospital, Groningen, The Netherlands
| | - M G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (Location VU), Amsterdam, The Netherlands
| | - H A H Winters
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (Location VU), Amsterdam, The Netherlands; Global Surgery Amsterdam, The Netherlands
| | - M K Nieuwenhuis
- Association of Dutch Burn Centers, Burn Center, The Netherlands; Burn Center, Martini Hospital, Groningen, The Netherlands
| | - P P M van Zuijlen
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (Location VU), Amsterdam, The Netherlands; Global Surgery Amsterdam, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands; Pediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, Location AMC and VUmc, Amsterdam, The Netherlands
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11
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Pigot GL, Al-Tamimi M, Nieuwenhuijzen JA, van der Sluis WB, Moorselaar RAV, Mullender MG, van de Grift TC, Bouman MB. Genital Gender-Affirming Surgery Without Urethral Lengthening in Transgender Men—A Clinical Follow-Up Study on the Surgical and Urological Outcomes and Patient Satisfaction. J Sex Med 2020; 17:2478-2487. [DOI: 10.1016/j.jsxm.2020.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
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12
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van de Grift TC, van Gelder ZJ, Mullender MG, Steensma TD, de Vries ALC, Bouman MB. Timing of Puberty Suppression and Surgical Options for Transgender Youth. Pediatrics 2020; 146:peds.2019-3653. [PMID: 33106340 DOI: 10.1542/peds.2019-3653] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Puberty suppression (PS) is a cornerstone of treatment in youth experiencing gender dysphoria. In this study, we aim to inform prescribing professionals on the long-term effects of PS treatment on the development of sex characteristics and surgical implications. METHODS Participants received PS according to the Endocrine Society guideline at Tanner 2 or higher. Data were collected from adolescents who received PS between 2006 and 2013 and from untreated transgender controls. Data collection pre- and post-PS and before surgery included physical examination and surgical information. RESULTS In total, 300 individuals (184 transgender men and 116 transgender women) were included. Of these, 43 individuals started PS treatment at Tanner 2/3, 157 at Tanner 4/5, and 100 used no PS (controls). Breast development was significantly less in transgender men who started PS at Tanner 2/3 compared with those who started at Tanner 4/5 and controls. Mastectomy was more frequently omitted or less invasive after PS. In transgender women, the mean penile length was significantly shorter in the PS groups compared with controls (by 4.8 cm [Tanner 2/3] and 2.1 cm [Tanner 4/5]). As a result, the likelihood of undergoing intestinal vaginoplasty was increased (odds ratio = 84 [Tanner 2/3]; odds ratio = 9.8 [Tanner 4/5]). CONCLUSIONS PS reduces the development of sex characteristics in transgender adolescents. As a result, transgender men may not need to undergo mastectomy, whereas transgender women may require an alternative to penile inversion vaginoplasty. These surgical implications should inform decision-making when initiating PS.
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Affiliation(s)
- Tim C van de Grift
- Departments of Plastic, Reconstructive and Hand Surgery, .,Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Medical Psychology and Sexology, and
| | | | - Margriet G Mullender
- Departments of Plastic, Reconstructive and Hand Surgery.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Thomas D Steensma
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Medical Psychology and Sexology, and
| | - Annelou L C de Vries
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Child and Adolescent Psychiatry, Vrije Universiteit Medical Center, Amsterdam, Netherlands; and
| | - Mark-Bram Bouman
- Departments of Plastic, Reconstructive and Hand Surgery.,Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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13
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Pigot GL, Al-Tamimi M, van der Sluis WB, Ronkes B, Mullender MG, Bouman MB. Scrotal Reconstruction in Transgender Men Undergoing Genital Gender Affirming Surgery Without Urethral Lenghtening: A Stepwise Approach. Urology 2020; 146:303. [PMID: 32980404 DOI: 10.1016/j.urology.2020.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Scrotal (re)construction, scrotoplasty, is performed as part of gender affirming surgery in transgender men. OBJECTIVE To describe, step-by-step, our scrotal reconstruction technique in transgender men undergoing genital gender affirming surgery without urethral lengthening. MATERIAL AND METHODS A 29-year-old transgender men underwent scrotal reconstruction and phalloplasty without urethral lengthening. For this purpose, the traditional scrotal reconstruction technique in patients that undergo urethral lengthening was modified. The patient is placed in lithotomy position. A pedicled horseshoe-shaped pubic flap, clitoral hood, and U-shaped labia majora flaps are used for scrotal reconstruction. The inner part of the labia minora (this is used to reconstruct the fixed part of the neourethra) is resected. The cranially pedicled U-shaped labia majora flaps are rotated 90 degrees medially to bring the neo-scrotum in front of the legs. Pedicled labia majora fat pads are released bilaterally and relocated in the neo-scrotum to achieve bulkiness. The meatus and vaginal orifice are diverted underneath the scrotum and a perineostomy is performed. RESULTS We present our scrotoplasty technique as a step-by-step video guide. The technique results in the reconstruction of a perineostomy at the perineal scrotal transition, an augmented neo-scrotum, minimal visible scars, and proper neo-perineal length. CONCLUSION Scrotal reconstruction using a horseshoe-shaped pedicled pubic flap, labia majora fat pads, and 2 cranially pedicled U-shaped labia majora flaps results in a neo-scrotum that resembles the biological scrotum closely in terms of bulkiness, size, shape, tactile sensation, and anatomical position.
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Affiliation(s)
- Garry L Pigot
- Department of Urology, VU University Medical Centre, Amsterdam, The Netherlands; Centre of Expertise on Gender Dysphoria, VU University Medical Centre, Amsterdam, The Netherlands; Amsterdam Public Health research institute, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Muhammed Al-Tamimi
- Department of Urology, VU University Medical Centre, Amsterdam, The Netherlands; Amsterdam Public Health research institute, Amsterdam UMC, VU University, Amsterdam, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
| | - Wouter B van der Sluis
- Centre of Expertise on Gender Dysphoria, VU University Medical Centre, Amsterdam, The Netherlands; Amsterdam Public Health research institute, Amsterdam UMC, VU University, Amsterdam, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - Brechje Ronkes
- Department of Urology, VU University Medical Centre, Amsterdam, The Netherlands; Centre of Expertise on Gender Dysphoria, VU University Medical Centre, Amsterdam, The Netherlands
| | - Margriet G Mullender
- Centre of Expertise on Gender Dysphoria, VU University Medical Centre, Amsterdam, The Netherlands; Amsterdam Public Health research institute, Amsterdam UMC, VU University, Amsterdam, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - Mark-Bram Bouman
- Centre of Expertise on Gender Dysphoria, VU University Medical Centre, Amsterdam, The Netherlands; Amsterdam Public Health research institute, Amsterdam UMC, VU University, Amsterdam, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands
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14
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Pigot GL, Belboukhaddaoui S, Bouman MB, Meuleman EJ, de Boer EM, Buncamper ME, Ronkes B, Mullender MG, Nieuwenhuijzen JA. Effectiveness of Preoperative Depilation of the Urethral Donor Site for Phalloplasty: Neourethral Hair Growth and its Effects on Voiding. Eur Urol Focus 2020; 6:770-775. [DOI: 10.1016/j.euf.2019.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 03/17/2019] [Accepted: 04/10/2019] [Indexed: 11/27/2022]
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15
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van de Grift TC, Mureau MAM, Negenborn VN, Dikmans REG, Bouman MB, Mullender MG. Predictors of women's sexual outcomes after implant-based breast reconstruction. Psychooncology 2020; 29:1272-1279. [PMID: 32419285 PMCID: PMC7496883 DOI: 10.1002/pon.5415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/30/2020] [Accepted: 05/11/2020] [Indexed: 11/05/2022]
Abstract
Objective Although breast reconstruction has become an important treatment modality following mastectomy, few studies assessed predictors of postoperative sexual outcomes after breast reconstruction. Therefore, we aimed to study three sexual outcomes following implant‐based breast reconstruction (IBBR), and associate multiple biopsychosocial factors with these outcomes. Methods Data collection was part of a multicenter prospective study on IBBR. A predictive model was tested including medical, background and psychological predictors, partner relationship factors and physical sexual function. Data collection included clinical and questionnaire data (preoperatively and 1 year following reconstruction) using the BREAST‐Q Sexual well‐being scale (BQ5), and questions regarding sexual dysfunction and sexual satisfaction questions (Female Sexual Function Index). Results The study sample consisted of 88 women who underwent mastectomy and IBBR. Mean postoperative BQ5 scores were lower than before surgery (M = 58 [SD = 18] vs 65 [SD = 20]; P = .01, Wilks' Lamdba = .88). Sexual dysfunctions were related strongest to orgasm inability and vaginal lubrication issues. The tested models predicted 37%‐46% of the sexual outcomes: sexual outcomes were mostly predicted by psychosocial well‐being, physical sexual function and partner support. Preoperative sexual and psychosocial well‐being were positively associated with postoperative sexual well‐being (r = 0.45 and r = 0.47). Conclusions Although moderately positive sexual outcomes were reported after IBBR, some women reported issues with vaginal lubrication, breast sensation and orgasm. Sexual dysfunctions were predicted by vaginal lubrication and medical treatments, while sexual well‐being and satisfaction were more predicted by psychosocial well‐being and partner support. We advocate supportive care that includes partners and psychosocial functioning to optimize sexual outcomes after IBBR.
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Affiliation(s)
- Tim C van de Grift
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center (VUmc), Amsterdam, The Netherlands.,Department Medical Psychology and Sexology, Amsterdam University Medical Center (VUmc), Amsterdam, The Netherlands.,Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | - Marc A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Vera N Negenborn
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center (VUmc), Amsterdam, The Netherlands
| | | | - Mark-Bram Bouman
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center (VUmc), Amsterdam, The Netherlands.,Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | - Margriet G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Center (VUmc), Amsterdam, The Netherlands.,Amsterdam Public Health Institute, Amsterdam, The Netherlands
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16
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Elfering L, van de Grift TC, Bouman MB, van Mello NM, Groenman FA, Huirne JA, Budiman IYW, Goijen LDJ, van Loenen DKG, Mullender MG. Combining total laparoscopic hysterectomy and bilateral salpingo-oophorectomy with subcutaneous mastectomy in trans men: The effect on safety outcomes. Int J Transgend Health 2020; 21:138-146. [PMID: 33015665 PMCID: PMC7430461 DOI: 10.1080/26895269.2020.1751014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Background: Masculinizing mastectomy is the most requested gender affirming surgery (GAS) in trans men, followed by genital GAS. Mastectomy and total laparoscopic hysterectomy, with or without bilateral salpingo-oophorectomy (TLH ± BSO), can both be performed in one single operation session. However, data on complication rates of the combined procedure is scarce and no consensus exists on the preferred order of procedures. Aims: To compare safety outcomes between mastectomy performed in a single procedure with those when performed in a combined procedure and assess whether the order of procedures matters when they are combined. Methods: A retrospective chart review was performed of trans men who underwent masculinizing mastectomy with or without TLH ± BSO in a combined session. The effects of the surgical procedure on complication and reoperation rate of the chest were assessed using logistic regression. Results: In total, 480 trans men were included in the study. Of these, 212 patients underwent the combined procedure. The gynecological procedure was performed first in 152 (71.7%) patients. In the total sample, postoperative hematoma of the chest occurred in 11.3%; 16% in the combined versus 7.5% in the single mastectomy group (p = 0.001). Reoperations due to hematoma of the chest were performed in 7.5% of all patients; 10.8% in the combined versus 4.9% in the single mastectomy group (p = 0.017). The order of procedures in the combined group had no significant effect on postoperative hematoma of the chest (p = 0.856), and reoperations (p = 0.689). Conclusion: Combining masculinizing mastectomy with TLH ± BSO in one session was associated with significantly more hematoma and reoperations compared with separately performing mastectomy. This increased risk of complications after a combined procedure should be considered when deciding on surgical options. The order of procedures in a combined procedure did not have an effect on safety outcomes.
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Affiliation(s)
- Lian Elfering
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Tim C. van de Grift
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam UMC, Amsterdam, The Netherlands
| | - Mark-Bram Bouman
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Norah M. van Mello
- Department of Obstetrics and Gynecology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Freek A. Groenman
- Department of Obstetrics and Gynecology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Judith A. Huirne
- Department of Obstetrics and Gynecology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ivo Y. W. Budiman
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Linde D. J. Goijen
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Margriet G. Mullender
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
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17
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Al-Tamimi M, Pigot GL, Ronkes B, de Haseth KB, van de Grift TC, van Moorselaar RJA, Mullender MG, Stojanovic B, van der Sluis WB, Djordjevic M, Bouman MB. The First Experience of Using the Pedicled Labia Minora Flap for Urethral Lengthening in Transgender Men Undergoing Anterolateral Thigh and Superficial Circumflex Iliac Artery Perforator Flap Phalloplasty: A Multicenter Study on Clinical Outcomes. Urology 2020; 138:179-187. [PMID: 31911083 DOI: 10.1016/j.urology.2019.10.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/10/2019] [Accepted: 10/12/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To describe the novel surgical technique of urethral lengthening in anterolateral thigh and superficial circumflex iliac artery perforator flap phalloplasty with a pedicled labia minora flap (PLMF) and report on the clinical outcomes. METHODS Between March 2014 and August 2018, 16 transgender men underwent phalloplasty with a PLMF for urethral lengthening at the Amsterdam UMC (VU university), the Netherlands and the Belgrade University Hospital, Serbia. Patient demographics, surgical characteristics, neourethra characteristics, intra- and postoperative complications, pre-and postoperative voiding evaluation, and the length of hospital stay were retrospectively identified from chart reviews. RESULTS The mean neourethral length was 16.8 ± 2.3 cm, and the pars pendulans 11.7 ± 2.2 cm. The neomeatus was localized on top of the neophallus in 12 (75%) patients. No intraoperative complications occurred. Urethral fistula formation occurred in 4 (25%) patients and strictures in 6 (37.5%) patients. In 3 (18.7%) patients a (temporary) perineostomy had to be performed. Voiding from a standing position was possible in 9 (56.3%) patients. CONCLUSION The PLMF for urethral reconstruction, both pars fixa and pars pendulans, in phalloplasty is a feasible surgical technique in transgender men undergoing anterolateral thigh or superficial circumflex iliac artery perforator flap phalloplasty with sufficient labia minora tissue.
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Affiliation(s)
- Muhammed Al-Tamimi
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, VU University, Amsterdam, The Netherlands; Department of Urology, Amsterdam UMC, VU University, Amsterdam, The Netherlands; Amsterdam Public Health research institute, Amsterdam UMC, VU University, Amsterdam, The Netherlands.
| | - Garry L Pigot
- Department of Urology, Amsterdam UMC, VU University, Amsterdam, The Netherlands; Amsterdam Public Health research institute, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Brechje Ronkes
- Department of Urology, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Kristin B de Haseth
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, VU University, Amsterdam, The Netherlands; Centre of Expertise on Gender Dysphoria, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Tim C van de Grift
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, VU University, Amsterdam, The Netherlands; Amsterdam Public Health research institute, Amsterdam UMC, VU University, Amsterdam, The Netherlands; Centre of Expertise on Gender Dysphoria, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | | | - Margriet G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, VU University, Amsterdam, The Netherlands; Amsterdam Public Health research institute, Amsterdam UMC, VU University, Amsterdam, The Netherlands; Centre of Expertise on Gender Dysphoria, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Borko Stojanovic
- Department of Urology, Belgrade University Hospital, Belgrade, Serbia
| | - Wouter B van der Sluis
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, VU University, Amsterdam, The Netherlands; Amsterdam Public Health research institute, Amsterdam UMC, VU University, Amsterdam, The Netherlands; Centre of Expertise on Gender Dysphoria, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | | | - Mark-Bram Bouman
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, VU University, Amsterdam, The Netherlands; Amsterdam Public Health research institute, Amsterdam UMC, VU University, Amsterdam, The Netherlands; Centre of Expertise on Gender Dysphoria, Amsterdam UMC, VU University, Amsterdam, The Netherlands
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van der Sluis WB, de Haseth KB, Elfering L, Özer M, Smit JM, Budding AE, van Bodegraven AA, Buncamper ME, de Boer NKH, Mullender MG, Bouman MB. Neovaginal discharge in transgender women after vaginoplasty: A diagnostic and treatment algorithm. Int J Transgend Health 2020; 21:367-372. [PMID: 34993515 PMCID: PMC8726601 DOI: 10.1080/26895269.2020.1725710] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
- Wouter B van der Sluis
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Kristin B de Haseth
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Lian Elfering
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Müjde Özer
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jan Maerten Smit
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Andries E Budding
- Department of Medical Microbiology and Infection Control, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Adriaan A van Bodegraven
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Department of Gastroenterology, Geriatrics, Intensive Care and Internal Medicine, Zuyderland Medical Centre, Geleen, The Netherlands
| | - Marlon E Buncamper
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
| | - Nanne K H de Boer
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Margriet G Mullender
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Mark-Bram Bouman
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
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19
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Al-Tamimi M, Pigot GL, van der Sluis WB, van de Grift TC, van Moorselaar RJA, Mullender MG, Weigert R, Buncamper ME, Özer M, de Haseth KB, Djordjevic ML, Salgado CJ, Belanger M, Suominen S, Kolehmainen M, Santucci RA, Crane CN, Claes KE, Monstrey S, Bouman MB. The Surgical Techniques and Outcomes of Secondary Phalloplasty After Metoidioplasty in Transgender Men: An International, Multi-Center Case Series. J Sex Med 2019; 16:1849-1859. [DOI: 10.1016/j.jsxm.2019.07.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/19/2019] [Accepted: 07/31/2019] [Indexed: 10/26/2022]
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20
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Hendriks TCC, Botman M, Rahmee CNS, Ket JCF, Mullender MG, Gerretsen B, Nuwass EQ, Marck KW, Winters HAH. Impact of short-term reconstructive surgical missions: a systematic review. BMJ Glob Health 2019; 4:e001176. [PMID: 31139438 PMCID: PMC6509599 DOI: 10.1136/bmjgh-2018-001176] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/19/2019] [Accepted: 01/25/2019] [Indexed: 01/04/2023] Open
Abstract
Introduction Short-term missions providing patients in low-income countries with reconstructive surgery are often criticised because evidence of their value is lacking. This study aims to assess the effectiveness of short-term reconstructive surgical missions in low-income and middle-income countries. Methods A systematic review was conducted according to PRISMA guidelines. We searched five medical databases from inception up to 2 July 2018. Original studies of short-term reconstructive surgical missions were included, which reported data on patient safety measurements, health gains of individual patients and sustainability. Data were combined to generate overall outcomes, including overall complication rates. Results Of 1662 identified studies, 41 met full inclusion criteria, which included 48 546 patients. The overall study quality according to Oxford CEBM and GRADE was low. Ten studies reported a minimum of 6 months’ follow-up, showing a follow-up rate of 56.0% and a complication rate of 22.3%. Twelve studies that did not report on duration or follow-up rate reported a complication rate of 1.2%. Fifteen out of 20 studies (75%) that reported on follow-up also reported on sustainable characteristics. Conclusions Evidence on the patient outcomes of reconstructive surgical missions is scarce and of limited quality. Higher complication rates were reported in studies which explicitly mentioned the duration and rate of follow-up. Studies with a low follow-up quality might be under-reporting complication rates and overestimating the positive impact of missions. This review indicates that missions should develop towards sustainable partnerships. These partnerships should provide quality aftercare, perform outcome research and build the surgical capacity of local healthcare systems. PROSPERO registration number CRD42018099285.
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Affiliation(s)
- Thom C C Hendriks
- Plastic, Reconstructive and Hand Surgery, VU Medisch Centrum, Amsterdam, The Netherlands.,Global Surgery Amsterdam, Amsterdam, The Netherlands
| | - Matthijs Botman
- Plastic, Reconstructive and Hand Surgery, VU Medisch Centrum, Amsterdam, The Netherlands.,Global Surgery Amsterdam, Amsterdam, The Netherlands
| | - Charissa N S Rahmee
- Plastic, Reconstructive and Hand Surgery, VU Medisch Centrum, Amsterdam, The Netherlands.,Global Surgery Amsterdam, Amsterdam, The Netherlands
| | | | - Margriet G Mullender
- Plastic, Reconstructive and Hand Surgery, VU Medisch Centrum, Amsterdam, The Netherlands
| | | | - Emanuel Q Nuwass
- Department of Surgery, Haydom Lutheran Hospital, Haydom, Tanzania
| | - Klaas W Marck
- Department of Plastic Surgery, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Henri A H Winters
- Plastic, Reconstructive and Hand Surgery, VU Medisch Centrum, Amsterdam, The Netherlands.,Global Surgery Amsterdam, Amsterdam, The Netherlands
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21
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Negenborn VL, Smit JM, Dikmans REG, Winters HAH, Twisk JWR, Ruhé PQ, Mureau MAM, Tuinder S, Eltahir Y, Posch NAS, van Steveninck-Barends JM, van der Hulst RRWJ, Ritt MJPF, Bouman MB, Mullender MG. Short-term cost-effectiveness of one-stage implant-based breast reconstruction with an acellular dermal matrix versus two-stage expander-implant reconstruction from a multicentre randomized clinical trial. Br J Surg 2019; 106:586-595. [PMID: 30835827 PMCID: PMC6593424 DOI: 10.1002/bjs.11102] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 10/11/2018] [Accepted: 12/02/2018] [Indexed: 11/25/2022]
Abstract
Background Implant‐based breast reconstruction (IBBR) is the most commonly performed reconstructive procedure and its economic impact is significant. This study aimed to analyse whether a direct one‐stage IBBR with use of an acellular dermal matrix (ADM) is more cost‐effective than two‐stage (expander‐implant) breast reconstruction. Methods The BRIOS (Breast Reconstruction In One Stage) study was an open‐label multicentre RCT in which women scheduled for skin‐sparing mastectomy and immediate IBBR were randomized between one‐stage IBBR with ADM or two‐stage IBBR. Duration of surgery and hospital stay, and visits for the primary surgery, unplanned and cosmetic procedures were recorded. Costs were estimated at an institutional level. Health status was assessed by means of the EuroQol Five Dimensions 5L questionnaire. Results Fifty‐nine patients (91 breasts) underwent one‐stage IBBR with ADM and 62 patients (92 breasts) two‐stage IBBR. The mean(s.d.) duration of surgery in the one‐stage group was significantly longer than that for two‐stage IBBR for unilateral (2·52(0·55) versus 2·02(0·35) h; P < 0·001) and bilateral (4·03(1·00) versus 3·25(0·58) h; P = 0·017) reconstructions. Costs were higher for one‐stage compared with two‐stage IBBR for both unilateral (€12 448 (95 per cent c.i. 10 722 to 14 387) versus €9871 (9373 to 10 445) respectively; P = 0·025) and bilateral (€16 939 (14 887 to 19 360) versus €13 383 (12 414 to 14 669); P = 0·002) reconstructions. This was partly related to the use of relatively expensive ADM. There was no difference in postoperative health status between the groups. Conclusion One‐stage IBBR with ADM was associated with higher costs, but similar health status, compared with conventional two‐stage IBBR. Registration number: NTR5446 (
http://www.trialregister.nl).
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Affiliation(s)
- V L Negenborn
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, the Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - J M Smit
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, the Netherlands.,Alexander Monro Breast Cancer Hospital, Bilthoven, the Netherlands
| | - R E G Dikmans
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, the Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - H A H Winters
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, the Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.,Alexander Monro Breast Cancer Hospital, Bilthoven, the Netherlands
| | - J W R Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, the Netherlands
| | - P Q Ruhé
- Department of Plastic, Reconstructive and Hand Surgery, Meander Medical Centre, Amersfoort, the Netherlands
| | - M A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - S Tuinder
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Y Eltahir
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - N A S Posch
- Department of Plastic, Reconstructive and Hand Surgery, Haga Ziekenhuis, Den Haag, the Netherlands
| | | | - R R W J van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Orbis Medical Centrum, Sittard, the Netherlands
| | - M J P F Ritt
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, the Netherlands
| | - M-B Bouman
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, the Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.,Alexander Monro Breast Cancer Hospital, Bilthoven, the Netherlands
| | - M G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, the Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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22
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van de Grift TC, Pigot GLS, Kreukels BPC, Bouman MB, Mullender MG. Transmen's Experienced Sexuality and Genital Gender-Affirming Surgery: Findings From a Clinical Follow-Up Study. J Sex Marital Ther 2019; 45:201-205. [PMID: 30672387 DOI: 10.1080/0092623x.2018.1500405] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Genital gender-affirming surgery (GAS) aims to alleviate feelings of gender dysphoria and support psychosexual outcomes. However, little is known of sexual activity and satisfaction of transmen after phalloplasty or metoidioplasty. A clinical follow-up study was conducted in transmen at least one year after genital GAS in order to evaluate measures of experienced sexuality. Participants (N = 38) received a set of self-constructed questionnaires on sexual relationships and orientation, use of genitals during sexual contact, and the experienced influence of surgery on sexuality. Twenty-nine had received phalloplasty, nine metoidioplasty. The average follow-up time was 32 months. The majority reported to be sexually active. The use and enjoyment of both chest and genitals during sexual activity increased after surgery. Other areas of improvement included arousability, sexual interest, and pleasure. Free text comments provided an insight into the role of genital sensation and sexual self-esteem in postoperative sexuality. In conclusion, genital GAS positively impacts transmen's sexuality, although possible issues with genital sensation or penetration may exist and should be communicated preoperatively. Therefore, we recommend interdisciplinary collaboration on this subject.
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Affiliation(s)
- Tim C van de Grift
- a Department of Plastic, Reconstructive and Hand Surgery , VU University Medical Center , Amsterdam , The Netherlands
- b Department of Medical Psychology, Section Gender and Sexology , VU University Medical Center , Amsterdam , The Netherlands
| | - Garry L S Pigot
- c Department of Urology , VU University Medical Center , Amsterdam , The Netherlands
| | - Baudewijntje P C Kreukels
- b Department of Medical Psychology, Section Gender and Sexology , VU University Medical Center , Amsterdam , The Netherlands
- d Amsterdam Public Health Research Institute , Amsterdam , The Netherlands
| | - Mark-Bram Bouman
- a Department of Plastic, Reconstructive and Hand Surgery , VU University Medical Center , Amsterdam , The Netherlands
| | - Margriet G Mullender
- a Department of Plastic, Reconstructive and Hand Surgery , VU University Medical Center , Amsterdam , The Netherlands
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23
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Dikmans RE, Krouwel EM, Ghasemi M, van de Grift TC, Bouman MB, Ritt MJPF, Elzevier HW, Mullender MG. Discussing sexuality in the field of plastic and reconstructive surgery: a national survey of current practice in the Netherlands. Eur J Plast Surg 2018; 41:707-714. [PMID: 30524177 PMCID: PMC6244988 DOI: 10.1007/s00238-018-1452-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/08/2018] [Indexed: 12/21/2022]
Abstract
Background Patient-reported outcomes have become increasingly important to assess the value of surgical procedures. Sexual function is a proven important constituent of quality of life, but is often overlooked by health care professionals. We aim to investigate to what extent plastic surgeons address or discuss issues concerning sexuality with their patients, and if there is a need for improvement. Methods We developed a survey to assess whether topics pertaining to sexual function were discussed during plastic surgical consultations. In 2016, all 385 members of the Dutch Association for Plastic Surgery were invited via post mail to participate. Results We received 106 completed surveys (27.5%). The median age of the respondents was 45 (29–66) years. Most participants (78.3%) indicated that they rarely to never discuss sexuality with their patients. Surgeons in the subspecialization gender and genital surgery discussed sexual function most frequently. Two thirds of all respondents indicated that their current knowledge on this topic was insufficient, yet there was generally no interest expressed in receiving additional training (78.6%). However, there was a need for proper patient brochures (43.4%) and an organized referral network (36.5%) regarding sexuality. Conclusions In plastic surgery practice, sexuality appears to be a rarely discussed subject, with the gender and genital surgery subspecialties as the exception. Although professionals and patients emphasize the importance of sexuality, plastic surgeons express limited urge to be trained and prefer written patient information and referring patients to other healthcare professionals. The authors stimulate more education on sexuality during (continued) plastic surgery training. Level of Evidence: Not ratable
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Affiliation(s)
- Rieky E Dikmans
- 1Department of Plastic Reconstructive and Hand Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, Netherlands
| | - Esmée M Krouwel
- 2Department of Urology and Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
| | - Mahsa Ghasemi
- 1Department of Plastic Reconstructive and Hand Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, Netherlands
| | - Tim C van de Grift
- 1Department of Plastic Reconstructive and Hand Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, Netherlands.,3Department of Medical Psychology, VU University Medical Center, Amsterdam, Netherlands
| | - Mark-Bram Bouman
- 1Department of Plastic Reconstructive and Hand Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, Netherlands
| | - Marco J P F Ritt
- 1Department of Plastic Reconstructive and Hand Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, Netherlands
| | - Henk W Elzevier
- 2Department of Urology and Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
| | - Margriet G Mullender
- 1Department of Plastic Reconstructive and Hand Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, Netherlands
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24
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Dikmans REG, van de Grift TC, Bouman MB, Pusic AL, Mullender MG. Sexuality, a topic that surgeons should discuss with women before risk-reducing mastectomy and breast reconstruction. Breast 2018; 43:120-122. [PMID: 30550924 DOI: 10.1016/j.breast.2018.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/28/2018] [Accepted: 12/03/2018] [Indexed: 11/19/2022] Open
Abstract
While sexual health is an important aspect of quality of life, sexual issues usually go unaddressed during patient-provider communication. Breast cancer treatments and specifically breast surgery impact women's sexual well-being. However, women do not receive adequate information on this subject. Women who underwent prophylactic mastectomy and breast reconstruction invariably reported that they had underestimated the impact of mastectomy and reconstruction on their sexuality, and expressed a need for information and creating realistic expectations pertaining to sexuality. Therefore, we urge breast surgeons to take the lead in addressing sexuality along with other health-related quality-of-life outcomes during pre-operative consultation.
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Affiliation(s)
- Rieky E G Dikmans
- Department of Plastic, Reconstructive and Hand Surgery, VUmc, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, the Netherlands
| | - Tim C van de Grift
- Department of Plastic, Reconstructive and Hand Surgery, VUmc, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, the Netherlands.
| | - Mark-Bram Bouman
- Department of Plastic, Reconstructive and Hand Surgery, VUmc, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, the Netherlands
| | - Andrea L Pusic
- Department of Surgery, Brigham and Women's Hospital, Boston MA, USA
| | - Margriet G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, VUmc, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, the Netherlands
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25
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Al-Tamimi M, Pigot GL, van der Sluis WB, van de Grift TC, Mullender MG, Groenman F, Bouman MB. Colpectomy Significantly Reduces the Risk of Urethral Fistula Formation after Urethral Lengthening in Transgender Men Undergoing Genital Gender Affirming Surgery. J Urol 2018; 200:1315-1322. [DOI: 10.1016/j.juro.2018.07.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Muhammed Al-Tamimi
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
- Department of Urology, VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Garry L. Pigot
- Department of Urology, VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Wouter B. van der Sluis
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Tim C. van de Grift
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Centre of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Margriet G. Mullender
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Centre of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Freek Groenman
- Department of Gynecology, VU University Medical Center, Amsterdam, The Netherlands
| | - Mark-Bram Bouman
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Centre of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
- Gender Surgery Amsterdam, Amsterdam, The Netherlands
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26
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Negenborn VL, van Turnhout AAWM, Fuchs SP, Lisabeth-Broné K, Vermulst N, Vogten JM, Twisk JWR, Vriens-Nieuwenhuis EJC, Mullender MG, van der Sluis WB. A retrospective study on surgical outcomes and patient satisfaction of EGIS ® ADM in one-stage implant-based breast reconstruction. J Plast Reconstr Aesthet Surg 2018; 72:137-171. [PMID: 30446418 DOI: 10.1016/j.bjps.2018.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 10/08/2018] [Accepted: 10/28/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Vera L Negenborn
- Department of Plastic, Reconstructive & Hand Surgery, VU University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; EMGO Institute for Health and Care Research Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Arjen A W M van Turnhout
- Department of Plastic, Reconstructive and Hand Surgery, Tergooi Hospital, Van Riebeeckweg 212, 1213 XZ Hilversum, The Netherlands
| | - Saskia P Fuchs
- Department of Plastic, Reconstructive and Hand Surgery, Tergooi Hospital, Van Riebeeckweg 212, 1213 XZ Hilversum, The Netherlands
| | - Kristel Lisabeth-Broné
- Department of Plastic, Reconstructive and Hand Surgery, Tergooi Hospital, Van Riebeeckweg 212, 1213 XZ Hilversum, The Netherlands
| | - Nieke Vermulst
- Department of Surgery, Tergooi Hospital, Van Riebeeckweg 212, 1213 XZ Hilversum, The Netherlands
| | - Jan M Vogten
- Department of Surgery, Tergooi Hospital, Van Riebeeckweg 212, 1213 XZ Hilversum, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology & Biostatistics, VU University Medical Centre, De Boelelaan 1089, 1081 HV Amsterdam, The Netherlands
| | | | - Margriet G Mullender
- Department of Plastic, Reconstructive & Hand Surgery, VU University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; MOVE Research Institute Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Wouter B van der Sluis
- Department of Plastic, Reconstructive & Hand Surgery, VU University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; EMGO Institute for Health and Care Research Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Tergooi Hospital, Van Riebeeckweg 212, 1213 XZ Hilversum, The Netherlands; Department of Surgery, Tergooi Hospital, Van Riebeeckweg 212, 1213 XZ Hilversum, The Netherlands.
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27
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Klassen AF, Kaur M, Johnson N, Kreukels BP, McEvenue G, Morrison SD, Mullender MG, Poulsen L, Ozer M, Rowe W, Satterwhite T, Savard K, Semple J, Sørensen JA, van de Grift TC, van der Meij-Ross M, Young-Afat D, Pusic AL. International phase I study protocol to develop a patient-reported outcome measure for adolescents and adults receiving gender-affirming treatments (the GENDER-Q). BMJ Open 2018; 8:e025435. [PMID: 30344182 PMCID: PMC6196938 DOI: 10.1136/bmjopen-2018-025435] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION A critical barrier to outcome assessment in gender-affirming healthcare is the lack of a specific patient-reported outcome measure (PROM). This phase I protocol describes an international collaboration between investigators in Canada, Denmark, the Netherlands and the USA who have coalesced to develop a new PROM (ie, the GENDER-Q) to evaluate outcomes of psychological, hormonal and surgical gender-affirming treatments. METHODS AND ANALYSIS This phase I study uses an interpretive description approach. Participants aged 16 years and older seeking any form of gender-affirming treatments in centres located in Canada, Denmark, the Netherlands and the USA will be invited to take part in qualitative interviews. Participants will review BREAST-Q and FACE-Q scales hypothesised to contain content relevant to specific gender-affirming treatments. Interviews will elicit new concepts for additional scale development. Each interview will be digitally recorded, transcribed and coded. The main outcome of this phase I study will be the development of a conceptual framework and set of scales to measure outcomes important to evaluating gender-affirming treatments. To this end, analysis will be used to add/drop/revise items of existing scales to achieve content validity. For new concepts, coding will assign top-level domains and themes/subthemes to participant quotes. Codes will be used to develop an item pool to inform scale development. Draft scales will be shown to transgender and gender diverse persons and experts to obtain feedback that will be used to refine and finalise the scales. The field-test version of the GENDER-Q will be translated by following rigorous methods to prepare for the international field-test study. ETHICS AND DISSEMINATION This study is coordinated at McMaster University (Canada). Ethics board approval was received from the Hamilton Integrated Ethics Board (Canada), the Medical Ethical Committee at VUmc (The Netherlands) and Advarra (USA). Findings will be published in peer-reviewed journals and presented at national and international conferences and meetings.
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Affiliation(s)
| | - Manraj Kaur
- McMaster University, Hamilton, Ontario, Canada
| | | | - Baudewijntje Pc Kreukels
- Department of Medical Psychology, Amsterdam Public Health research institute, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Shane D Morrison
- Division of Plastic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, Washington, USA
| | - Margriet G Mullender
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam Public Health Research Institute, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Lotte Poulsen
- Department of Plastic and Reconstructive Surgery, Odense University Hospital, Odense, Denmark
| | - Mujde Ozer
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam Public Health Research Institute, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Will Rowe
- McMaster University, Hamilton, Ontario, Canada
| | | | | | - John Semple
- Women's College Hospital, Toronto, Ontario, Canada
| | - Jens Ahm Sørensen
- Department of Plastic and Reconstructive Surgery, Odense University Hospital, Odense, Denmark
| | - Tim C van de Grift
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam Public Health Research Institute, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Maeghan van der Meij-Ross
- Department of Plastic Reconstructive and Hand Surgery, Amsterdam Public Health Research Institute, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Danny Young-Afat
- Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Andrea L Pusic
- Brigham and Women's Hospital, Boston, Massachusetts, USA
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Paul CPL, Emanuel KS, Kingma I, van der Veen AJ, Holewijn RM, Vergroesen PPA, van de Ven PM, Mullender MG, Helder MN, Smit TH. Changes in Intervertebral Disk Mechanical Behavior During Early Degeneration. J Biomech Eng 2018; 140:2678255. [PMID: 29801164 DOI: 10.1115/1.4039890] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Indexed: 11/08/2022]
Abstract
Intervertebral disk (IVD) degeneration is commonly described by loss of height and hydration. However, in the first stage of IVD degeneration, this loss has not yet occurred. In the current study, we use an ex vivo degeneration model to analyze the changes in IVDs mechanical behavior in the first phase of degeneration. We characterize these changes by stretched-exponential fitting, and suggest the fitted parameters as markers for early degeneration. Enzymatic degeneration of healthy lumbar caprine IVDs was induced by injecting 100 μL of Chondroïtinase ABC (Cabc) into the nucleus. A no-intervention and phosphate buffered saline (PBS) injected group were used as controls. IVDs were cultured in a bioreactor for 20 days under diurnal, simulated-physiological loading (SPL) conditions. Disk deformation was continuously monitored. Changes in disk height recovery behavior were quantified using stretched-exponential fitting. Disk height, histological sections, and water- and glycosaminoglycan (GAG)-content measurements were used as gold standards for the degenerative state. Cabc injection caused significant GAG loss from the nucleus and had detrimental effects on poro-elastic mechanical properties of the IVDs. These were progressive over time, with a propensity toward more linear recovery behavior. On histological sections, both PBS and Cabc injected IVDs showed moderate degeneration. A small GAG loss yields changes in IVD recovery behavior, which can be quantified with stretched-exponential fitting. Parameters changed significantly compared to control. Studies on disk degeneration and biomaterial engineering for degenerative disk disease (DDD) could benefit from focusing on IVD biomechanical behavior rather than height and water-content, as a marker for early disk degeneration.
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Affiliation(s)
- Cornelis P L Paul
- Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam 1105 AZ, The Netherlands
| | - Kaj S Emanuel
- Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam 1105 AZ, The Netherlands
| | - Idsart Kingma
- Department of Human Movement Sciences, Vrije Universiteit, Amsterdam Movement Sciences, Amsterdam 1081 BT, The Netherlands
| | - Albert J van der Veen
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam 1081 HV, The Netherlands
| | - Roderick M Holewijn
- Department of Orthopedic Surgery, VU University Medical Center, Amsterdam 1081 HV, The Netherlands
| | - Pieter-Paul A Vergroesen
- Department of Orthopedic Surgery, VU University Medical Center, Amsterdam 1081 HV, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam 1081 BT, The Netherlands
| | - Margriet G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam 1081 HV, The Netherlands
| | - Marco N Helder
- Department of Oral and Maxillofacial Surgery, VU University Medical Center, Amsterdam 1081 HV, The Netherlands
| | - Theodoor H Smit
- Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam 1105 AZ, The Netherlands.,Department of Medical Biology, Academic Medical Center, University of Amsterdam, Amsterdam 1105 AZ, The Netherlands e-mail:
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van de Grift TC, Mullender MG, Bouman MB. Shared Decision Making in Gender-Affirming Surgery. Implications for Research and Standards of Care. J Sex Med 2018; 15:813-815. [PMID: 29803349 DOI: 10.1016/j.jsxm.2018.03.088] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 03/27/2018] [Accepted: 03/31/2018] [Indexed: 12/18/2022]
Affiliation(s)
- Tim C van de Grift
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands; Department of Medical Psychology (Gender and Sexology), VU University Medical Center, Amsterdam, The Netherlands; Amsterdam Institute of Public Health, Amsterdam, The Netherlands.
| | - Margriet G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands; Amsterdam Institute of Public Health, Amsterdam, The Netherlands
| | - Mark-Bram Bouman
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands; Amsterdam Institute of Public Health, Amsterdam, The Netherlands
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Özer M, Pigot GLS, Bouman MB, van de Grift TC, Elfering L, van Mello NM, Al-Itejawi HHM, Buncamper ME, Mullender MG. Development of a Decision Aid for Genital Gender-Affirming Surgery in Transmen. J Sex Med 2018; 15:1041-1048. [PMID: 29861358 DOI: 10.1016/j.jsxm.2018.04.644] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/24/2018] [Accepted: 04/27/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND As genital gender-affirming surgery (GAS) is a demanding and life-changing intervention, transmen should be able to make choices about the surgical treatment based on outcomes that are most important to them, while taking into consideration the concomitant risks involved. AIM Develop a decision aid (DA) for genital surgery in transmen (DA-GST) that can assist both transmen and health care professionals (HCPs) in making a well-informed decision about the surgical treatment. METHODS A qualitative focus group study was performed. 5 Focus groups were organized with both HCPs and transmen. These were led by an independent professional moderator. Data collected during these focus groups were analyzed to provide content for the DA. OUTCOMES To develop content for a DA-GST. RESULTS Data collected during the focus groups related to the treatment options, information deemed relevant by transmen, and the arguments for or against each treatment option. Collected items were divided into the following themes: outcome, quality of life, environment, sexuality, and beliefs. CLINICAL IMPLICATIONS The tool will be useful in assisting both transmen and HCPs in the shared decision-making process regarding genital GAS by exploring which domains are most relevant for each specific individual. STRENGTHS & LIMITATIONS This DA was developed according to an iterative participatory design approach to fit the needs of both transmen and HCPs. Issues that transmen find important and relevant pertaining to genital GAS were translated into arguments that were incorporated in the DA-GST. The study is limited by the group that had participated. Not all arguments for or against specific surgical options may be covered by the DA-GST. CONCLUSION An online DA was developed to support transmen with their decision-making process concerning all surgical options for removal of reproductive organs and genital GAS. Özer M, Pigot GL, Bouman M-B, et al. Development of a Decision Aid for Genital Gender-Affirming Surgery in Transmen. J Sex Med 2018;15:1041-1048.
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Affiliation(s)
- Müjde Özer
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands; Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands.
| | - Garry L S Pigot
- Department of Urology, VU University Medical Center, Amsterdam, The Netherlands; Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Mark-Bram Bouman
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands; Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Tim C van de Grift
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands; Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Lian Elfering
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands; Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Norah M van Mello
- Department of Gynecology and Obstetrics, VU University Medical Center, Amsterdam, The Netherlands; Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Hoda H M Al-Itejawi
- Department of Urology, VU University Medical Center, Amsterdam, The Netherlands
| | - Marlon E Buncamper
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands; Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Margriet G Mullender
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands; Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands; Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
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31
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Negenborn VL, Dikmans REG, Bouman MB, Winters HAH, Twisk JWR, Ruhé PQ, Mureau MAM, Smit JM, Tuinder S, Hommes J, Eltahir Y, Posch NAS, van Steveninck-Barends JM, Meesters-Caberg MA, van der Hulst RRWJ, Ritt MJPF, Mullender MG. Predictors of complications after direct-to-implant breast reconstruction with an acellular dermal matrix from a multicentre randomized clinical trial. Br J Surg 2018; 105:1305-1312. [PMID: 29663320 PMCID: PMC6099293 DOI: 10.1002/bjs.10865] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/12/2017] [Accepted: 02/19/2018] [Indexed: 11/05/2022]
Abstract
BACKGROUND In the multicentre randomized trial BRIOS (Breast Reconstruction In One Stage), direct-to-implant (DTI) breast reconstruction with an acellular dermal matrix (ADM) was associated with a markedly higher postoperative complication rate compared with two-stage tissue expander/implant breast reconstruction. This study aimed to identify factors that contribute to the occurrence of complications after DTI ADM-assisted breast reconstruction. METHODS Data were obtained from the BRIOS study, including all patients treated with DTI ADM-assisted breast reconstruction. Logistic regression analyses were performed to identify factors predictive of postoperative complications. RESULTS Fifty-nine patients (91 breasts) were included, of whom 27 (35 breasts) developed a surgical complication. Reoperations were performed in 29 breasts (32 per cent), with prosthesis removal in 22 (24 per cent). In multivariable analyses, mastectomy weight was associated with complications (odds ratio (OR) 1·94, 95 per cent c.i. 1·33 to 2·83), reoperations (OR 1·70, 1·12 to 2·59) and removal of the implant (OR 1·55, 1·11 to 2·17). Younger patients (OR 1·07, 1·01 to 1·13) and those who received adjuvant chemotherapy (OR 4·83, 1·15 to 20·24) more frequently required reoperation. In univariable analyses, adjuvant radiotherapy showed a trend towards more complications (OR 7·23, 0·75 to 69·95) and removal of the implant (OR 5·12, 0·76 to 34·44), without reaching statistical significance. CONCLUSION Breast size appeared to be the most significant predictor of complications in DTI ADM-assisted breast reconstruction. The technique should preferably be performed in patients with small to moderate sized breasts. Registration number: NTR5446 ( http://www.trialregister.nl).
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Affiliation(s)
- V L Negenborn
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health, Amsterdam, The Netherlands
| | - R E G Dikmans
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health, Amsterdam, The Netherlands
| | - M B Bouman
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health, Amsterdam, The Netherlands.,Department of Plastic Surgery, Alexander Monro Breast Cancer Hospital, Bilthoven, The Netherlands
| | - H A H Winters
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health, Amsterdam, The Netherlands.,Department of Plastic Surgery, Alexander Monro Breast Cancer Hospital, Bilthoven, The Netherlands
| | - J W R Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health, Amsterdam, The Netherlands
| | - P Q Ruhé
- Department of Plastic, Reconstructive and Hand Surgery, Meander Medical Centre, Amersfoort, The Netherlands
| | - M A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - J M Smit
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.,Department of Plastic Surgery, Alexander Monro Breast Cancer Hospital, Bilthoven, The Netherlands
| | - S Tuinder
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J Hommes
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Y Eltahir
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - N A S Posch
- Department of Plastic, Reconstructive and Hand Surgery, Haga Ziekenhuis, The Hague, The Netherlands
| | | | - M A Meesters-Caberg
- Department of Plastic, Reconstructive and Hand Surgery, Orbis Medical Centre, Sittard, The Netherlands
| | - R R W J van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M J P F Ritt
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - M G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health, Amsterdam, The Netherlands
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de Vet HC, Mullender MG, Eekhout I. Specific agreement on ordinal and multiple nominal outcomes can be calculated for more than two raters. J Clin Epidemiol 2018; 96:47-53. [DOI: 10.1016/j.jclinepi.2017.11.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/24/2017] [Accepted: 11/28/2017] [Indexed: 11/30/2022]
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33
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Smit JM, Negenborn VL, Jansen SM, Jaspers MEH, de Vries R, Heymans MW, Winters HAH, van Leeuwen TG, Mullender MG, Krekel NMA. Intraoperative evaluation of perfusion in free flap surgery: A systematic review and meta-analysis. Microsurgery 2018; 38:804-818. [DOI: 10.1002/micr.30320] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 02/03/2018] [Accepted: 03/02/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Jan Maerten Smit
- Department of Plastic, Reconstructive & Hand Surgery; VU University Medical Centre; Amsterdam The Netherlands
| | - Vera L. Negenborn
- Department of Plastic, Reconstructive & Hand Surgery; VU University Medical Centre; Amsterdam The Netherlands
- Amsterdam Public Health research institute; VU University Medical Center; Amsterdam The Netherlands
| | - Sanne M. Jansen
- Department of Plastic, Reconstructive & Hand Surgery; Academical Medical Center; Amsterdam The Netherlands
| | - Mariëlle E. H. Jaspers
- Department of Plastic, Reconstructive & Hand Surgery; VU University Medical Centre; Amsterdam The Netherlands
- Association of Dutch Burn Centers; Beverwijk The Netherlands
| | - Ralph de Vries
- Medical Library, Vrije Universiteit; Amsterdam The Netherlands
| | - Martijn W. Heymans
- Department of Epidemiology & Biostatistics; VU University Medical Centre; Amsterdam The Netherlands
| | - Hay A. H. Winters
- Department of Plastic, Reconstructive & Hand Surgery; VU University Medical Centre; Amsterdam The Netherlands
| | - Ton G. van Leeuwen
- Department of. Biomedical Engineering & Physics; Academical Medical Center; Amsterdam The Netherlands
| | - Margriet G. Mullender
- Department of Plastic, Reconstructive & Hand Surgery; VU University Medical Centre; Amsterdam The Netherlands
- Amsterdam Movement Sciences; VU University Medical Center; Amsterdam The Netherlands
| | - Nicole M. A. Krekel
- Department of Plastic, Reconstructive & Hand Surgery; VU University Medical Centre; Amsterdam The Netherlands
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34
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van der Sluis WB, Pavan N, Liguori G, Bucci S, Bizic MR, Kojovic V, Hess J, Meijerink WJ, Mullender MG, Özer M, Smit JM, Buncamper ME, Krege S, Djordjevic ML, Trombetta C, Bouman MB. Ileal vaginoplasty as vaginal reconstruction in transgender women and patients with disorders of sex development: an international, multicentre, retrospective study on surgical characteristics and outcomes. BJU Int 2018; 121:952-958. [DOI: 10.1111/bju.14155] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Wouter B. van der Sluis
- Department of Plastic, Reconstructive and Hand Surgery; VU University Medical Center; Amsterdam The Netherlands
| | - Nicola Pavan
- Urology Clinic; Department of Medical, Surgical and Health Science; University of Trieste; Trieste Italy
| | - Giovanni Liguori
- Urology Clinic; Department of Medical, Surgical and Health Science; University of Trieste; Trieste Italy
| | - Stefano Bucci
- Urology Clinic; Department of Medical, Surgical and Health Science; University of Trieste; Trieste Italy
| | - Marta R. Bizic
- School of Medicine; University of Belgrade; Belgrade Serbia
| | | | - Jochen Hess
- Department of Urology; University Hospital Essen; Essen Germany
| | - Wilhelmus J.H.J. Meijerink
- Department of Gastro-Intestinal Surgery and Advanced Laparoscopy; VU University Medical Center; Amsterdam The Netherlands
- Department of Operation Rooms; Radboud University Medical Centre; Nijmegen The Netherlands
| | - Margriet G. Mullender
- Department of Plastic, Reconstructive and Hand Surgery; VU University Medical Center; Amsterdam The Netherlands
| | - Müjde Özer
- Department of Plastic, Reconstructive and Hand Surgery; VU University Medical Center; Amsterdam The Netherlands
| | - Jan Maerten Smit
- Department of Plastic, Reconstructive and Hand Surgery; VU University Medical Center; Amsterdam The Netherlands
| | - Marlon E. Buncamper
- Department of Plastic, Reconstructive and Hand Surgery; VU University Medical Center; Amsterdam The Netherlands
| | - Susanne Krege
- Department of Urology; Kliniken Essen Mitte; Essen Germany
| | | | - Carlo Trombetta
- Urology Clinic; Department of Medical, Surgical and Health Science; University of Trieste; Trieste Italy
| | - Mark-Bram Bouman
- Department of Plastic, Reconstructive and Hand Surgery; VU University Medical Center; Amsterdam The Netherlands
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35
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36
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Paul CPL, Smit TH, de Graaf M, Holewijn RM, Bisschop A, van de Ven PM, Mullender MG, Helder MN, Strijkers GJ. Quantitative MRI in early intervertebral disc degeneration: T1rho correlates better than T2 and ADC with biomechanics, histology and matrix content. PLoS One 2018; 13:e0191442. [PMID: 29381716 PMCID: PMC5790235 DOI: 10.1371/journal.pone.0191442] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 01/04/2018] [Indexed: 12/13/2022] Open
Abstract
Introduction Low-back pain (LBP) has been correlated to the presence of intervertebral disc (IVD) degeneration on T2-weighted (T2w) MRI. It remains challenging, however, to accurately stage degenerative disc disease (DDD) based on T2w MRI and measurements of IVD height, particularly for early DDD. Several quantitative MRI techniques have been introduced to detect changes in matrix composition signifying early DDD. In this study, we correlated quantitative T2, T1rho and Apparent Diffusion Coefficient (ADC) values to disc mechanical behavior and gold standard early DDD markers in a graded degenerated lumbar IVD caprine model, to assess their potential for early DDD detection. Methods Lumbar caprine IVDs were injected with either 0.25 U/ml or 0.5 U/ml Chondroïtinase ABC (Cabc) to trigger early DDD-like degeneration. Injection with phosphate-buffered saline (PBS) served as control. IVDs were cultured in a bioreactor for 20 days under axial physiological loading. High-resolution 9.4 T MR images were obtained prior to intervention and after culture. Quantitative MR results were correlated to recovery behavior, histological degeneration grading, and the content of glycosaminoglycans (GAGs) and water. Results Cabc-injected IVDs showed aberrancies in biomechanics and loss of GAGs without changes in water-content. All MR sequences detected changes in matrix composition, with T1rho showing largest changes pre-to-post in the nucleus, and significantly more than T2 and ADC. Histologically, degeneration due to Cabc injection was mild. T1rho nucleus values correlated strongest with altered biomechanics, histological degeneration score, and loss of GAGs. Conclusions T2- and T1rho quantitative MR-mapping detected early DDD changes. T1rho nucleus values correlated better than T2 and ADC with biomechanical, histological, and GAG changes. Clinical implementation of quantitative MRI, T1rho particularly, could aid in distinguishing DDD more reliably at an earlier stage in the degenerative process.
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Affiliation(s)
- Cornelis P L Paul
- Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Theodoor H Smit
- Department of Orthopedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Medical Biology, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Magda de Graaf
- Department of Orthopedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Roderick M Holewijn
- Department of Orthopedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Arno Bisschop
- Department of Orthopedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Margriet G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Marco N Helder
- Department of Oral and Maxillofacial Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Gustav J Strijkers
- Department of Biomedical Engineering and Physics, Academic Medical Center (AMC), Amsterdam, the Netherlands
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37
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van de Grift TC, Pigot GL, Boudhan S, Elfering L, Kreukels BP, Gijs LA, Buncamper ME, Özer M, van der Sluis W, Meuleman EJ, Bouman MB, Mullender MG. A Longitudinal Study of Motivations Before and Psychosexual Outcomes After Genital Gender-Confirming Surgery in Transmen. J Sex Med 2017; 14:1621-1628. [DOI: 10.1016/j.jsxm.2017.10.064] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/16/2017] [Accepted: 10/17/2017] [Indexed: 11/17/2022]
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38
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van der Sluis WB, Smit JM, Pigot GLS, Buncamper ME, Winters HAH, Mullender MG, Bouman MB. Double flap phalloplasty in transgender men: Surgical technique and outcome of pedicled anterolateral thigh flap phalloplasty combined with radial forearm free flap urethral reconstruction. Microsurgery 2017; 37:917-923. [PMID: 28556461 PMCID: PMC5697604 DOI: 10.1002/micr.30190] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 04/19/2017] [Accepted: 05/12/2017] [Indexed: 01/10/2023]
Abstract
Introduction Radial forearm free flap (RFFF) tube‐in‐tube phalloplasty is the most performed phalloplasty technique worldwide. The conspicuous donor‐site scar is a drawback for some transgender men. In search for techniques with less conspicuous donor‐sites, we performed a series of one‐stage pedicled anterolateral thigh flap (ALT) phalloplasties combined with RFFF urethral reconstruction. In this study, we aim to describe this technique and assess its surgical outcome in a series of transgender men. Patients and Methods Between January 2008 and December 2015, nineteen transgender men (median age 37, range 21–57) underwent pedicled ALT phalloplasty combined with RFFF urethral reconstruction in one stage. The surgical procedure was described. Patient demographics, surgical characteristics, intra‐ and postoperative complications, hospitalization length, and reoperations were recorded. Results The size of the ALT flaps ranged from 12 × 12 to 15 × 13 cm, the size of the RFFFs from 14 × 3 to 17 × 3 cm. Median clinical follow‐up was 35 months (range 3–95). Total RFFF failure occurred in two patients, total ALT flap failure in one patient, and partial necrosis of the ALT flap in one patient. Long‐term urinary complications occurred in 10 (53%) patients, of which 9 concerned urethral strictures. Conclusions In experienced hands, one‐stage pedicled ALT phalloplasty combined with RFFF urethral reconstruction is a feasible alternative surgical option in eligible transgender men, who desire a less conspicuous forearm scar. Possible drawbacks comprise flap‐related complications, difficult inner flap monitoring and urethral complications.
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Affiliation(s)
- Wouter B van der Sluis
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands.,EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Jan Maerten Smit
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands.,Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Garry L S Pigot
- Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands.,Department of Urology, VU University Medical Center, Amsterdam, The Netherlands
| | - Marlon E Buncamper
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands.,EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.,Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands.,Gender Surgery Amsterdam (GSA, www.gendersurgeryamsterdam.com), Amsterdam, The Netherlands
| | - Henri A H Winters
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Margriet G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands.,EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.,Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Mark-Bram Bouman
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands.,EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.,Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands.,Gender Surgery Amsterdam (GSA, www.gendersurgeryamsterdam.com), Amsterdam, The Netherlands
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39
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Paul CPL, de Graaf M, Bisschop A, Holewijn RM, van de Ven PM, van Royen BJ, Mullender MG, Smit TH, Helder MN. Static axial overloading primes lumbar caprine intervertebral discs for posterior herniation. PLoS One 2017; 12:e0174278. [PMID: 28384266 PMCID: PMC5383039 DOI: 10.1371/journal.pone.0174278] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 03/05/2017] [Indexed: 11/25/2022] Open
Abstract
Introduction Lumbar hernias occur mostly in the posterolateral region of IVDs and mechanical loading is an important risk factor. Studies show that dynamic and static overloading affect the nucleus and annulus of the IVD differently. We hypothesize there is also variance in the effect of overloading on the IVD’s anterior, lateral and posterior annulus, which could explain the predilection of herniations in the posterolateral region. We assessed the regional mechanical and cellular responses of lumbar caprine discs to dynamic and static overloading. Material and methods IVDs (n = 125) were cultured in a bioreactor and subjected to simulated-physiological loading (SPL), high dynamic (HD), or high static (HS) overloading. The effect of loading was determined in five disc regions: nucleus, inner-annulus and anterior, lateral and posterior outer-annulus. IVD height loss and external pressure transfer during loading were measured, cell viability was mapped and quantified, and matrix integrity was assessed. Results During culture, overloaded IVDs lost a significant amount of height, yet the distribution of axial pressure remained unchanged. HD loading caused cell death and disruption of matrix in all IVD regions, whereas HS loading particularly affected cell viability and matrix integrity in the posterior region of the outer annulus. Conclusion Axial overloading is detrimental to the lumbar IVD. Static overloading affects the posterior annulus more strongly, while the nucleus is relatively spared. Hence, static overloading predisposes the disc for posterior herniation. These findings could have implications for working conditions, in particular of sedentary occupations, and the design of interventions aimed at prevention and treatment of early intervertebral disc degeneration.
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Affiliation(s)
- Cornelis P. L. Paul
- Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, The Netherlands
- * E-mail:
| | - Magda de Graaf
- Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, The Netherlands
| | - Arno Bisschop
- Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, The Netherlands
| | - Roderick M. Holewijn
- Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, The Netherlands
| | - Peter M. van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Barend J. van Royen
- Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, The Netherlands
| | - Margriet G. Mullender
- Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Theodoor H. Smit
- Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, The Netherlands
- Department of Anatomy, Embryology and Physiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marco N. Helder
- Department of Orthopaedic Surgery, VU University Medical Center, Amsterdam Movement Sciences, The Netherlands
- Department of Oral and Maxillofacial Surgery, VU University Medical Center, Amsterdam, The Netherlands
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Dikmans REG, Negenborn VL, Bouman MB, Winters HAH, Twisk JWR, Ruhé PQ, Mureau MAM, Smit JM, Tuinder S, Eltahir Y, Posch NA, van Steveninck-Barends JM, Meesters-Caberg MA, van der Hulst RRWJ, Ritt MJPF, Mullender MG. Two-stage implant-based breast reconstruction compared with immediate one-stage implant-based breast reconstruction augmented with an acellular dermal matrix: an open-label, phase 4, multicentre, randomised, controlled trial. Lancet Oncol 2016; 18:251-258. [PMID: 28012977 DOI: 10.1016/s1470-2045(16)30668-4] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 10/15/2016] [Accepted: 10/18/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND The evidence justifying the use of acellular dermal matrices (ADMs) in implant-based breast reconstruction (IBBR) is limited. We did a prospective randomised trial to compare the safety of IBBR with an ADM immediately after mastectomy with that of two-stage IBBR. METHODS We did an open-label, randomised, controlled trial in eight hospitals in the Netherlands. Eligible women were older than 18 years with breast carcinoma or a gene mutation linked with breast cancer who intended to undergo skin-sparing mastectomy and immediate IBBR. Randomisation was done electronically, stratified per centre and in blocks of ten to achieve roughly balanced groups. Women were assigned to undergo one-stage IBBR with ADM (Strattice, LifeCell, Branchburg, NJ, USA) or two-stage IBBR. The primary endpoint was quality of life and safety was assessed by the occurrence of adverse outcomes. Analyses were done per protocol with logistic regression and generalised estimating equations. This study is registered at Nederlands Trial Register, number NTR5446. FINDINGS 142 women were enrolled between April 14, 2013, and May 29, 2015, of whom 59 (91 breasts) in the one-stage IBBR with ADM group and 62 (92 breasts) in the two-stage IBBR group were included in analyses. One-stage IBBR with ADM was associated with significantly higher risk per breast of surgical complications (crude odds ratio 3·81, 95% CI 2·67-5·43, p<0·001), reoperation (3·38, 2·10-5·45, p<0·001), and removal of implant, ADM, or both (8·80, 8·24-9·40, p<0·001) than two-stage IBBR. Severe (grade 3) adverse events occurred in 26 (29%) of 91 breasts in the one-stage IBBR with ADM group and in five (5%) of 92 in the two-stage IBBR group. The frequency of mild to moderate adverse events was similar in the two groups. INTERPRETATION Immediate one-stage IBBR with ADM was associated with adverse events and should be considered very carefully. Understanding of selection of patients, risk factors, and surgical and postsurgical procedures needs to be improved. FUNDING Pink Ribbon, Nuts-Ohra, and LifeCell.
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Affiliation(s)
- Rieky E G Dikmans
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Centre, Amsterdam, Netherlands; EMGO Institute for Health and Care Research Amsterdam, Amsterdam, Netherlands
| | - Vera L Negenborn
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Centre, Amsterdam, Netherlands; EMGO Institute for Health and Care Research Amsterdam, Amsterdam, Netherlands
| | - Mark-Bram Bouman
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Centre, Amsterdam, Netherlands; EMGO Institute for Health and Care Research Amsterdam, Amsterdam, Netherlands; Alexander Monro Breast Cancer Hospital, Bilthoven, Netherlands
| | - Hay A H Winters
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Centre, Amsterdam, Netherlands; EMGO Institute for Health and Care Research Amsterdam, Amsterdam, Netherlands; Alexander Monro Breast Cancer Hospital, Bilthoven, Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, Netherlands
| | - P Quinten Ruhé
- Department of Plastic, Reconstructive, and Hand Surgery, Meander Medical Centre, Amersfoort, Netherlands
| | - Marc A M Mureau
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Jan Maerten Smit
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Centre, Amsterdam, Netherlands; Alexander Monro Breast Cancer Hospital, Bilthoven, Netherlands
| | - Stefania Tuinder
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Yassir Eltahir
- Department of Plastic, Reconstructive, and Hand Surgery, University Medical Centre Groningen, Groningen, Netherlands
| | - Nicole A Posch
- Department of Plastic, Reconstructive, and Hand Surgery, Haga Ziekenhuis, Den Haag, Netherlands
| | | | - Marleen A Meesters-Caberg
- Department of Plastic, Reconstructive, and Hand Surgery, Orbis Medisch Centrum, Sittard, Netherlands
| | - René R W J van der Hulst
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Marco J P F Ritt
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Centre, Amsterdam, Netherlands
| | - Margriet G Mullender
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Centre, Amsterdam, Netherlands; EMGO Institute for Health and Care Research Amsterdam, Amsterdam, Netherlands.
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Groen JW, Negenborn VL, Twisk JWR, Ket JCF, Mullender MG, Smit JM. Autologous Fat Grafting in Cosmetic Breast Augmentation: A Systematic Review on Radiological Safety, Complications, Volume Retention, and Patient/Surgeon Satisfaction. Aesthet Surg J 2016; 36:993-1007. [PMID: 27329661 DOI: 10.1093/asj/sjw105] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Autologous fat grafting (AFG) is increasingly used in cosmetic surgery. However, its efficacy and safety are still ambiguous. Both a comprehensive overview and recapitulation of the relevant literature provide current evidence on the efficacy and outcomes of AFG in cosmetic breast surgery. OBJECTIVES This review provides an up-to-date overview of the literature on AFG in cosmetic breast augmentation. METHODS A systematic review of the literature on AFG used for cosmetic breast augmentation was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. This study included selected studies that were published between January 1996 and February 2016 and reported on 10 patients or more who had a minimal mean follow-up period of 1 year. RESULTS In this study, 22 articles that reported on 3565 patients with follow-up periods ranging from 12 to 136 months were included. A complication rate of 17.2% (95% CI 15.9-18.5) was seen. Indurations were the most frequent complication (33.3%, 95% CI 20.4-46.3), followed by persistent pain (25%, 95% CI 0.5-49.5), and hematoma (16.4%, 95% CI 14.5-18.4). Mammograms revealed micro-calcifications (9.0%, 95% CI 6.4-11.5) and macro-calcifications (7.0%, 95% CI 3.8-10.2). The mean volume retention was 62.4% (range, 44.7-82.6%), with a satisfaction rate of 92% in patients and 89% in surgeons. CONCLUSIONS AFG is a promising method in achieving autologous cosmetic breast augmentation with satisfactory volume retention and satisfaction rates in eight and six studies, respectively. Complications and radiological findings are comparable to those after implant augmentation. Future studies should focus on cancer occurrence and detection to further substantiate AFG safety. In addition, grafting methods and the use of auxiliary procedures to identify factors leading to better outcomes in terms of volume retention should be investigated. Finally, objective questionnaires are needed to represent patient satisfaction. LEVEL OF EVIDENCE 3 Therapeutic.
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Affiliation(s)
- Jan-Willem Groen
- Drs Groen and Negenborn are PhD Candidates, Dr Mullender is an Associate Professor and the Head of Research, and Dr Smit is a Plastic Surgeon, Department of Plastic Surgery, VU University Medical Center, and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands. Dr Twisk is a Professor and Statistician, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands. Mr Ket is a Medical Information Specialist, Medical Library, VU University Medical Center, Amsterdam, The Netherlands
| | - Vera L Negenborn
- Drs Groen and Negenborn are PhD Candidates, Dr Mullender is an Associate Professor and the Head of Research, and Dr Smit is a Plastic Surgeon, Department of Plastic Surgery, VU University Medical Center, and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands. Dr Twisk is a Professor and Statistician, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands. Mr Ket is a Medical Information Specialist, Medical Library, VU University Medical Center, Amsterdam, The Netherlands
| | - Jos W R Twisk
- Drs Groen and Negenborn are PhD Candidates, Dr Mullender is an Associate Professor and the Head of Research, and Dr Smit is a Plastic Surgeon, Department of Plastic Surgery, VU University Medical Center, and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands. Dr Twisk is a Professor and Statistician, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands. Mr Ket is a Medical Information Specialist, Medical Library, VU University Medical Center, Amsterdam, The Netherlands
| | - Johannes C F Ket
- Drs Groen and Negenborn are PhD Candidates, Dr Mullender is an Associate Professor and the Head of Research, and Dr Smit is a Plastic Surgeon, Department of Plastic Surgery, VU University Medical Center, and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands. Dr Twisk is a Professor and Statistician, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands. Mr Ket is a Medical Information Specialist, Medical Library, VU University Medical Center, Amsterdam, The Netherlands
| | - Margriet G Mullender
- Drs Groen and Negenborn are PhD Candidates, Dr Mullender is an Associate Professor and the Head of Research, and Dr Smit is a Plastic Surgeon, Department of Plastic Surgery, VU University Medical Center, and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands. Dr Twisk is a Professor and Statistician, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands. Mr Ket is a Medical Information Specialist, Medical Library, VU University Medical Center, Amsterdam, The Netherlands
| | - Jan Maerten Smit
- Drs Groen and Negenborn are PhD Candidates, Dr Mullender is an Associate Professor and the Head of Research, and Dr Smit is a Plastic Surgeon, Department of Plastic Surgery, VU University Medical Center, and EMGO Institute for Health and Care Research, Amsterdam, The Netherlands. Dr Twisk is a Professor and Statistician, Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands. Mr Ket is a Medical Information Specialist, Medical Library, VU University Medical Center, Amsterdam, The Netherlands
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42
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van de Grift TC, Kreukels BPC, Elfering L, Özer M, Bouman MB, Buncamper ME, Smit JM, Mullender MG. Body Image in Transmen: Multidimensional Measurement and the Effects of Mastectomy. J Sex Med 2016; 13:1778-1786. [PMID: 27667355 DOI: 10.1016/j.jsxm.2016.09.003] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/30/2016] [Accepted: 09/05/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Transmen are generally dissatisfied with their breasts and often opt for mastectomy. However, little is known about the specific effects of this procedure on this group's body image. AIM To prospectively assess the effect of mastectomy on the body image of transmen, including cognitive, emotional, and behavioral aspects. METHODS During a 10-month period, all transmen applying for mastectomy were invited to participate in this study. The 33 participants completed assessments preoperatively and at least 6 months postoperatively. MAIN OUTCOME MEASURES Participants were surveyed on body satisfaction (Body Image Scale for Transsexuals), body attitudes (Multidimensional Body-Self Relations Questionnaire), appearance schemas (Appearance Schemas Inventory), situational bodily feelings (Situational Inventory of Body Image Dysphoria), body image-related quality of life (Body Image Quality of Life Inventory), and self-esteem (Rosenberg Self-Esteem Scale). Control values were retrieved from the literature and a college sample. RESULTS Before surgery, transmen reported less positive body attitudes and satisfaction, a lower self-esteem and body image-related quality of life compared with cisgender men and women. Mastectomy improved body satisfaction most strongly, although respondents reported improvements in all domains (eg, decreased dysphoria when looking in the mirror and improved feelings of self-worth). Most outcome measurements were strongly correlated. CONCLUSION Mastectomy improves body image beyond satisfaction with chest appearance alone. Body satisfaction and feelings of "passing" in social situations are associated with a higher quality of life and self-esteem.
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Affiliation(s)
- Tim C van de Grift
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Baudewijntje P C Kreukels
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Lian Elfering
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Müjde Özer
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Mark-Bram Bouman
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Marlon E Buncamper
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Jan Maerten Smit
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Margriet G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands.
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Bouman MB, van der Sluis WB, van Woudenberg Hamstra LE, Buncamper ME, Kreukels BP, Meijerink WJ, Mullender MG. Patient-Reported Esthetic and Functional Outcomes of Primary Total Laparoscopic Intestinal Vaginoplasty in Transgender Women With Penoscrotal Hypoplasia. J Sex Med 2016; 13:1438-1444. [DOI: 10.1016/j.jsxm.2016.06.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/22/2016] [Accepted: 06/10/2016] [Indexed: 10/21/2022]
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44
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Negenborn VL, Groen JW, Smit JM, Niessen FB, Mullender MG. Autologous Fat Grafting: A Promising Technique with Various Indications. Reply: The Use of Autologous Fat Grafting for Treatment of Scar Tissue and Scar Related Conditions: A Systematic Review. Plast Reconstr Surg 2016; 138:1077e-1078e. [PMID: 27541617 DOI: 10.1097/prs.0000000000002810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | | | - Jan Maerten Smit
- Department of Plastic, Reconstructive, and Hand Surgery and EMGO+ Institute for Health and Care Research VU University Medical Center Amsterdam, The Netherlands
| | - Frank B Niessen
- Department of Plastic, Reconstructive, and Hand Surgery and EMGO+ Institute for Health and Care Research VU University Medical Center Amsterdam, The Netherlands
| | - Margriet G Mullender
- Department of Plastic, Reconstructive, and Hand Surgery and EMGO+ Institute for Health and Care Research VU University Medical Center Amsterdam, The Netherlands
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Negenborn VL, Groen JW, Smit JM, Niessen FB, Mullender MG. The Use of Autologous Fat Grafting for Treatment of Scar Tissue and Scar-Related Conditions: A Systematic Review. Plast Surg Nurs 2016; 36:131-143. [PMID: 27606589 DOI: 10.1097/psn.0000000000000155] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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46
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van der Sluis WB, Bouman MB, de Boer NK, Buncamper ME, van Bodegraven AA, Neefjes-Borst EA, Kreukels BP, Meijerink WJ, Mullender MG. Long-Term Follow-Up of Transgender Women After Secondary Intestinal Vaginoplasty. J Sex Med 2016; 13:702-10. [DOI: 10.1016/j.jsxm.2016.01.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/16/2015] [Accepted: 01/16/2016] [Indexed: 12/14/2022]
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47
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van der Sluis WB, Buncamper ME, Bouman MB, Neefjes-Borst EA, Heideman DAM, Steenbergen RDM, Mullender MG. Symptomatic HPV-related neovaginal lesions in transgender women: case series and review of literature. Sex Transm Infect 2016; 92:499-501. [DOI: 10.1136/sextrans-2015-052456] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 02/24/2016] [Accepted: 03/05/2016] [Indexed: 11/04/2022] Open
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van der Sluis WB, Bouman MB, Meijerink WJ, Elfering L, Mullender MG, de Boer NK, van Bodegraven AA. Diversion neovaginitis after sigmoid vaginoplasty: endoscopic and clinical characteristics. Fertil Steril 2016; 105:834-839.e1. [DOI: 10.1016/j.fertnstert.2015.11.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 11/04/2015] [Accepted: 11/05/2015] [Indexed: 12/15/2022]
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49
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van der Sluis WB, Neefjes-Borst EA, Bouman MB, Meijerink WJHJ, De Boer NKH, Mullender MG, van Bodegraven AA. Morphological spectrum of neovaginitis in autologous sigmoid transplant patients. Histopathology 2015; 68:1004-12. [DOI: 10.1111/his.12894] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 10/14/2015] [Indexed: 02/03/2023]
Affiliation(s)
- Wouter B van der Sluis
- Department of Plastic, Reconstructive and Hand Surgery; VU University Medical Center; Amsterdam the Netherlands
- EMGO and Institute for Health and Care Research; VU University Medical Center; Amsterdam the Netherlands
| | | | - Mark-Bram Bouman
- Department of Plastic, Reconstructive and Hand Surgery; VU University Medical Center; Amsterdam the Netherlands
- EMGO and Institute for Health and Care Research; VU University Medical Center; Amsterdam the Netherlands
- Center of Expertise on Gender Dysphoria; VU University Medical Center; Amsterdam the Netherlands
| | - Wilhelmus J H J Meijerink
- Center of Expertise on Gender Dysphoria; VU University Medical Center; Amsterdam the Netherlands
- Department of Gastro-Intestinal Surgery and Advanced Laparoscopy; VU University Medical Center; Amsterdam the Netherlands
| | - Nanne K H De Boer
- Department of Gastroenterology and Hepatology; VU University Medical Center; Amsterdam the Netherlands
| | - Margriet G Mullender
- Department of Plastic, Reconstructive and Hand Surgery; VU University Medical Center; Amsterdam the Netherlands
- EMGO and Institute for Health and Care Research; VU University Medical Center; Amsterdam the Netherlands
- Center of Expertise on Gender Dysphoria; VU University Medical Center; Amsterdam the Netherlands
| | - Adriaan A van Bodegraven
- Department of Gastroenterology and Hepatology; VU University Medical Center; Amsterdam the Netherlands
- Department of Internal Medicine, Gastroenterology, and Geriatrics; Orbis Medical Center; Sittard-Geleen the Netherlands
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50
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Buncamper ME, Honselaar JS, Bouman MB, Özer M, Kreukels BPC, Mullender MG. Response to Editorial Comment on: Aesthetic and Functional Outcomes of Neovaginoplasty Using Penile Skin in Male-to-Female Transsexuals. J Sex Med 2015; 12:1637. [PMID: 26193765 DOI: 10.1111/jsm.12917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Marlon E Buncamper
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.,Centre of Expertise on Gender Dysphoria, VU University Medical Centre, Amsterdam, The Netherlands
| | - Jara S Honselaar
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - Mark-Bram Bouman
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.,Centre of Expertise on Gender Dysphoria, VU University Medical Centre, Amsterdam, The Netherlands
| | - Müjde Özer
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.,Centre of Expertise on Gender Dysphoria, VU University Medical Centre, Amsterdam, The Netherlands
| | - Baudewijntje P C Kreukels
- Department of Medical Psychology, VU University Medical Centre, Amsterdam, The Netherlands.,Centre of Expertise on Gender Dysphoria, VU University Medical Centre, Amsterdam, The Netherlands.,EMGO Institute for Health and Care Research Amsterdam, The Netherlands
| | - Margriet G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.,Centre of Expertise on Gender Dysphoria, VU University Medical Centre, Amsterdam, The Netherlands.,EMGO Institute for Health and Care Research Amsterdam, The Netherlands
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