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Background: Partly as a result of the increasing attention directed toward transgender individuals and despite much research work on the topic of quality of life (QOL) of transgender, there is still a lack of studies using standardized questionnaires in their evaluation., Aims: We designed a survey to evaluate the influence of surgery after phalloplasty (osteofasciocutaneous fibula free flap or osteofasciocutaneous radial free forearm flap) on QOL, emotional stability, self-esteem, and psyche of postoperated transgender men., Methods: The present study included 32 transgender men who had undergone gender-affirming surgery (GAS) exclusively in our department between 2000 and 2012. Apart from our self-developed, indication-specific questionnaire with questions on socioeconomic and demographic data as well as postoperative satisfaction, the testing instrument included 4 frequently used, standardized testing instruments, which we compared with normative data. These included (a) a self-assessment test Fragebogen zur Lebenszufriedenheit with questions on QOL consisting of 3 modules (general satisfaction, satisfaction with health, and satisfaction with body image/outer appearance), (b) the Freiburg Personality Inventory, (c) the Rosenberg Self-Esteem Questionnaire, and (d) the Patient Health Questionnaire 4., Findings: Our self-developed, indication-specific questionnaire showed that 88% of our patients were very satisfied with the aesthetic result, 75% have had sex after surgery, and 72% were very satisfied with sexual function after GAS. Eighty-one percent had a strong improvement of QOL, and 91% would undergo the same treatment again. Eighty-four percent would recommend GAS to others. All patients lived as men fulltime., Discussion: Our study reveals that GAS plays an important part in the interdisciplinary treatment of transgender individuals as it improves the QOL in transgender men in most aspects of everyday life and has a positive influence on the patients' psyche and self-esteem in a retrospective study., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: There are few studies evaluating depression, self-esteem, and mental health after gender confirming treatment of transgender women. Most of these studies include different surgical techniques and nonvalidated questionnaires. With our survey, we are aiming to assess psychopathologies and mental health as well as sexuality among a group of patients treated by the same surgeon performing our self-developed combined surgical technique. This vaginoplasty approach is characterized by constructing the vaginal cavity with parts of the penile and scrotal skin as well as the longitudinally incised urethra., Materials and Methods: Forty-seven transgender women who underwent gender confirming treatment between 2007 and 2013 were included in a retrospective study. The assessment of our study group was performed by means of self-developed indication-specific questionnaires and 3 standardized questionnaires that can be compared with norm data., Results: Preoperative psychotherapy was mostly considered as helpful by the patients, yet postoperatively, only a third of our study participants were still under therapeutic treatment. Furthermore, we could show a change in sexual preference toward a more bisexual orientation. Gender confirming treatment satisfied the expectations for most of the patients and, in their opinion, should have been performed earlier. Results of the standardized Patient Health Questionnaire 4, a short depression screening questionnaire, did not significantly differ from healthy norm data. The Freiburg Personality Inventory, Revised, revealed normal emotionality and sane self-assessment within our study group. High self-esteem and significantly higher scores than norm data were found for the Rosenberg Self-esteem Scale., Conclusions: Gender confirming treatment with the combined technique is an important part of a multi-structured treatment of transgenders and does have effects on psychological well-being. It seems to decrease psychopathologies and implicates several ameliorations for transgender women. Findings need to be verified in prospective studies including preoperative evaluations.

Precise and objective calculation of breast volume is helpful to evaluate the aesthetic result of breast surgery, but traditional methods are unsatisfactory. Three-dimensional (3D) scanning of the body surface allows reproducible and objective assessment of the complex breast region but requires further investigation before clinical application. The main goal of this study was to investigate the precision and accuracy of breast volume measurement using 3D body scanning. Five independent observers standardized the 3D scanning method using 2 dummy models (n = 200) and examined its applicability with 6 test subjects and 10 clinical patients (n = 2220). Breast volume measurements obtained with the 3D-scanner technology were compared with reference measurements obtained from test subjects through nuclear magnetic resonance imaging. The mean deviation of the breast volume measurements of 1 test subject by all observers, expressed as percentage of volume, was 2.86 +/- 0.98, significantly higher than the deviation for the dummy models, 1.65 +/- 0.42 (P < 0.001). With respect to all clinical patients, the mean measurement precision obtained preoperatively was less precise than that obtained postoperatively (3.31 +/- 1.02 versus 1.66 +/- 0.49, respectively). Interobserver differences in measurement precision were not statistically significant. The mean breast volumes obtained by nuclear magnetic resonance imaging (441.42 +/- 137.05 mL) and 3D scanning (452.51 +/- 141.88 mL) significantly correlated (r = 0.995, P < 0.001). Breast volume measurement with 3D surface imaging represents a sufficiently precise and accurate method to guarantee objective and exact recording.

The anatomic conditions of the female breast require imaging the breast region 3-dimensionally in a normal standing position for quality assurance and for surgery planning or surgery simulation. The goal of this work was to optimize the imaging technology for the mammary region with a 3-dimensional (3D) laser scanner, to evaluate the precision and accuracy of the method, and to allow optimum data reproducibility. Avoiding the influence of biotic factors, such as mobility, we tested the most favorable imaging technology on dummy models for scanner-related factors such as the scanner position in comparison with the torso and the number of scanners and single shots. The influence of different factors of the breast region, such as different breast shapes or premarking of anatomic landmarks, was also first investigated on dummies. The findings from the dummy models were then compared with investigations on test persons, and the accuracy of measurements on the virtual models was compared with a coincidence analysis of the manually measured values. The best precision and accuracy of breast region measurements were achieved when landmarks were marked before taking the shots and when shots at 30 degrees left and 30 degrees right, relative to the sagittal line, were taken with 2 connected scanners mounted with a +10-degree upward angle. However, the precision of the measurements on test persons was significantly lower than those measured on dummies. Our findings show that the correct settings for 3D imaging of the breast region with a laser scanner can achieve an acceptable degree of accuracy and reproducibility.

In the study presented, the long-term outcome and satisfaction of 34 patients who underwent simultaneous bilateral breast reconstruction with a free transverse rectus abdominis muscle (TRAM) flap between 1988 and 2001 were assessed. Flap complications affected 13 of 68 flaps (19.1%). Anastomosis revision was needed in 6 cases (8.8%), the salvage rate being 50%. The rates of total and partial flap loss were 4.4% and 1.5%, respectively. Bilateral flap loss did not occur. Four patients developed donor site complications (11.7%), with wound healing problems being the most common (5.8%). Most patients were satisfied with their decision to have had breast reconstruction with free TRAM, 91% would choose the same operation again, and 91% would recommend this procedure to other patients. Of the operated patients, 20.8% felt an improvement in their sexual life; more patients, however, reported an improvement concerning their social life (37.5%) and life in general (50%).