En 2015, nous avions relaté notre expérience à propos de la courbe d'apprentissage en chirurgie de la réassignation génitale et souligné un concept d'apprentissage traditionnel en quatre étapes. Dans cet article, nous présentons notre première expérience d'aïdoïopoïèse (vaginoplastie) menée sur modèle SIMLIFE®, mannequin humanoïde à très haut degré de réalisme utilisant des corps humains issus de don du corps associés à un dispositif de circulation pulsatile et un dispositif de ventilation. La technique chirurgicale utilisée était celle de l'inversion pénienne, décomposée en 14 étapes distinctes. Le temps chirurgical total fut de 182 minutes. On ne dénotait aucune complication intraopératoire, et il n'y eut aucune lésion de l'urètre ou du rectum. Le saignement intraopératoire mesuré par la perte de liquide opératoire était de 280 mL. Nous revenons sur les avantages de cette technologie adaptée à la chirurgie de la transsexualité. Nous avons démontré la faisabilité d'une aïdoïopoïèse avec le modèle humanoïde de simulation SIMLIFE® et l'amélioration de la technique d'apprentissage de ce type de chirurgie avec ce modèle. Cette technologie pourrait trouver de nombreuses autres applications chirurgicales. Elle se heurte cependant aux contraintes de coût et de la législation sur les cadavres. In 2015, we reported our experience with the learning curve in genital reassignment surgery and highlighted a four-step learning concept. In this article, we present our first vaginoplasty performed on a humanoid model SIMLIFE®, a human body associated with a pulsating circulation device and a ventilation device. The surgical technique included 14 steps. The total surgical time was 182 minutes. There was no intraoperative complication, and there was no damage to the urethra or rectum. The intraoperative bleeding measured by the loss of operative fluid was 280 mL. We discuss the advantages of this technology perfectly adapted to transsexual surgery. We demonstrated the feasibility of vaginoplasty performed on a humanoid model SIMLIFE® and highlighted improvement of the surgical skills with this model. This technology could find many other surgical applications. However, it faces cost constraints and legislation on corpses.

INTRODUCTION:In 2015, we reported our experience with the learning curve in genital reassignment surgery and highlighted a four-step learning concept. CLINICAL CASE:In this article, we present our first vaginoplasty performed on a humanoid model SIMLIFE®, a human body associated with a pulsating circulation device and a ventilation device. RESULTS:The surgical technique included 14 steps. The total surgical time was 182minutes. There was no intraoperative complication, and there was no damage to the urethra or rectum. The intraoperative bleeding measured by the loss of operative fluid was 280mL. We discuss the advantages of this technology perfectly adapted to transsexual surgery. CONCLUSION:We demonstrated the feasibility of vaginoplasty performed on a humanoid model SIMLIFE® and highlighted improvement of the surgical skills with this model. This technology could find many other surgical applications. However, it faces cost constraints and legislation on corpses.

Few studies have been conducted to explore the utility of the Integra® dermal regeneration template (IDRT) combined with a delayed split-thickness skin graft (STSG) for reconstructing complex dorsal hand, digit, and thumb injuries. This study reports the indications and outcomes for 14 patients treated with this technique via a two-stage process. We retrospectively reviewed all patients treated by IDRT combined with STSG from May 2015 to October 2018. The inclusion criterion was traumatic or post-infectious soft tissue defects (STDs) of the dorsal hand, fingers, and thumb, not suitable for direct wound closure and requiring local, pedicle, or free flap reconstruction. After debridement, a two-stage procedure was applied, namely IDRT followed by STSG. Indications, functional outcomes, aesthetic results, complications, patient satisfaction, and the STSG take rate were evaluated over a 36-month follow-up using standardised instruments. A total of 14 patients with 15 reconstructions (average age = 48 years) were included. The dominant hand was involved in 50% of cases. Dorsal STDs involved the hand, fingers, thumb, and hand and thumb in 7, 3, 2 and 2 cases, respectively. The mean STD size was 35 cm2 (range: 3–150 cm2). The wound was associated with exposed tendons (without peritenon), bone (without periosteum), and joints (without a capsule) in eight cases (57%). The IDRT/STSG take rate was 97%. The average Vancouver Scar Scale score was 2 (1–4). The 36-month follow-up demonstrated that IDRT is a safe and reliable technique that can be considered a viable alternative to flap reconstruction for the management of traumatic STDs in selected patients. The aesthetic outcomes are acceptable, functional recovery of the fingers is excellent, patient satisfaction is very high and the rate of complications is very low.

Resume Introduction En 2015, nous avions relate notre experience a propos de la courbe d’apprentissage en chirurgie de la reassignation genitale et souligne un concept d’apprentissage traditionnel en quatre etapes. Cas clinique Dans cet article, nous presentons notre premiere experience d’aidoiopoiese (vaginoplastie) menee sur modele SIMLIFE®, mannequin humanoide a tres haut degre de realisme utilisant des corps humains issus de don du corps associes a un dispositif de circulation pulsatile et un dispositif de ventilation. Resultats La technique chirurgicale utilisee etait celle de l’inversion penienne, decomposee en 14 etapes distinctes. Le temps chirurgical total fut de 182 minutes. On ne denotait aucune complication intraoperatoire, et il n’y eut aucune lesion de l’uretre ou du rectum. Le saignement intraoperatoire mesure par la perte de liquide operatoire etait de 280 mL. Nous revenons sur les avantages de cette technologie adaptee a la chirurgie de la transsexualite. Conclusion Nous avons demontre la faisabilite d’une aidoiopoiese avec le modele humanoide de simulation SIMLIFE® et l’amelioration de la technique d’apprentissage de ce type de chirurgie avec ce modele. Cette technologie pourrait trouver de nombreuses autres applications chirurgicales. Elle se heurte cependant aux contraintes de cout et de la legislation sur les cadavres.

Introduction: Some transgender men express the wish to undergo genital gender-affirming surgery. Metoidioplasty and phalloplasty are procedures that are performed to construct a neophallus. Genital gender-affirming surgery contributes to physical well-being, but dissatisfaction with the surgical results may occur. Disadvantages of metoidioplasty are the relatively small neophallus, the inability to have penetrative sex, and often difficulty with voiding while standing. Therefore, some transgender men opt to undergo a secondary phalloplasty after metoidioplasty. Literature on secondary phalloplasty is scarce. Aim: Explore the reasons for secondary phalloplasty, describe the surgical techniques, and report on the clinical outcomes. Methods: Transgender men who underwent secondary phalloplasty after metoidioplasty were retrospectively identified in 8 gender surgery clinics (Amsterdam, Belgrade, Bordeaux, Austin, Ghent, Helsinki, Miami, and Montreal). Preoperative consultation, patient motivation for secondary phalloplasty, surgical technique, perioperative characteristics, complications, and clinical outcomes were recorded. Main Outcome Measure: The main outcome measures were surgical techniques, patient motivation, and outcomes of secondary phalloplasty after metoidioplasty in transgender men. Results: Eighty-three patients were identified. The median follow-up was 7.5 years (range 0.8-39). Indicated reasons to undergo secondary phalloplasty were to have a larger phallus (n = 32; 38.6%), to be able to have penetrative sexual intercourse (n = 25; 30.1%), have had metoidioplasty performed as a first step toward phalloplasty (n = 17; 20.5%), and to void while standing (n = 15; 18.1%). Each center had preferential techniques for phalloplasty. A wide variety of surgical techniques were used to perform secondary phalloplasty. Intraoperative complications (revision of microvascular anastomosis) occurred in 3 patients (5.5%) undergoing free flap phalloplasty. Total flap failure occurred in 1 patient (1.2%). Urethral fistulas occurred in 23 patients (30.3%) and strictures in 27 patients (35.6%). Clinical Implications: A secondary phalloplasty is a suitable option for patients who previously underwent metoidioplasty. Strengths & Limitations: This is the first study to report on secondary phalloplasty in collaboration with 8 specialized gender clinics. The main limitation was the retrospective design. Conclusion: In high-volume centers specialized in gender affirming surgery, a secondary phalloplasty in transgender men can be performed after metoidioplasty with complication rates similar to primary phalloplasty. Copyright (C) 2019, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

The Electronic Supplementary Material originally published with this article has been removed due to lack of appropriate permissions from the copyright holder.

Background: The medial triceps brachii is vascularized by the middle collateral artery and the arterial circle of the elbow. This vascularization allows a distal pedicled use to cover soft tissue defects of the elbow. We report our experience using this flap to cover traumatic and postsurgical wounds. Methods: Patients who underwent a pedicled medial triceps brachii flap procedure between 2008 and 2015 were included. Data concerning characteristics of the patients, wound size, surgical technique, and complications were retrospectively reviewed. An independent observer examined patients and assessed outcome of the coverage procedure: wound healing, scar length, range of elbow motion, and patient satisfaction. Results: Eight patients were included (70.6 +/- 17.7 years old at the time of surgery). All patients had serious comorbidities and risk factors of poor wound healing. Defects were due to postoperative healing complications (5 patients), skin necrosis secondary to an underlying olecranon fracture (1 patient), and direct open fractures (2 patients). Soft tissue defects had a median surface of 17 (14-22) cm(2). The olecranon was exposed in 7 cases and the medial humeral epicondyle in 1 case. Mean procedure duration was 83 +/- 14 minutes. There was no intraoperative or postoperative complication. All patients healed properly at 3 weeks of follow-up. No wound recurrence or surgery-related complication was reported after a median followup of 40.5 (21.5-69.5) months. Conclusion: Favorable outcomes in all of our 8 patients make this flap an interesting option to cover small to medium-sized defects of the posterior aspect of the elbow. Level of evidence: Level IV; Case Series; Treatment Study (C) 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

Objective. - Facial feminization surgery is becoming a more frequently requested procedure in transsexual male to female patients transformation. A global way of reporting outcomes data and showing the beneficial impact of this specific procedure is necessary. The objective of this study is to develop a reliable and valid tool to report patients' outcomes after facial feminization surgery. Methods. - A systematic literature review, input from experts working with transsexual patients and patient interviews were used to develop the conceptual framework of the questionnaire. It includes the outcomes deemed important to facial feminization surgery and it was used to construct items of the questionnaire. Results. - There is no specific tool for measuring patients outcomes after facial feminization surgery. Ten experts and 18 patients participated to this study. The conceptual framework includes the following themes: satisfaction with facial feminine appearance; adverse effects; quality of life. The questionnaire includes fourteen separate Likert scales, with preoperative and postoperative versions. The reliability of the questionnaire is excellent with a medium Alpha score of 0.85. Facial feminization surgery is associated with high patient satisfaction in this sample (83.7 +/- 7.41). Conclusion. - QESFF1 is a reliable questionnaire and its development follows the steps recommended by the patient-reported outcomes process. A large sample pilot test is needed to demonstrate its validity. The QESFF1 can provide physicians with the necessary tools to measure the impact of facial feminization surgery on male to female transsexual patients and also has the potential to support clinical trials. (C) 2018 Elsevier Masson SAS. All rights reserved.

The medial head of the triceps brachii muscle (MTB)-free flap is an attractive solution to cover small-to-medium defects of the lower limb. This muscular head has no well-identified function, suggesting minimal impact of its removal on elbow mobility. The aim of this study was to evaluate the safety and reliability of the harvest procedure and the functional and cosmetic morbidity of this donor site.

Introduction. - Breast reconstruction techniques are multiple and they should be chosen in order to improve women's satisfaction and well-being, thus obtaining a personalized treatment. This report's major purpose was to study, through the Breast-Q questionnaire, how the functional and aesthetic outcomes, as well as the complications, of the main autologous breast reconstruction techniques, can affect patients quality of life and well-being at long-term. The secondary purpose was to analyse, thus to identify, the independent factors characterizing the different reconstructive techniques, which may affect patients' satisfaction. Methods. - Women who underwent autologous breast reconstruction through deep inferior epigastric artery perforator or Latissimus dorsi muscle flap from May 2006 to May 2013 were included. The assessment was based on the Breast-Q reconstruction questionnaire. All times of post-mastectomy reconstruction were concerned: immediate, delayed, after previous procedure failure or conversion to another reconstructive technique due to the patient's dissatisfaction. Results. - A total of 98 patients were included. Concerning patients satisfaction, the breast-Q score is highest in patients who underwent immediate breast reconstruction, while scores after delayed breast reconstruction, previous surgery failure or conversion to another technique are generally equivalent. Higher scores have been observed in patients who underwent reconstruction through autologous Latissimus dorsi compared to Latissimus dorsi with prosthetic implant reconstruction. Conclusion. - The authors identified factors of higher patients' satisfaction, like absence of major complication and advanced patient's age, in order to personalize the surgical planning according to the patient's priorities. (C) 2017 Elsevier Masson SAS. All rights reserved.

INTRODUCTION:Learning a new technique, even for an established surgeon, requires a learning curve; however, in transsexual surgery especially, there is a lack of professional and public tolerance for suboptimal aesthetic and functional results due to a learning curve.AIMS:In this context, we have tried to build a learning concept for vaginoplasty that includes four steps: (i) formal identification of the surgical steps in order to provide both measure of surgical process and measures of outcomes; (ii) training on cadavers with expert assistance; (iii) performing the live surgery with assistance from expert; and (iv) performing the surgery alone. Herein, we emphasize the second step of our learning concept.MATERIAL AND METHODS:Between September 2013 and December 2013, 15 cadavers were operated on by an established surgeon learning vaginoplasty under assistance from two expert practitioners. Mean global time and mean time necessary to perform each step of the operation were recorded by the experts. Intraoperative complications were systematically registered. The final depth and diameter of the neaovaginal cavity were precisely measured. For each cadaver, the aesthetic results were assessed by one of the experts.RESULTS:Mean total operating time was 179 ± 34 minutes and decreased from 262 minutes for the first training attempt to 141 minutes for the last one. Intraoperative expert correction included modification of the scrotal triangular flap design and change of position of the urethra: This happened during the first training. No lesion of the urethra or of the anus occurred. The two experts judged the outcomes as excellent in seven cases, very good in four cases, good in two cases, and fair in two cases.CONCLUSION:Despite the numerous reports on vaginoplasty in the literature, there is a real lack of published information on the learning curve of this operation. We make the hypothesis that introducing a learning concept with assistance from expert practitioners at the beginning of the surgeon's experience can optimize both the duration of his learning curve and reduce the risk of major complications.

Rosemary Basson, MD, FRCP(UK),* Allan Young, MD, PhD, FRCPsyche, FRCP(C),† Lori A. Brotto, PhD,‡ Miriam Driscoll, MD, FRCP(C),* Shauna Correia, MD, FRCP(C)*, and Fernand Labrie, MD, PhD§ *Psychiatry, University of British Columbia, Vancouver, BC, Canada; †Psychological Medicine, King’s College, London, UK; ‡Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; §Laval University Hospital, Research Center in Molecular Endocrinology, Oncology, and Human Genomics, Laval University, Laval, QC, Canada

Introduction Male-to-female sex reassignment surgery involves three main procedures, namely, clitoroplasty, new urethral meatoplasty and vaginopoiesis. Herein we describe the key steps of our surgical technique.Methods Male-to-female sex reassignment surgery includes the following 14 key steps which are documented in this article: (1) patient installation and draping, (2) urethral catheter placement, (3) scrotal incision and vaginal cavity formation, (4) bilateral orchidectomy, (5) penile skin inversion, (6) dismembering of the urethra from the corpora, (7) neoclitoris formation, (8) neoclitoris refinement, (9) neovaginalphallic cylinder formation, (10) fixation of the neoclitoris, (11) neovaginalphallic cylinder insertion, (12) contouring of the labia majora and positioning the neoclitoris and urethra, (13) tie-over dressing and (14) compression dressing.Results The size and position of the neoclitoris, position of the urethra, adequacy of the neovaginal cavity, position and tension on the triangular flap, size of the neo labia minora, size of the labia majora, symmetry and ease of intromission are important factors when considering the immediate results of the surgery. We present our learning process of graduated responsibility for optimisation of these results. We describe our postoperative care and the possible complications.Conclusion Herein, we have described the 14 steps of the Baudet technique for male-to-female sex reassignment surgery which include clitoroplasty, new urethral meatoplasty and vaginopoiesis. The review of each key stage of the procedure represents the first step of our global teaching process.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

BACKGROUND:The prevalence of acellular dermal matrices in reconstructive surgery has increased through the last decade with satisfying outcomes. Long-term follow-up and effectiveness studies could enable appropriate use of these devices and challenge the current gold-standard treatments. This paper presents functional and cosmetic long-term outcomes on the Integra(®) Dermal Regeneration Template (IDRT) for treating traumatic soft-tissue defects of the foot and ankle. METHODS:All adult patients who underwent severe traumatic foot and ankle reconstruction with Integra(®) since 2004 were retrospectively included. Results were evaluated using standardized outcome instruments. RESULTS:Twenty-one reconstructions were evaluated 4.5 ± 2.5 years after foot and ankle injury. Major complications inducing a second application included 1 hematoma and 1 infection. Seven patients (35%) had good or excellent Foot and Ankle Ability Measures. Subjectively, when asked to compare current function with pre-injury status, the mean response was 66 ± 23%. The Observer Scar Assessment Scale scored 17 ± 5 points (possible range, 5-50), while the Patient Scar Assessment Scale scored 30 ± 11 points (possible range, 6-60). CONCLUSIONS:Long-term functional and cosmetic outcomes 4.5 years after severe traumatic foot and ankle wounds treated with IDRTs were rated fair in the great majority of patients. Nevertheless, because complications and surgical revisions were few, potential benefits might be underestimated because of the initial combined injuries and their sequelae. In this way, for appropriately selected patients with severe traumatic foot and ankle soft-tissue defects, including subacute coverage, it appears that this treatment may be a viable first option.

Introduction Lipomas are associated with a variety of symptoms including neuropathies, local compression of the surrounding tissues, aesthetic complaints and may be graded as liposarcomas histologically. This study was performed to review our surgical management at the level of the hand. Materials and methods Between 2008 and 2013, 14 patients were referred to our department for suspected adipose tumour of the hand. Preoperative MRI was used to assess tumour and surrounding tissue to plan the surgical therapy. We reviewed the clinical history, MRI findings, surgical approach, and outcomes. Results Complaints leading to consultation were pain in 11 cases, compression neuropathy in 7 cases, aesthetic concern in 8 cases, and limited wrist range of motion in 2 cases. Magnetic resonance imaging was performed in 13 cases, confirming the diagnosis of adipose tumour in all but two cases. These two cases were diagnosed in one case as a ganglion and the other as an epithelioid sarcoma. An amputation of the fifth digit was performed regarding the latter case and the patient received additional radiotherapy. The mean follow-up period was 32 ± 20 months. There was no recurrence of lipoma or sarcoma. Conclusion MRI is useful for diagnosing and planning of the surgical intervention performed in the latter case adipose tumours. Rapidly evolving tumours with subfascial localization are absolute surgical indications. Incision biopsy is mandatory for entities of unknown dignity and for malignant tumours. Interdisciplinary tumour board meetings should discuss each patient before surgery is performed. Level of evidence and study type IV.

Recto-neovaginal fistulae (RNVF) are the most troublesome complications after the construction of a vagina for a male-to-female (MtF) transsexual. The majority are iatrogenic, most commonly the res...

INTRODUCTION:Traumatic soft tissue defect is a common issue for the trauma surgeon. The aim of this study was to evaluate the use of a dermal regeneration template (DRT) associated to a split-thickness skin graft (STSG) to cover severe traumatic wounds involving exposure of deep functional structures.MATERIALS AND METHODS:Patients with severe traumatic defects, either open fractures or full-thickness skin wounds involving exposure of tendons without paratenon, bones without periosteum or joints without articular capsule, managed in the authors' trauma centre, were included in a prospective fashion. They were treated by DRT, associated to STSG within a month and followed up to 18 months. The primary outcome was STSG percentage of take at 18 months. The secondary outcomes included complications rate, functional results, scar retraction rate at 18 months and aesthetic results.RESULTS:A total of 15 patients were included, with 100% follow-up at 18 months. The mean age was 44.3 years, with nine men. Eighty percent of the wounds were located on the lower limb. After 18 months, the mean STSG take rate was 99.3%. Between the placement of the template and the STSG procedure, the reported complications were template unsticking, seroma, local infection and local oedema. There was no reported haematoma. In terms of functional outcome, percentages of patients undergoing rehabilitation from the time of the skin graft until the end of the follow-up decreased from 80% to 20%. There was 8.7% of retraction in length, and an 8.2% retraction in width. The Vancouver Scar Scale score constantly decreased until 2.5 at 18 months. The final functional and aesthetic subjective scores showed the marks to be located above the 'Satisfying' threshold, either by the surgeon or by the patients.DISCUSSION AND CONCLUSION:Eighteen months' follow-up demonstrated that DRT reconstruction is a simple, reliable, efficient tool to treat complex traumatic soft tissue defects.

IntroductionLes brûlures des paumes des mains de l’enfant sont le plus souvent observées entre 10 et 14 mois à la période de l’apprentissage de la marche. Elles sont causées par un contact prolongé avec une surface chaude, le plus souvent un insert de cheminée ou un poêle. La prolongation du contact brûlant malgré le stimulus douloureux est en rapport avec l’immaturité des muscles redresseurs du rachis à cet âge. Il en résulte le plus souvent une brûlure du 3e degré localisée à la paume de la main et à la face palmaire des doigts. L’excision tangentielle-greffe de peau précoce est actuellement le traitement de choix. Toutefois, aucune étude clinique randomisée et contrôlée, n’a montré la supériorité de la greffe de peau totale ou de peau fine pour la couverture de ces pertes de substance. L’objectif de notre étude est d’analyser les résultats fonctionnels et esthétiques à long terme de l’utilisation d’une greffe de peau fine dans cette indication afin d’informer les parents de l’évolution envisageable.Matériel et méthodesLe service d’information médicale de notre centre hospitalo-universitaire a été sollicité afin de retrouver au plus anciennement possible l’ensemble des enfants de moins de 3ans le jour de la brûlure ayant bénéficié d’une excision-greffe de peau fine précoce pour brûlure profonde de la paume de la main. Les patients et/ou leurs parents ont été convoqués pour une consultation chirurgicale au cours de laquelle, après avoir obtenu leur consentement, les questionnaires POSAS et DASH étaient remplis. Une étude de la sensibilité fine était également réalisée. Les séquelles du site donneur étaient analysées. Les dossiers médicaux des patients étaient compulsés afin de retracer l’historique chirurgical.RésultatsLes données informatisées étaient accessibles à partir de 1994 ce qui a permis d’inclure rétrospectivement 40 patients dans l’étude. Parmi eux, 20 ont été vus en consultation. Les résultats des questionnaires étaient satisfaisants et la sensibilité des greffes était normale. Les séquelles des sites donneurs de greffe étaient considérées comme mineures. Le suivi moyen à long terme était de 10ans. Les enfants bénéficiaient en moyenne de 1,3 interventions réparatrices dans les suites des greffes de peau.DiscussionLes résultats fonctionnels et esthétiques de l’excision-greffe précoce des brûlures profondes de la paume des mains de l’enfant sont conditionnés par l’application rigoureuse d’un protocole de rééducation adapté. Malgré cette prise charge optimale, l’évolution à long terme est difficilement prévisible car liée à de multiples facteurs comme la croissance, la « compliance » de l’enfant (relations parents/enfants), la localisation des brûlures et leur rapidité de cicatrisation. Les résultats de notre étude montrent une acceptation esthétique des cicatrices et surtout une fonction proche de la normale à long terme. Toutefois l’évolution est émaillée par plusieurs interventions réparatrices de brides de la paume et des commissures. L’application clinique immédiate des résultats de notre étude permet d’informer les parents sur l’évolution et de les rassurer pendant la période initiale de prise en charge.

BACKGROUND:Satisfaction with breasts, sexual well-being, psychosocial well-being, and physical well-being are essential outcome factors following breast augmentation surgery in male-to-female transsexual patients. The aim of this study was to measure change in patient satisfaction with breasts and sexual, physical, and psychosocial well-being after breast augmentation in male-to-female transsexual patients.METHODS:All consecutive male-to-female transsexual patients who underwent breast augmentation between 2008 and 2012 were asked to complete the BREAST-Q Augmentation module questionnaire before surgery, at 4 months, and later after surgery. A prospective cohort study was designed and postoperative scores were compared with baseline scores. Satisfaction with breasts and sexual, physical, and psychosocial outcomes assessment was based on the BREAST-Q.RESULTS:Thirty-five male-to-female transsexual patients completed the questionnaires. BREAST-Q subscale median scores (satisfaction with breasts, +59 points; sexual well-being, +34 points; and psychosocial well-being, +48 points) improved significantly (p < 0.05) at 4 months postoperatively and later. No significant change was observed in physical well-being.CONCLUSIONS:In this prospective, noncomparative, cohort study, the current results suggest that the gains in breast satisfaction, psychosocial well-being, and sexual well-being after male-to-female transsexual patients undergo breast augmentation are statistically significant and clinically meaningful to the patient at 4 months after surgery and in the long term.CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, IV.