Dr. Saber’s Blog
Over the past decade, gender affirming healthcare has emerged as a vast field. Unfortunately, however, many people still have questions and misunderstandings about what this type of healthcare includes and why a person might need it. This article will examine this topic in detail. In particular, it will take a look at the effects of plastic surgery as it relates to this situation.
Gender affirming care involves a wide range of medical, psychological, and psychosocial interventions meant to help transgender, gender nonconforming, and non-binary individuals look and live in accordance with their gender identity.
One of the most visible interventions is plastic surgery because it can create permanent changes in the body. The cosmetic surgery field frequently battles questions about postoperative regret. Postoperative regret is when a patient, for one reason or another, wishes they had not had the surgery in the first place.
This possibility has unfairly impacted gender affirming surgeries. It is used as an argument against granting gender-affirming care to trans and nonbinary patients.
However, we now have an emerging list of evidence-based studies and systematic reviews examining the topic. So, it is time to take a humane, fact-based look at the data.
What do the numbers say? The data shows that gender affirming care has an unmistakably positive impact on the mental health and quality of life of transgender and cisgender people.
Also known as GAS, gender affirmation surgeries involve many different surgeries that can help alleviate the stress and psychological pain caused by gender dysphoria. Gender dysphoria is when a person is severely distressed or unhappy because they feel that their birth gender does not match their gender identity.
GAS are often divided into “top” and “bottom” surgeries depending on the part of the body which is worked on. Esthetic facial tweaks sometimes accompany them and may come before, after, or independently from other gender transition therapies, such as hormone therapy, voice training, or psychological support.
Top surgery refers to surgical procedures that align an individual’s chest with their gender identity. It can be a deeply personal and transformative experience, leading to increased self-esteem, self-acceptance, and overall mental well-being.
Depending on the patient’s goal, top surgery for trans women can involve breast implants and feminizing chest contouring, or a total mastectomy to create a flatter, more masculine chest for trans men.
The term “bottom surgery” encompasses different types of genital surgery. For transgender women, this may include vaginoplasty (the surgical creation of a vagina) or other feminizing genital procedures. For transgender men, options include a phalloplasty (constructing a penis) or a metoidioplasty (enlarging the clitoris using hormones).
These procedures are generally more complex and fall under the spectrum of urology and gynecology as much as plastics. Recovery periods also tend to be longer and are often pursued later in a person’s transition journey.
People seek plastic surgery for many different reasons. After the procedure, some will experience some degree of postoperative regret (regret after surgery). We need to be careful when speaking about this.
“Regretting plastic surgery” sounds like a simple idea but it is not because there are levels of regret.
For example, during the first few days and weeks after major surgery, pain, discomfort, and lack of independence can place a gray cloud over the experience. However, this temporary level of regret usually passes, leaving people with joy and satisfaction at the results.
On the other hand, unmet expectations, complications, or changing beauty standards can cause others to have a more long-lasting remorse. Some patients may wish they had not done the surgery at all, or that some part of the decision-making process had gone differently.
Due to these nuances, we don’t have many major studies looking into the prevalence of decision regret. Some polls show that up to 65% of people regret their surgery at some point in the recovery process. Yet, there can be big differences depending on the type and reason for the surgery. A 2017 review found that only about 14% of patients who had a mastectomy following a cancer diagnosis regretted undergoing surgery.
Overall, gender affirmation surgery has much lower rates of regret when compared with general plastic surgery.
One of the largest studies on the topic so far dates back to 2021. It looked at transgender patients who underwent both transmasculine and transfeminine procedures. This meta-analysis study looked at over 7,000 patients and found that barely 1% of them regretted their GAS.
More recently, a handful of other researchers have looked at more specific outcomes among transgender individuals. While some types of GAS are more complex than others, most have consistently low rates of regret.
The outcomes of top surgeries for trans men who were assigned female at birth appear especially encouraging. In 2023, a cross-sectional study published in JAMA looked at the patient-reported regret rate of people who had undergone a mastectomy as part of their transition.
The survey respondents were at least two years post-operation (at least one was 23 years post-operation), and none reported undergoing reversal procedures. Once again, the overwhelming majority reported a high level of patient satisfaction. In fact, on a five-point satisfaction scale, the average response was 4.8 with a median score of 5!
An oversized part of the debate surrounding gender-affirming healthcare is centered around people who choose to detransition, especially if they started treating their gender dysphoria as adolescents. Detransition is when a person chooses to reverse their gender-affirming treatments and return to their birth gender.
In reality, detransitioning remains a remarkably rare event. So far, only one survey shows that approximately 8% of transgender patients go back to living as their birth sex at birth at some point after a complete transition. But even this relatively low number needs to be taken with a grain of salt. First, it includes those who only “temporarily detransitioned.” Second, the survey showed that many such instances happened due to non-surgical reasons, such as pressure from family members, difficulties with finding a job, lapses in health coverage, or fear of discrimination.
A previous study looking at results from the 2015 U.S. Transgender Survey found a dramatic connection between gender-affirming surgery and mental health. For trans and nonbinary patients, undergoing at least one type of gender-affirming surgery was associated with a 42% reduction in psychological distress, a 44% reduction in suicidal ideation (thoughts about or impulses to commit suicide), and a 35% reduction in smoking. In turn, each one of these reductions can bring about further positive health outcomes for trans people, who continue to face significant barriers when accessing proper care.
As a surgeon who specializes in gender-affirming care, I find the study both reassuring and affirming. It underscores what many of us in the medical community have known anecdotally but now have empirical data to support: gender-affirming surgeries can be lifesaving.
In my practice, I’ve seen the joy and relief that plastic surgery can bring to patients. The decision to undergo top surgery is highly personal and can be life-altering. It’s not merely cosmetic; it’s a critical step in aligning one’s physical appearance with their identity.
While not every trans, nonbinary, or gender-diverse patient will want surgery, those who do should have safe access to plastic and reconstructive surgery, just as cis patients do. Meanwhile, as surgeons, we must go above and beyond when serving this demographic. The Standards of Care for the Health of Transgender and Gender Diverse People, as published by the World Professional Association for Transgender Health, are an excellent starting point. They must be followed up by a holistic and customized assessment that helps each patient achieve the peace they deserve.
If you or someone you know is considering top surgery or any form of gender-affirming surgery, seek consultation with a knowledgeable and compassionate medical professional. Your health and happiness are paramount, and the right medical team can make all the difference in your journey.
CALL (818) 770-7050 OR CLICK HERE TO SCHEDULE ONLINE
Access to gender-affirming plastic surgery improves mental health, quality of life, self-image, and overall well-being. That’s why Dr. Sepideh Saber, M.D., is proud to provide a variety of cosmetic surgeries and procedures for trans and nonbinary patients.
Dr. Sepideh Saber is a renowned plastic surgeon based in Los Angeles, specializing in gender-affirming surgeries and cosmetic procedures. She believes in empowering her patients through knowledge, empathy, and expert care.
If you’re ready to pursue this step in your gender journey, schedule your free consultation today.
Call (877) 205-4100 or schedule a consultation online.
The practice of Dr. Saber is located in Encino, CA, for patients throughout the Los Angeles area. We are also convenient to Encino, Woodland Hills, Sherman Oaks, Calabasas, Burbank, Glendale, Hidden Hills, Agoura Hills, Northridge, North Hollywood, Malibu, Topanga, Canoga Park, Reseda, Valley Glen, Chatsworth, West Hills, Winnetka, Universal City, Bel Air, Beverly Hills, Downtown Los Angeles, Silverlake, and Echo Park.
Dr. Saber graduated from Stanford University’s world-renowned medical school and did her plastic and reconstructive surgery residency at the equally lauded University of Southern California. She then completed a fellowship at New York University in the highly challenging and delicate disciplines of hand surgery and microsurgery.
Dr. Saber offers a more sensitive, female perspective for patients of all ages, genders, and orientations. Former patients from all walks of life have praised not only their treatment outcomes but her caring, thoughtful approach to a wide array of appearance and health-related matters.