Lipografting - and Sculpturing in Female-to-Male Transgender Patients

This case report presents several surgical procedures that amply lipotransfer and -sculpturing to treat specific volume sequelae and scar-related impairments in FtM patients after failure of conservative surgical primary therapy. From November 2016 till November 2018 three FtM patients with typical scar related sequelae underwent sequential lipografting – and sculpturing. Our minimally invasive operative protocol (ACRT) was combined if required to a gender reassigning liposculpturing of the trunk or forearm augmentation for flap preformation. Clinical and aesthetic outcome were measured with photographs, the Patient and Observer Scar Assessment Scale (POSAS), Visual Analogue Scale (VAS) for pain, ROM measurements and nerve conduction studies (NCS). In all three patients a relevant functional and aesthetic improvement was achieved associated with very short hospitalization (average 3.2 days) and minor complications like swelling or bruising of the donor site. Clinical outcome showed improved scar appearance; 55% mean decrease of pain perception leading to 37% higher ROM in the left wrist mostly in extension. Increase of neophallus’ size or forearm’s subcutaneous layer prior to phalloplasty as well as a typical V-shape masculine trunk were accomplished after maximum three procedures.