Association of a standardized postoperative recovery atlas with early recovery-related concerns after female genital cosmetic surgery: a prospective before-after study

Abstract Background Female genital cosmetic surgery (FGCS) is associated with substantial early postoperative changes that may be difficult for patients to interpret. We developed a standardized postoperative recovery atlas and examined whether its use was associated with early recovery-related concerns and patient experience. Methods This single-center prospective before-after study comprised a control phase (M1; September 2024-February 2025; routine education; n = 60) and an intervention phase (M2; August 2025-January 2026; routine education plus recovery atlas; n = 72). The atlas was developed after M1 from standardized serial photographs of the 60 M1 patients. The principal patient-reported outcome in the revised analysis was a study-specific postoperative week-1 recovery-related concern score (3 items; total 3–15; higher scores indicating greater concern). Additional outcomes included a study-modified 7-item FGSIS (5-point response format; total 7–35), month-1 satisfaction, and month-1 recovery experience. VPAHS scores were used to characterize the photographic healing trajectory. Results The M2 group had a lower week-1 recovery-related concern score than the M1 group [median 7.0 (Q1-Q3, 7.0–8.0) vs. 10.0 (9.0–12.0); P < 0.001; Cliff’s delta = -0.763, 95% CI -0.873 to -0.636]. Month-1 recovery experience was higher in M2 [10.0 (9.0–10.0) vs. 9.0 (8.0–10.0); P < 0.001; delta = 0.354, 95% CI 0.179–0.518], although no minimally important difference has been established for this study-specific scale. FGSIS scores increased from baseline within both groups, but the between-group difference in change was not significant ( P = 0.345). Satisfaction did not differ significantly ( P = 0.295) and showed marked ceiling clustering. VPAHS scores peaked on postoperative day 1 and subsequently declined. Interobserver ICCs for the VPAHS total score ranged from 0.684 to 0.790 across time points. Conclusions Use of the recovery atlas was associated with lower early recovery-related concern scores and higher recovery-experience ratings. Because the study was nonrandomized and no preoperative baseline measure of recovery-related concern was obtained, these findings should not be interpreted as causal.