“Surgical Outcomes in Body Contouring Procedures: A Retrospective Cohort Study of 168 Patients”

Introduction: Transgender and gender diverse (TGD) individuals may undergo feminizing body contouring (FBC), liposuction with or without fat grafting to the buttocks and hips, to fulfill embodiment goals. There is currently little literature describing FBC outcomes. Methods: A retrospective review of patients who were ≥18 years old with ≥1 postoperative appointment who underwent FBC from 1/2019-10/2024 by four surgeons was performed. Demographic data, medical history, perioperative details, and complications were reviewed. Results: A total of 168 primary procedures were completed. Most patients (n=161, 96.4%) used hormones for an average of 8.5 years. Average age was 37.1 years old and average BMI was 29.3 kg/m2. Average fat transferred was 2.2 L, most commonly from the abdomen (98.8%), back (94.6%), and medial thighs (59.5%). A third of patients (33.3%) attended at least one hyperbaric oxygen chamber therapy session with an average of 12.7 sessions. At average follow-up of 318.5 days, 19.6% of patients experienced any complication, 4.2% with contour deformity, 3.0% with fat necrosis, 2.4% with cellulitis, 2.4% having seroma, and 2.4% being readmitted. Revision rate for fat loss or deformity was 20.2%. Increased age was associated with fat necrosis (p=0.05) and increased HBOT sessions was associated with decreased odds of any complication (p=0.03). While BMI did not correlate with complication rates, increasing fat grafting volume trended toward statistical significance for association with any complication (p = 0.07) Conclusion: FBC appears to be a safe and customizable procedure for transfeminine patients, with relatively low rates of major complications. Clinical counseling should emphasize potential need for revision due to fat loss or contour deformity.