Margriet Mullender

Amsterdam University Medical Center | VUmc · Department of Plastic, Reconstructive and Hand Surgery

Background Access to gender-affirming medical care has life-saving effects on transgender and gender diverse (TGD) individuals. An increasing number of TGD individuals seek care which led to waiting times of years. We assessed the duration and effects of excessive waiting for gender-affirming care. Methods In this mixed-methods cross-sectional pop...

When seeking gender-affirming care, trans* and gender-diverse individuals often describe experiencing barriers. However, a deeper understanding of what constitutes such barriers is generally lacking. The present research sought to better understand the barriers trans* and gender-diverse individuals experienced, and their effects, when seeking gende...

Objectives Various procedures and techniques for genital surgery are available to transgender and gender diverse individuals. Prior research on feminizing (i.e., vaginoplasty, vulvoplasty, labiaplasty, and clitoroplasty) and masculinizing (i.e. phalloplasty, metoidioplasty, scrotoplasty and coronaplasty) genital gender affirming surgery measures an...

Objective: Sexual wellbeing is an important aspect of quality-of-life. In transgender individuals who seek gender affirming treatment, various aspects of sexuality have been assessed. However, not much is known on how transgender individuals themselves perceive sexual wellbeing. This study aims to explore the perception of sexual wellbeing in tran...

Background: A variety of physical complaints have been related to chronic diastasis recti (DR), including back pain, pelvic pain, and urinary incontinence. However, its clinical significance is still subject of debate, leaving many patients to feel unheard when experiencing symptoms. This study aims to assess current knowledge on DR, its potential...

Objective: This study aimed to acquire insight into the perceived user friendliness, accessibility and inclusiveness of a personalized digital care pathway. Materials & methods: Usability of the tool was tested in an experimental setting. Mixed methods data collection consisted of scenario-based eye tracking tests in a web- or mobile-based proto...

Background: Gender-affirming treatments are reported to improve mental health significantly. However, a substantial number of transgender individuals report a relapse in, or persistence of, mental health problems following gender-affirming treatments. This is due to multiple stressors occurring during this period, and in general as a consequence o...

Objective A prerequisite for patient-centredness in healthcare organisations is offering patients access to adequate health information, which fits their needs. A personalised digital care pathway (PDCP) is a tool that facilitates the provision of tailored and timely information. Despite its potential, barriers influence the implementation of digit...

Background Osteoradionecrosis of the jaw is a severe complication of radiotherapy in head and neck cancer patients . If conservative treatment and surgical debridement have been unsuccessful, the preferred treatment for symptomatic mandibular osteoradionecrosis (mORN) is radical surgery and subsequent reconstruction with a free vascularized flap. T...

Background The emphasis on implementation of value-based healthcare (VBHC) has increased in the Dutch healthcare system. Yet, the translation of the theoretical principles of VBHC towards actual implementation in daily practice has been rarely described. Our aim is to present a pragmatic step-by-step approach for VBHC implementation, developed and...

Sexual-wellbeing is recognized as an important aspect of quality-of-life. Yet, no overview exists of which aspects of sexual-wellbeing have been assessed in trans individuals seeking or undergoing medical treatment, nor is it clear what tools are used to evaluate the effect of medical treatment on sexual-wellbeing. First, to identify which topics p...

Literature provides a moderate level of evidence for the beneficial effects of incisional negative pressure wound therapy (iNPWT) on scar quality. The purpose of this study was to establish if iNPWT results in improved scar outcomes in comparison to the standard of care. Therefore, a within‐patient randomized controlled, open‐label trial was conduc...

Background After gender-affirming mastectomies with free nipple grafts, satisfaction with nipples tends to fall short behind chest outcomes. This might be related to changes in nipple areolar complex (NAC) dimensions over time. Therefore, the aim of this study is to establish the long-term changes in NAC morphology and compare these to cisgender ma...

The correct positioning of nipple-areolar complexes (NAC) during gender-affirming mastectomies remains a particular challenge. Recently, a Dutch two-step algorithm was proposed predicting the most ideal NAC-position derived from a large cisgender male cohort. We aimed to externally validate this algorithm in a Belgian cohort. The Belgian validation...

Background The morphometric results after breast augmentations are generally understood to be clinically different between trans(gender) and cis(gender) women. The objective of this study was to establish these morphometric differences between the augmented breasts of trans and cis women and their implications for preoperative planning and expectat...

Introduction Tactile and erogenous sensitivity of the neophallus after phalloplasty is assumed to affect the sexual well-being of transmasculine persons and, ultimately, their quality of life. The experienced and objective sensation of the neophallus and their association are largely unknown. Aim This study evaluated experienced tactile and erotic...

Background: Incisional negative-pressure wound therapy (iNPWT) is widely adopted by different disciplines for multiple indications. Questions about the most appropriate uses and value of iNPWT have been raised. Methods: An open-label within-patient RCT was conducted in transgender men undergoing gender-affirming mastectomies. The objective was to d...

Introduction & Objectives In our institution, genital Gender-Affirming Surgery (gGAS, phalloplasty or metoidioplasty) in transgender men is offered with or without Urethral Lengthening (UL). The aim of this study was to assess the effect of gGAS with or without UL on several patient-reported outcomes, and to identify predictors of overall patient s...

Part 3 of this first-of-its-kind 3-part series helps show how pediatric primary care providers (PPCPs) are uniquely situated to screen, identify, and care for transgender and gender-diverse youths.

Objective The aim of this study was to assess the development of burn scar contractures and their impact on joint function, disability and quality of life in a low-income country. Methods Patients with severe burns were eligible. Passive range of motion (ROM) was assessed using lateral goniometry. To assess the development of contractures, the mea...

Background: In our institution, genital Gender-Affirming Surgery (gGAS;phalloplasty or metoidioplasty) in transgender men is offered with or without Urethral Lengthening (UL). Aim: The aim of this cross-sectional and retrospective study was to assess the effect of gGAS with or without UL on several Patient-Reported Outcomes (PROs), and to identify...

Background In the treatment of gender dysphoria, appropriate nipple-areola complex (NAC) positioning is essential for achieving a natural appearing male chest after subcutaneous mastectomy. An accurate predictive model for the ideal personalized position of the NAC is still lacking. The aim of this study is to determine the anthropometry of the mal...

Objectives: Puberty suppression (PS) is a cornerstone of treatment in youth experiencing gender dysphoria. In this study, we aim to inform prescribing professionals on the long-term effects of PS treatment on the development of sex characteristics and surgical implications. Methods: Participants received PS according to the Endocrine Society gui...

Background: Genital gender-affirming surgery (gGAS) with urethral lengthening (UL) in transgender men is associated with high urological complication and reoperation rates. Since 2009, we offer gGAS without UL to avoid these complications. Aim: The aim of this study was to assess what portion of the transgender men opted for gGAS without UL and to...

BACKGROUND Scrotal (re)construction, scrotoplasty, is performed as part of gender affirming surgery in transgender men. Objective To describe, step-by-step, our scrotal reconstruction technique in transgender men undergoing genital gender affirming surgery without urethral lengthening. Material and Methods A 29-year-old transgender men underwent...

Background: Breast implants are frequently used in cosmetic and reconstructive breast surgery. Capsular contracture, the most common long-term complication, is usually graded using the Baker classification. Despite its widespread use, its reliability has never been established. The aim of this study was to determine the inter-observer reliability...

Background Multiple options of genital gender-affirming surgery are available to transmen. The transman should be able to weigh these options based on the outcomes, risks, and consequences that are most important to him. For this reason, a decision aid for genital surgery in transmen (DA-GST) was developed. It aims to support the transman in making...

Objective: Although breast reconstruction has become an important treatment modality following mastectomy, few studies assessed predictors of postoperative sexual outcomes after breast reconstruction. Therefore, we aimed to study three sexual outcomes following implant-based breast reconstruction (IBBR), and associate multiple biopsychosocial fact...

Background: Masculinizing mastectomy is the most requested gender affirming surgery (GAS) in trans men, followed by genital GAS. Mastectomy and total laparoscopic hysterectomy, with or without bilateral salpingo-oophorectomy (TLH ± BSO), can both be performed in one single operation session. However, data on complication rates of the combined proce...

Surgical construction of a vagina may be indicated in transgender women and cisgender women with congenital or acquired vaginal absence. It has a positive effect on quality of life and generally enables patients to engage in penetrative sexual intercourse. Different surgical techniques exist for vaginal (re)construction. Genital surgery in transgen...

Purpose: To determine the urologic complications and lower urinary tract functions after genital gender affirming surgery (gGAS) with urethral lengthening (UL) in transmen. Materials and Methods: A single-center, retrospective cohort study was performed from January 2013 to January 2018. Patient demographics, medical history, perioperative data, s...

Objective: To describe the novel surgical technique of urethral lengthening in anterolateral thigh (ALT) and superficial circumflex iliac artery perforator flap (SCIP) phalloplasty with a pedicled labia minora flap (PLMF) and report on the clinical outcomes. Methods: Between March 2014 and August 2018, 16 transgender men underwent phalloplasty w...

Background: The number of individuals with gender identity incongruence seeking treatment, including genital gender-affirming surgery, has increased over the past decade. Surgical techniques for genital gender-affirming surgery in transgender men have evolved considerably. The aim of this study was to present an overview of the evolution of genita...

Introduction: Testicular prosthesis implantation may be used for neoscrotal augmentation in transgender men. Aim: Assess the clinical outcomes and risk factors for postoperative complications of this procedure in transgender men. Methods: All transgender men who underwent neoscrotal augmentation with testicular implants between January 1992 an...

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 a...

Background: Phalloplasty is performed as genital gender-affirming surgery in transmasculine persons. It requires the harvest of sizeable autologous fasciocutaneous flaps, which is associated with donor-site morbidity and extensive scarring. Flap preexpansion has been used to facilitate wound closure and reduce scarring, but the efficacy of flap pr...

Objectives The intestinal microbiota plays an important role in intestinal health. After colonic diversion from the fecal stream, luminal nutrients for bacteria are expected to be depleted, inducing changes in microbial composition. In this study, we describe microbial changes in the healthy colon following surgical fecal stream diversion, studied...

Introduction Short-term missions providing patients in low-income countries with reconstructive surgery are often criticised because evidence of their value is lacking. This study aims to assess the effectiveness of short-term reconstructive surgical missions in low-income and middle-income countries. Methods A systematic review was conducted acco...

Background For transgender men choosing to undergo phalloplasty with urethral lengthening, there is a potential for hair growth in the neourethra. Depilation of the urethral donor site may reduce subsequent intraurethral hair growth. Objectives To evaluate the effectiveness of preoperative laser depilation and assess the correlation between urethr...

Background Implant‐based breast reconstruction (IBBR) is the most commonly performed reconstructive procedure and its economic impact is significant. This study aimed to analyse whether a direct one‐stage IBBR with use of an acellular dermal matrix (ADM) is more cost‐effective than two‐stage (expander‐implant) breast reconstruction. Methods The BR...

Genital gender-affirming surgery (GAS) aims to alleviate feelings of gender dysphoria and support psychosexual outcomes. However, little is known of sexual activity and satisfaction of transmen after phalloplasty or metoidio-plasty. A clinical follow-up study was conducted in transmen at least one year after genital GAS in order to evaluate measure...

Background Patient-reported outcomes have become increasingly important to assess the value of surgical procedures. Sexual function is a proven important constituent of quality of life, but is often overlooked by health care professionals. We aim to investigate to what extent plastic surgeons address or discuss issues concerning sexuality with thei...

While sexual health is an important aspect of quality of life, sexual issues usually go unaddressed during patient-provider communication. Breast cancer treatments and specifically breast surgery impact women's sexual well-being. However, women do not receive adequate information on this subject. Women who underwent prophylactic mastectomy and brea...

Introduction A critical barrier to outcome assessment in gender-affirming healthcare is the lack of a specific patient-reported outcome measure (PROM). This phase I protocol describes an international collaboration between investigators in Canada, Denmark, the Netherlands and the USA who have coalesced to develop a new PROM (ie, the GENDER-Q) to ev...

Table S1 Influence of operation date on complication, reoperation and implant removal rate (per breast, n=91)

Background: Plastic surgery to improve chest appearance is becoming increasingly popular. The BODY-Q is a patient-reported outcome (PRO) instrument designed for weight loss and/or body contouring. In this paper, we describe the development of a new module for masculinizing chest contouring surgery. Methods: Qualitative methods were used to devel...

Background: The effectiveness of gender-confirming surgery is best evaluated on the basis of patient-reported outcomes. This is the first explorative study using the BODY-Q chest module, administered in trans men before and after mastectomy. Methods: Between October of 2016 and May of 2017, trans men were recruited to participate in a cross-sect...

Background: There is increasing interest in the use of acellular dermal matrices (ADMs) in implant-based breast reconstruction (IBBR). Suggested advantages are that ADMs facilitate one-stage IBBR and improve aesthetic outcomes. We compared immediate one-stage ADM-assisted IBBR with two-stage IBBR (current standard of care). Our previously reported...

Purpose: To assess the effect of performing a colpectomy before (primary) or after (secondary) gender affirming surgery (GAS) with single-stage urethral lengthening on the incidence of urethral fistulas in transgender men. Materials and methods: Retrospective chart review of all transgender men who underwent GAS with urethral lengthening between...

Organotypic models to investigate host-microbiome interactions are still a challenge for the field of tissue engineering. This is particularly the case for organs such as the urethra. Several cell line, animal and tissue models are available to study C. trachomatis infections, but none fully reflect natural infection in native human tissue. Therefo...

Intervertebral disk (IVD) degeneration is commonly described by loss of height and hydration. However, in the first stage of IVD degeneration, this loss has not yet occurred. In the current study, we use an ex vivo degeneration model to analyze the changes in IVDs mechanical behavior in the first phase of degeneration. We characterize these changes...

Background As genital gender-affirming surgery (GAS) is a demanding and life-changing intervention, transmen should be able to make choices about the surgical treatment based on outcomes that are most important to them, while taking into consideration the concomitant risks involved. Aim Develop a decision aid (DA) for genital surgery in transmen (...

Intervertebral disk (IVD) degeneration is commonly described by loss of height and hydration. However, in the first stage of IVD degeneration, this loss has not yet occurred. In the current study, we use an ex vivo degeneration model to analyze the changes in IVDs mechanical behavior in the first phase of degeneration. We characterize these changes...

Background Free flap survival relies on adequate tissue perfusion. We aim to give an overview of the available literature of all objective methods to intraoperatively assess free flap tissue perfusion, and the effects on (partial) flap loss. Methods A systematic review and meta‐analysis according to the PRISMA guidelines was performed (PubMed, Coc...

Labiaplasty (also known as labia minora reduction) is attracting increasing attention in the media and in online forums. Controversy exists among health-care professionals on how to manage a request for this surgery. Furthermore, the indications for and outcomes of labiaplasty have not yet been systematically assessed, and long-term outcomes have n...

Background Although the use of acellular dermal matrices (ADMs) in implant-based reconstruction increases, there is a lack of studies evaluating patient-reported outcome measures after this reconstruction method. We aim to evaluate the patient satisfaction after ADM-assisted implant-based breast reconstruction (IBBR) in 1 of the largest series of p...

Introduction Low-back pain (LBP) has been correlated to the presence of intervertebral disc (IVD) degeneration on T2-weighted (T2w) MRI. It remains challenging, however, to accurately stage degenerative disc disease (DDD) based on T2w MRI and measurements of IVD height, particularly for early DDD. Several quantitative MRI techniques have been intro...

With all pre- and post-experimental MRI values per disc region. This supplementary table shows all pre- and post-experimental MRI values of T2, T1rho, and ADC maps (mean ± SD) per experimental group and disc region. There were no significant differences in values between experimental groups per ROI. Of note: for the statistical analyses in the stud...

Objective: The concept of specific agreement has been proposed for dichotomous outcomes for two and more raters. We aim to extend this concept for variables with more than two ordinal or nominal categories and more than two raters. Study design and setting: We used two data sets: 4 plastic surgeons classifying photographs after breast reconstruc...

Background: Capsular contracture is the most frequent complication after breast augmentation or reconstruction with breast implants. The immune system plays a prominent role in capsular contracture formation, albeit to an unknown extent. Bacterial contamination in situ has been hypothesized to be causative for capsular contracture. How this relate...

Background: Genital dissatisfaction is an important reason for transmen to undergo genital gender-confirming surgery (GCS; phalloplasty or metoidioplasty). However, little is known about motives for choosing specific techniques, how transmen