RECONSTRUCTIVE

Assessing Quality of Life and Patient-Reported

Satisfaction with Masculinizing Top Surgery: A
Mixed-Methods Descriptive Survey Study
Grace Poudrier, B.A.
Background: Masculinizing top surgery (bilateral mastectomy with chest wall
Ian T. Nolan, B.M.
reconstruction) is an important gender-affirming procedure sought by many
Tiffany E. Cook, B.G.S.
transmasculine and nonbinary individuals. Current literature is focused pri-
Whitney Saia, F.N.P.-C. marily on details of surgical technique and complication rates, with limited
Catherine C. Motosko, B.S. data available on how top surgery affects subjective quality-of-life measures.
John T. Stranix, M.D. Methods: An anonymous online survey was distributed to 81 of the senior
Jennifer E. Thomson, B.S. author’s former top-surgery patients. The survey response rate was 72 percent
M. David Gothard, M.S.
Downloaded from http://journals.lww.com/plasreconsurg by BhDMf5ePHKbH4TTImqenVIkERnkI2IOHAF0VULVV9mxs5r+vyrKFkngtmcwvXbLX on 01/07/2019

(58 respondents). Responses were analyzed to investigate quality of life, sexual

Alexes Hazen, M.D.
New York, N.Y.; and Canton, Ohio
confidence, mental health, satisfaction with top surgery, and patient attitudes
toward top surgery’s role in gender affirmation.
Results: Following top surgery, measures of quality of life and sexual confi-
dence improved significantly (p < 0.001). In addition, 86 percent reported
improvement in gender dysphoria–related mental health conditions. All but
one respondent reported that top surgery had an overall positive impact on
their life.
Conclusions: Top surgery had major positive effects on all mental health and
quality-of-life metrics. The authors’ findings contribute to a much-needed body
of evidence that top surgery markedly improves the daily lives and functioning
of transgender and nonbinary individuals who choose to undergo it.  (Plast.
Reconstr. Surg. 143: 272, 2019.)

T
ransgender, or trans, is a catch-all umbrella
term used to describe individuals whose gen-
der identity and gender expression differ
from their sex assigned at birth. In this article, the
term transmasculine refers to transgender people
who were assigned female at birth but who iden-
tify more strongly with masculinity, which includes
but is not limited to transgender men. Nonbinary
individuals identify outside of the gender binary,
either as not exclusively feminine or masculine, or
as another gender entirely. It should be noted that
an individual may identity as both transmasculine
and nonbinary.
Transgender people living in the United States
report lower quality of life and routinely encounter
provider insensitivity and discriminatory practices
when seeking health care. Transgender individu-
als also have heightened rates of depression and
From the Hansjörg Wyss Department of Plastic Surgery, New
York Langone Health; and Biostats, Inc.
Received for publication November 24, 2017; accepted July
18, 2018.
Copyright © 2018 by the American Society of Plastic Surgeons
DOI: 10.1097/PRS.0000000000005113
suicidality (attempts and ideation) compared with
the general public.1,2 These higher rates of depres-
sion and suicidality are attributable to societal and
structural discrimination experienced by trans
and nonbinary people.
Some trans individuals experience gender
dysphoria, or distress related to the incongruence
between their gender identity and body.3 This
incongruence, compounded by the aforemen-
tioned widespread societal discrimination, can be
associated with immense bodily and emotional
distress.
Gender-affirming surgery, defined as any surgi-
cal procedure that modifies an individual’s body to
reach congruence with their gender identity and
expression, is one treatment option available for
gender dysphoria. Not all transmasculine individu-
als seek or need surgery; however, gender-affirming
surgery is a medically necessary standard-of-care
treatment, if in line with a patient’s goals.4
Disclosures: The authors have no financial interest
to declare in relation to the content of this article.

272 www.PRSJournal.com
Copyright © 2018 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
 Volume 143, Number 1 • Quality of Life after Male Top Surgery
Masculinizing top surgery (bilateral mastec-
tomy with chest wall reconstruction) is one form
of gender-affirming surgery commonly sought
by transmasculine and nonbinary patients. Cur-
rently, it is often the first and only form of gen-
der-affirming surgery they pursue.1,5 Obtaining
a male chest contour may allow transmasculine
and nonbinary individuals to inhabit their bodies
more comfortably, improving self-confidence and
conferring a greater sense of safety in public and
private settings.6,7
Many transmasculine individuals who desire
top surgery bind their chest as an interim mea-
sure until surgery can be obtained. Some trans-
masculine individuals who do not desire surgery
also use chest binding as a means of masculine
gender expression and/or to cope with gen-
der dysphoria. Chest binding refers to any activ-
ity that involves the compression of breast tissue
to achieve the appearance of a flatter chest. For
many, chest binding markedly improves mental
and emotional health. However, long-term chest
binding is associated with a host of negative health
impacts, including but not limited to musculoskel-
etal, neurologic, gastrointestinal, respiratory, and
dermatologic problems that may cause discomfort
and affect future surgical outcomes.8 Top surgery
may facilitate relief from many of these negative
health impacts.9,10
Relatively minimal research has been con-
ducted to evaluate how masculinizing top sur-
gery, independent of other gender-affirming
operations, affects patient-reported mental
health, quality of life, and sexual confidence.
Existing literature primarily evaluates surgical
techniques, aesthetic results, and complication
rates. Although technical and aesthetic outcomes
are critical to the success of this procedure, the
primary goal of top surgery, and gender-affirm-
ing surgery more generally, is ultimately subjec-
tive: to alleviate symptoms of gender dysphoria
experienced by individual patients and improve
quality of life.
In this research study, an anonymous online
survey was designed to examine the psychosocial
effects of masculinizing top surgery for transmas-
culine and nonbinary patients who underwent
surgery at New York University Langone Health
performed by a single surgeon. Primary outcome
measures included patient-reported quality of life,
mental health, and sexual confidence. Secondary
outcome measures included patient satisfaction
with surgical outcomes, the role of top surgery in
the gender-affirmation process, and incidence of
postoperative regret.
Copyright © 2018 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
PATIENTS AND METHODS
Survey Development and Design
Survey questions were generated following
a comprehensive literature review. Three matri-
ces from the BREAST-Q, a validated patient-
reported outcomes instrument used in cosmetic
and reconstructive breast surgery, were modified
to suit the unique psychosocial needs of trans-
masculine patients.11 As we rarely differentiate
between cisgender and transgender men and
women in medical research, there are few, if
any, validated instruments for the transgender
population, and there are none related to top
surgery satisfaction. Modified instruments have
thus become the standard in transgender health
research, as there is an urgent need to build an
evidence base for this underserved and marginal-
ized population.
The preliminary survey was revised by the
principal investigator (A.H.) and her colleagues,
drawing from extensive clinical experience in
the field. As there is significant medical mis-
trust in the trans and nonbinary communities,
we also sought feedback from three transmascu-
line individuals who had previously completed
top surgery. They further revised our survey for
appropriateness of terminology, structure, and
content.
The final survey consisted of multiple-choice
questions, matrices, and short answer prompts
for qualitative data collection. All multiple-choice
questions and matrices included additional space
for comments and elaboration. The study was
approved by the New York University School of
Medicine Institutional Review Board in August of
2016.
Survey Distribution
An invitation to participate in the research
study was e-mailed to 81 eligible subjects using the
secure, Health Insurance Portability and Account-
ability Act of 1996–compliant Qualtrics Survey
Platform (Qualtrics, LLC, Provo, Utah). Eligible
individuals were those who (1) were assigned
female at birth; (2) identified as transmasculine,
nonbinary, or as a trans man; (3) underwent top
surgery at New York University Langone Health
performed by the senior author (A.H.); (4) were
at least 3 months postoperative; (5) were at least
18 years old, and (6) had authorized New York
University Langone Health to contact them by
means of e-mail.
Participation was voluntary and respondents
did not receive any form of compensation for
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 Plastic and Reconstructive Surgery • January 2019

survey completion. Responses were anonymous Table 1.   Patient Characteristics

and Internet Protocol addresses were not col-
Characteristics Value (%)
lected. All portions of the survey were optional
and could be left blank without penalty. Over a What is your gender identity?* (n = 58)
 Male 25 (43)
6-month period (November of 2016 through April  Female 0 (0)
of 2017), 58 surveys (response rate, 72 percent)  Trans male/trans man 38 (66)
were anonymously submitted.  Trans female/trans woman 0 (0)
 Genderqueer/gender nonconforming 13 (22)
 Other† 3 (5)
Data Analysis At what age did you undergo top surgery?
(n = 57)
Survey responses were summarized using fre-  Mean, yr 33
quencies and percentages for categorical data.  Range, yr 18–58
McNemar tests were conducted to compare  18–24 yr 10 (18)
 25–34 yr 31 (54)
paired preoperative and postoperative nominal  35–44 yr 10 (18)
data. Five-point Likert scales were grouped into  45–54 yr 2 (4 )
three categories for data analysis: “satisfied,”  54–66 yr 4 (7)
At what age did you first start considering
“neutral,” or “dissatisfied.” Additional explor- top surgery? (n = 58)
atory analysis was performed using exact linear  Mean, yr 25
association chi-square testing to detect relation-  Range, yr 8–55
  ≤13 yr 5 (9)
ships between surgical timing and surgical sat-  14–18 yr 9 (16)
isfaction. To do this, respondents were divided  19–30 yr 29 (52)
into two groups: those who underwent surgery  31–40 yr 6 (11)
 41–50 yr 4 (7)
less than 1 year ago (n = 36) and those who  >50 yr 3 (5)
underwent surgery 1 or more years ago (n = 22). About how long ago did you have top surgery?
Further analysis was undertaken to detect dif- (n = 58)
 <1 yr 33 (57)
ferences in surgical satisfaction and quality of  1–2 yr 13 (22)
life between the following groups: those who  3–4 yr 1 (2)
reported chest binding before top surgery com-  4–6 yr 5 (9)
 >6 yr 6 (10)
pared to their nonbinding counterparts, and Preoperative hormone therapy (n = 57)
those who reported preoperative hormone ther-  Yes 46 (81)
apy compared to those who did not. Statistical  No 11 (19)
Duration of preoperative hormone therapy
analyses were conducted using IBM SPSS Version (n = 46)
24.0 software (IBM Corp., Armonk, N.Y.), and  Mean, yr 2
 Range, yr 0.25–8
significance was held at p < 0.05.  <1 yr 17 (37)
 1–2 yr 17 (37)
 2.1–5 yr 7 (15)
RESULTS  >5 yr 5 (11)
Was top surgery your first gender-affirming
Patient Characteristics surgery? (n = 58)
 Yes 56 (97)
In nonexclusive gender identity categories,  No 2 (3)
respondents identified as male [n = 25 (43 per- Preoperatively, were you concerned about
cent)], trans male [n = 39 (66 percent)], gender- potential loss of nipple sensation? (n = 56)
 Yes 14 (25)
queer or nonbinary [n = 14 (22 percent)], and/  Unsure 7 (13)
or “different identity (please state)” [n = 3 (5 per-  No 35 (63)
cent)]. Respondents completed top surgery at a Preoperatively, did you fear later regretting
your decision? (n = 56)
mean age of 33 years (range, 18 to 58 years) and  Yes 6 (1)
were less than 1 year [n = 33 (57 percent)], 1 to 2   No 50 (89)
years [n = 13 (22 percent)], 3 to 4 years [n = 1 (2 *Selections were not mutually exclusive.
percent)], 4 to 6 years [n = 5 (9 percent)], and 6 †Participant wrote in gender identity.

or more years [n = 6 (10 percent)] postoperative.

Most respondents [n = 46 (81 percent)] reported
preoperative hormone therapy for an average
duration of 1.9 years (range, 0.25 to 8 years)
(Table 1).
Preoperative chest binding was reported by
the majority (n = 47 (81 percent)] of respondents
for a mean duration of 5 years (range, 1 month to
20 years). Of these, 91 percent reported at least
one negative health effect. Skin irritation (63 per-
cent), back pain (61 percent), difficulty breathing
(49 percent), and chest pain (13 percent) were
the most common (Table 2).

274
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 Volume 143, Number 1 • Quality of Life after Male Top Surgery

Table 2.  Self-Reported Negative Health Effects of were satisfied on any given measure that asked
Chest Binding about preoperative life. Following top surgery,
No. of All Effects
subjects’ quality of life and sexual confidence
Participants (%) Reported (%)* improved significantly in all domains (p < 0.001):
Total no. 41 135
feeling self-confident (91 percent reported
Negative effect improvement), confident in a social setting (85
 Respiratory† 21 (51.22) 57 (42.22) percent), attractive (83 percent), comfortable
 Musculoskeletal‡ 4 (9.76) 4 (2.96) in their clothes (96 percent), satisfied with their
 Skin§ 26 (63.41) 35 (25.93)
 Breast 1 (2.44) 1 (0.74) bodies (94 percent), less dissatisfied with their
 Pain║ 34 (82.93) 34 (82.93) bodies (96 percent), emotionally able to do the
 Psychosocial¶ 8 (19.51) 13 (9.63) things they wanted to do (83 percent), and emo-
*Participants reported multiple negative health effects. tionally healthy (78 percent) (Fig. 1). Similar
†Respiratory: difficulty breathing, difficulty taking deep breaths.
‡Musculoskeletal: poor posture, muscle atrophy, shoulder dislocation. improvements (76 to 94 percent) were observed
§Skin: scarring, swelling, acne, itching, redness/color changes, rash, in the context of sexuality: degree of sexual confi-
bruising, blistering, irritation, sweating/overheating. dence (77 percent reported improvement), satis-
║Pain: chest pain, shoulder pain, back pain, rib pain, muscle/gener-
alized soreness and discomfort, other. faction with sex life overall (76 percent), comfort
¶Psychosocial: concern for health, decreased job performance, dif- and ease during sexual activity (81 percent), feel-
ficulty engaging in physical activity, anxiety, irritability, financial bur- ing sexually attractive while clothed (91 percent),
den of buying multiple binders, decreased body image, sadness.
feeling sexually attractive unclothed (94 per-
cent), sexual confidence without a shirt on (91
percent), and likely to remove shirt for sex (85
Top surgery was the first gender-affirming percent) (Fig. 2).
surgery for all but two individuals [n = 56 (97 Preoperatively, approximately half [n = 30
percent)], both of whom reported prior hysterec- (53 percent) of participants characterized their
tomies. Only nine respondents (17 percent) had overall mental health as “poor,” and 46 (81
undergone additional gender-affirming surgery percent) reported depression, anxiety, and/
since their top surgery—eight had hysterectomies or another mental health condition related to
(with and without oophorectomies) and three gender dysphoria. Of the 49 respondents who
had phalloplasties. reported being on medication before top sur-
gery, 26 (46 percent) reported taking selective
Preoperative and Postoperative Quality of Life, serotonin reuptake inhibitors and benzodiaz-
Sexual Confidence, and Mental Health epines. In optional free response prompts that
Most respondents rated their quality of life corresponded with questions about preoperative
and sexual confidence before top surgery as very life, respondents’ recounted experiences with
low; no more than 30 percent of respondents depression, suicidal ideation, self-harm, ongoing

Fig. 1. Improvement in quality of life. Percentage of respondents who reported

preoperative-to-postoperative improvements in feeling emotionally healthy,
more satisfied with their body, less dissatisfied with their body, comfortable in
their clothes, attractive, confident in social settings, and self-confident.

275
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 Plastic and Reconstructive Surgery • January 2019

Fig. 2. Improvement in sexual confidence. Percentage of respondents who

reported preoperative-to-postoperative improvements in feeling satisfied
with their sex life overall, sexually confident, comfortable and at ease during
sexual activity, likely to remove their shirt for sex, sexually confident without a
shirt on, sexually attractive when unclothed, and sexually attractive in clothes.

discomfort from chest binding, physical and loss of nipple sensation, only 13 (24 percent)
emotional bodily discomfort, stress headaches, expressed complete dissatisfaction with current
and anxiety in social settings. After top surgery, nipple sensation.
38 (86 percent) reported improvement in their Fears of postoperative regret were not sub-
mental health. Only one respondent character- stantiated in the six respondents (11 percent)
ized their mental health as “unchanged” since who indicated that fear of later regretting surgery
top surgery, and zero reported diminished men- hindered their surgical decision-making process.
tal health.
There were no statistically significant differ-
ences in postoperative quality of life, sexual con- Table 3.  Satisfaction with Top Surgery
fidence, or mental health detected based on time Measure No. (%)
elapsed since top surgery. Patients who had top
Total 54
surgery less than 1 year previously were at least as Feeling that top surgery changed your life
satisfied as respondents who had top surgery over for the better
1 year previously.  Agree 53 (98)
 Neutral 1 (2)
Satisfaction with Decision  Disagree 0 (0)
Impact of top surgery on life
Respondents were highly satisfied with the  Huge positive effect 46 (85)
decision to undergo top surgery (Table 3); 53  Moderate or minimal positive effect 6 (11)
(98 percent) said that top surgery positively  No positive effect 0 (0)
 Unsure or neutral 1 (2)
impacted their life, and 85 percent characterized  Other 1 (2)
that impact as “huge.” Almost universally, respon- Do you ever regret having top surgery?
dents reported that undergoing top surgery was  Never 52 (96)
 Occasionally 2 (4)
important in their public [n = 49 (91 percent)]  Always 0 (0)
and private [n = 50 (93 percent)] sphere gender- Feeling that a reconstructed chest is much
affirmation process, and that having a masculine better than the alternative (n = 53)
 Agree 50 (94)
chest was important in affirming their personal  Neutral 2 (4)
gender identity and expression [n = 52 (96 per-  Disagree 1 (2)
cent)] (Table 4). Willingness to encourage other people in
similar situations to have top surgery
Respondents were satisfied with how much  Agree 47 (87)
their reconstructed chest felt like a “natural” part  Neutral 7 (13)
of their body [n = 49 (91 percent)], how their  Disagree 0 (0)
Satisfied with your decision to undergo top
reconstructive chest felt now compared to before surgery
surgery [n = 50 (93 percent)], and the quality of  Agree 53 (98)
their scars [n = 40 (74 percent)]. Although most  Neutral 1 (2)
 Disagree 0
respondents [n = 53 (96 percent)] reported some

276
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 Volume 143, Number 1 • Quality of Life after Male Top Surgery
Table 4.  Role of Top Surgery in Gender-Affirmation
Process*
Total
How important was the role that top surgery had
in affirming your gender in the public sphere?
 Somewhat or very important
 Neutral
 Somewhat or very unimportant
How important was the role that top surgery had
in affirming your gender in the private sphere?
 Somewhat or very important
 Neutral
 Somewhat or very unimportant
Overall, how important is having a male chest to
your personal gender identity?
 Somewhat or very important
 Neutral
 Somewhat or very unimportant
*Discrepancy in sum of percentages is caused by rounding.
Almost all (n = 52) respondents reported never
experiencing any postsurgical regret, two peo-
ple (4 percent) reported occasional misgivings
related to aesthetic outcomes, and zero reported
complete regret.
DISCUSSION
Existing research into transmasculine experi-
ences with gender-affirming surgery is dispropor-
tionately concerned with genital reconstruction
surgery (i.e., phalloplasty and metoidioplasty),
despite the fact that, currently, few transgender
men in the United States undergo these proce-
dures.1,5,12,13 Relatively minimal research has evalu-
ated how masculinizing top surgery, independent
of other gender-affirming procedures, affects
patient-reported mental health, quality of life,
and sexual confidence.
The overwhelming majority of respondents
in this study experienced statistically significant
and clinically important improvements in quality
of life, mental health, and/or sexual confidence.
In general, technical goals of top surgery include
removing breast tissue and excess skin, reposi-
tioning and reshaping the nipple-areola complex,
and minimizing chest wall scars.14,15 Surgical tech-
nique is chosen based on patient characteristics—
most notably breast size and body habitus—and
may have important implications for aesthetic
outcomes, postoperative nipple sensation, and
patient satisfaction. Our data represent an aggre-
gate of several surgical techniques, which could
not be parsed out because of an anonymous sur-
vey design that precluded access to respondents’
medical records.
Copyright © 2018 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
Our findings corroborate the stance that the
primary goal of gender-affirming surgery is sub-
No. (%)
jective rather than technical. Although 96 percent
of respondents in this study reported some loss
54 of nipple sensation, only 24 percent expressed
outright dissatisfaction with their current nipple
49 (91) sensation. It is generally normal to have acutely
1 (2) diminished nipple sensation during the healing
4 (7)
process, which is separate from “long-term” sen-
sation that never returns. Anecdotally, patients
50 (93) report that nipple sensation is different from their
2 (4)
2 (4) sensation previously, but most are not bothered
by the difference. For many patients, the potential
benefits of masculinizing top surgery far outweigh
52 (96)
1 (2) the potential for sensation loss, but it is neverthe-
1 (2) less a crucial aspect of surgery that must be dis-
cussed preoperatively. Similarly, respondents who
expressed lower satisfaction with the appearance
and feel of their chest wall and/or the size, color,
and projection of their nipple-areola complex did
not report decreased satisfaction with top surgery
overall.
It is notable that preoperative chest binding
was a major source of physical and mental distress
for the vast majority (81 percent) of study partici-
pants. On average, participants practiced binding
for 5 years. At the extreme, patients reported hav-
ing endured a long list of negative health impacts
for 15 to 20 years. Having top surgery likely facili-
tated relief from many of these negative health
impacts.
Although not all respondents expressed com-
plete satisfaction with their postsurgical bod-
ies, none completely regretted their decision to
undergo top surgery. Gender dysphoria is a com-
plicated and multifactorial issue tied to numer-
ous factors beyond the appearance of the chest
wall. In this regard, top surgery alone cannot
be expected to completely alleviate gender dys-
phoria and associated impairments to quality of
life, mental health, and sexual confidence. One
recurrent theme in qualitative analysis was that
top surgery did not alleviate bottom dysphoria
or dissatisfaction with genitalia, which can also
negatively impact quality of life. Furthermore,
even the “ideal” surgical result does not address
the systemic social discrimination that contribute
to precipitating gender dysphoria. Despite these
considerations, top surgery significantly improved
overall quality of life for participants in this
research study.
Our findings have several important limita-
tions. First, this was a retrospective survey study
comparing subjective feelings at two different
time points in the past, predisposing to error.
277
 Plastic and Reconstructive Surgery • January 2019
Because all survey questions were optional, some
surveys were incomplete or missing data. The
respondents, who completed top surgery at a pri-
vate academic medical center in New York City
and agreed to complete an online survey, rep-
resent only a small sample of patients, and their
experiences are not representative of all transmas-
culine and/or nonbinary individuals. The study
follow-up period was variable between subjects
and relatively short term (range, 3 months to ≥6
years). Although survey questions were designed
by a panel of experts and transmasculine patients
to address the issues being studied, they were
not themselves validated. Notably, no validated
patient-reported outcome instruments currently
exist in gender-affirming surgery.16,17 Finally, like
any major surgery, top surgery comes with compli-
cations. This study did not include review of par-
ticipants’ medical records, severely limiting the
validity of revision and complication data.
Despite these limitations, our results strongly
demonstrate the relative positive impact that top
surgery can have for transmasculine and nonbi-
nary individuals. The results of this survey study
suggest that the gains in bodily satisfaction, psy-
chosocial well-being, and sexual satisfaction fol-
lowing top surgery are both clinically meaningful
to the patient and statistically significant as early
as 3 months and as late as 6 or more years after
surgery.
CONCLUSIONS
Patient-reported satisfaction is a critical
marker of surgical success. In clinical practice,
the degree to which masculinizing top surgery
enhances the lives of patients is strikingly appar-
ent, and perhaps this partially accounts for the
lack of systematic data collection on quality-of-
life outcomes and long-term patient satisfaction.
Although numerous articles have addressed
advancements in surgical techniques, aesthetic
outcomes, and complication rates, the active
voices of patients to corroborate surgical success
have not been adequately represented.
Our findings from a survey study of individu-
als ranging from 3 months to over 6 years post-
operatively provide unquestionably powerful
evidence that masculinizing top surgery enacts
statistically significant and clinically meaningful
improvements in patient-reported quality of life,
sexual confidence, and psychosocial well-being.
Patient satisfaction with the procedure was very
high, and complete regret was not reported by
any subjects.
278
Copyright © 2018 American Society of Plastic Surgeons. Unauthorized reproduction of this article is prohibited.
In our experience, positive results of this mag-
nitude are not typical of most plastic surgery oper-
ations. As public and private insurance coverage
for top surgery remains inconsistent throughout
the United States, our findings contribute to a
much-needed body of evidence that top surgery
improves the quality of life and mental health of
transmasculine individuals to a marked extent.
Alexes Hazen, M.D.
Hansjörg Wyss Department of Plastic Surgery
New York University Langone Health
305 East 33rd Street
New York, N.Y. 10016
alexes.hazen@nyumc.org
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