Recently, Dr. Jedrzejewski and Dr. Safir hopped on Instagram Live to discuss the prevalence of post-surgical regret. In this conversation, Dr. Jedrzejewski shares details about a recent study she co-authored about surgical regret in gender-affirming surgery, and both doctors discuss
common misconceptions.
Check out the Instagram Live video below to learn more!
Dr. Safir:
Certified reconstructive urologist at Align Surgical’s LA office, and I’m pleased to introduce Briana Jedrzejewski, who is a reconstructive plastic surgeon at our office in San Francisco. I thank you all for joining us this evening. We are going to turn off the comments just to avoid any potentially harmful commentary, but you should feel free at any point to type in your questions using the question function. We’ll leave some time at the end to answer a few audience questions. And with that, let’s dive in. This is Instagram Live, so anything could happen. I really want to get Dr. Jedrzejewski’s feelings about this topic of surgical regret, but maybe we can take a few moments, Briana, just to tell everyone who you are, why you’re doing gender surgery, and then maybe just a little bit about the important study that you did addressing regret.
Dr. Jedrzejewski:
Thank you so much for the introduction. My name is Briana Jedrzejewski. I just started with Align Surgical Associates earlier this year. I graduated from Oregon Health and Science University, completing plastic and reconstructive surgery residency there. I’m originally from California, and I’ve always had an interest in social justice. As I moved through my trajectory in surgery, I found that in plastic surgery, any kind of reconstructive surgeon deals with a lot of revision of trauma—whether it’s physical or emotional. They’re kind of tied together. That’s what drew me to plastic surgery.
I was fortunate to train at a high-volume center for gender-affirming surgery in Portland, Oregon, and that really led me to pursue this field.
Dr. Safir:
That’s great. As surgeons, we love to talk about the surgery that we do and how it’s done and the nuances and the improvements we’re making. But I think it’s also wonderful and commendable that you were involved in research regarding surgical regret, since I think it’s important to dispel any ideas that regret is a very common outcome of the surgery that we do. Maybe you could tell us a little bit about how common regret is and what we’re really talking about when we’re talking about regret—like “I wish I never had the surgery,” or “I wish I never went down this path,” or “I’ve had a hard time recovering from a complex operation.” Give us a little bit of insight.
Dr. Jedrzejewski:
Sure. Regret is a really complicated idea—an emotion, a concept to kind of wrap our minds around. At its core, it’s a highly negative feeling where one wishes the outcome wasn’t as it is. When we talk about regret for surgery, you could be talking about negative feelings of pain after the operation, maybe complications, or how the surgery turned out in the end—whether that’s functional or aesthetic. You could be talking about not having the appropriate support after surgery, recovering alone, or regretting the timing of that surgery. Those are all concepts that, no matter what surgery someone undergoes, can involve regret.
In gender-affirming surgery, there’s a lot of attention placed on detransitioning. People wonder: do patients undergo a surgery they then can’t reverse? What’s the percentage of patients who encounter that after gender-affirming surgery?
I was lucky to be part of a workgroup in Oregon that looked at six years of gender-affirming surgeries from 2016 to 2021. It included 1,989 patients—almost 2,000—and 2,863 procedures, because many patients get more than one procedure if they decide to go down the route of surgical intervention. We found that six individuals—less than 1%—requested reversal surgery or transitioned otherwise to the sex assigned at birth. Those are quite encouraging data that show the vast majority of patients do not regret gender-affirming surgery.
Dr. Safir:
How would you say—since you have particular knowledge—how do rates of regret for gender-affirming operations compare with other elective procedures unrelated to gender? Can you give us some insight?
Dr. Jedrzejewski:
Sure. When you’re looking at different kinds of elective, non-cosmetic surgeries—for example, elective knee surgery—the rate of regret in the literature is anywhere from 10 to 20%. So, given what we know from this particular study, which aligns with existing literature, a regret rate of less than 1% is extremely low.
If you think about how individuals approach gender-affirming surgery—no one can just show up to a surgeon’s office and say, “I want to sign up for surgery.” It’s a process that takes at least a year of living in your chosen gender before embarking on surgical intervention—whether that journey includes hormones or not. It takes a long time and involves mental health professionals before someone can undergo gender-affirming surgery.
Take another surgery not related to gender—like bariatric surgery. Those patients undergo counseling for up to a year prior to surgery and also show a low rate of regret, about 2%. So I would venture to say it’s because these patients undergo so much preparation that the regret rate is so low.
Dr. Safir:
Yeah, your point about the education they get is really important. For example, I saw a patient last week who wanted surgery as soon as possible. They had not sought out counseling from mental health providers, were not on hormonal therapy, and really knew very little about the operation. This is the kind of patient that, in the early parts of screening, we might say, “Look, surgery may be in your future, but there’s a lot of preparation you need to go through before we can move forward.”
Having a multidisciplinary approach is so important. The letters that mental health providers give us to help make surgical decisions—sometimes they’re very illuminating, and in some cases they actually dissuade us from proceeding with surgery at that time. It’s important to dispel the idea that we rubber-stamp these decisions. It’s not just checking all the boxes and moving on to surgery. This is a long process. Patients often undergo multiple operations and receive a tremendous amount of education.
I agree with you. That’s why our operations have relatively low regret. Other operations like bariatric surgery also benefit from this educational component—patients are well-informed and generally happy.
Also, dissatisfaction with one element of a surgery is very different from someone’s desire to detransition. When people talk about regret, detransitioning often comes to mind—but that’s not all-encompassing. Don’t you think?
Dr. Jedrzejewski:
I agree. People often conflate regret with detransitioning. Someone might regret the recovery or the process they went through, but that doesn’t necessarily mean they wouldn’t do it again. If you asked them, “Would you do that surgery again?” they might say yes.
Regret is multifaceted. You can have true gender-related regret, which is very, very rare, given how long people live in their desired gender and the education they receive beforehand. But you can also experience social regret. There are serious repercussions in society for presenting as trans or gender-diverse. Some people lose jobs, relationships, or status after undergoing gender-affirming surgery. These are life-altering events people could regret—not necessarily the surgery, but the repercussions.
Then, of course, there are complications. No surgery is without risk. We want every surgery to go perfectly, but that’s not realistic. Every patient has their own healing process, and every surgery has its own set of obstacles. You could regret a complication you had after surgery and still be happy you had the surgery.
Dr. Safir:
When I started doing this surgery back in 2017, I don’t know that I was initially prepared for patients, right after surgery, having some negative feelings. I thought, “They’ve been waiting for this operation for so many years—surely, the next day they’re going to be so happy.” But I think sometimes the reality of recovering from a big operation sets in. You have the fantasy of what’s in your future, and we try as hard as we can to get patients there, but the road to ultimate satisfaction sometimes detours.
They might say, “I’m having pain after surgery,” or, “I’m not getting the support I should,” or, “Some members of my family who weren’t supportive are now getting in touch and questioning me.” Those are real things. Our patients are tough—I have so much admiration and respect for them—but those feelings can creep in after surgery. Like anything else, you think, “I didn’t know this was going to hurt,” or, “I’m having a lot of swelling,” or, “This changed—is that normal?” Even if the outcome will be positive, the path isn’t always direct. Don’t you agree?
Dr. Jedrzejewski:
Absolutely. I’ve also had the privilege of seeing patients wake up in tears because they’re so happy after surgery—which is beautiful and emotional. But I’ve also seen patients, once the long-lasting numbing medication wears off, get upset and start questioning whether they should’ve gone through with surgery. Thankfully, in my experience, those patients are ultimately happy they did.
It’s often tied to the pain and discomfort they’re experiencing. Everyone has a different pain tolerance and coping mechanisms. If you have dysphoria about an area of your body and then you have surgery on that area, suddenly you’re dealing with physical pain that can aggravate your emotions about the entire process.
Gender isn’t a linear path—neither is the journey after surgery. There are steps forward and steps back depending on how recovery goes.
Dr. Safir:
I think what sometimes doesn’t come out is that we use the patient experience afterwards to reflect on how we deliver care. After caring for many patients, we look at how we can better prepare them for some of the challenges they might face.
If we think we need to do better with pain relief, we look into new methods or techniques. It’s not just, “You’re going to have a lot of pain—deal with it.” When patients have complications or unexpected outcomes, we dig in deep. Especially in our group, we meet every couple of weeks to talk about difficult cases—how to enhance outcomes and the patient experience.
This is a dynamic process. I hope it helps limit short-term negative feelings during recovery. And I think regret is less likely when outcomes are better. Everything we do to support better outcomes—to learn from each other, to stay attuned to advances in surgery and to participate in those changes—helps us improve patient experience.
Dr. Jedrzejewski:
Exactly. The most important thing is to support patients—however they may be feeling. It’s important for us to hold space for them if they’re experiencing regret after surgery. It’s okay. We shouldn’t take it personally or get defensive. It’s part of the process.
The more we can help patients understand that regret exists in different forms, the better. I don’t think we can fully eliminate it, because you can’t know how you’re going to feel after surgery until you’ve had surgery. But if we can support patient autonomy and minimize mental health distress throughout the process, then that’s our responsibility as providers.
Dr. Safir:
It’s something we are chipping away at. We look to our patients for guidance. I really believe the care we provide today is much better than it was even three or four years ago. And I think it’s great when surgeons like yourself devote time to topics like regret.
We love talking about how we improve the technical aspects of surgery, but diving into issues that our opposition sometimes uses as ammunition—like regret—and really studying them, that’s important. We let the evidence lead us. If patients have a lot of regret or very little regret, we report what the outcomes are.
Of course, we’re elated that the results of the study support what we’re doing and show general satisfaction with surgical outcomes. But I think it’s helpful for patients to understand that we dig into the hard topics. We don’t shy away from them. We get granular with the issues, even ones we’d rather not always think about.
Dr. Jedrzejewski:
Thank you so much. I hope this study inspires further studies. The more feedback we can get from patients, the better. We can incorporate that into system improvements and the work we do.
Unfortunately, even when presented with this data, some people choose not to listen or choose to find flaws. But I hope this helps patients feel heard, because this is something our patients have known for a long time—that the rate of regret is low. I’m glad we can now include that in the scientific literature.
Dr. Safir:
Let’s take a look and see if we have any questions here.
Dr. Jedrzejewski:
I have one that says, “Do you think hormone therapy is required for gender-affirming surgery?” No, I actually don’t think it’s required for gender-affirming surgery.
In terms of insurance coverage in the past, it was often a recommendation—or even a requirement—that patients be on hormones for at least a year before surgery. But thankfully, the field has evolved in its understanding of nonbinary gender. Sometimes hormones aren’t part of an individual’s plan. It shouldn’t be a requirement or a barrier to surgery.
Dr. Safir:
Yeah, I agree. For many of our nonbinary patients, hormones simply aren’t part of their transition process—and they’re no less committed to surgical changes than patients who are on hormonal therapy.
Dr. Jedrzejewski:
Exactly. I think removing those obstacles for nonbinary individuals can help reduce regret in the future. And that’s already happening.
Dr. Safir:
Reducing roadblocks is important. The idea that patients had to be on hormonal therapy—as if that somehow made them more primed for surgery or was a measure of commitment—that’s flawed.
There are patients who go on hormones and don’t like it. Some find it worsens their dysphoria rather than improving it. And some patients have medical reasons why they can’t go on hormonal therapy. To restrict access to care for those patients—I think that’s a bad idea. That was a really good question.
Dr. Jedrzejewski:
Hormones definitely have their place. If they’re part of someone’s gender expression, then it can make sense to wait. For example, if someone is undergoing breast augmentation and is taking estrogen, we usually see the majority of breast development after a year. Waiting helps optimize outcomes and avoid issues like asymmetry after augmentation.
Dr. Safir:
Okay, do we have other questions?
Dr. Jedrzejewski:
No, I don’t see any other questions right now.
Dr. Safir:
So maybe, Briana, how do you talk to someone who’s not on board with gender surgery—someone who doesn’t understand it or has political or religious opposition? How do we use this information to try to educate people who aren’t necessarily receptive? Some people will never listen, but I guess it’s our hope that the public—especially family members—who use science in decision-making will take in this kind of data and become more accepting. How do we talk to people who aren’t our allies yet?
Dr. Jedrzejewski:
I think people respond well to comparisons they can relate to. So, someone who’s not receptive to gender-affirming surgery but has had knee surgery or some other elective surgery—and maybe has had feelings of regret about it—can start to see the similarities. If they appreciate the data in those other surgical contexts, they might be more open to seeing that regret rates for gender-affirming surgery are actually very low.
That’s why I use examples outside of gender-affirming surgery. I hope it invites people to see this from someone else’s perspective.
Dr. Safir:
Yeah. Someone asked me, “What’s the best way to think about this?” I said the best way is to realize: this isn’t about you. This is about someone else. It’s not about your own biases—it’s about understanding that someone else doesn’t share those biases. That’s a good way to approach these conversations, I think.
Briana, I think to try to just chip away at opposition, studies like yours will be really helpful in those dialogues.
We’re almost out of time. I do want to plug our website:
www.alignsurgical.com
There’s a lot of important information on the site. We’ve put together a lot of educational content, and I think it’s a great resource for patients, family members, and the general public to learn more about the work we do. We hope to have more of these Instagram Live sessions, so keep checking our Instagram page for the latest updates and upcoming topics. And as always, we invite your questions.
Dr. Jedrzejewski:
Great—thank you so much. This was a pleasure. I hope we were able to inform people about the great results of the study. Thank you.
Dr. Safir:
Thank you.