Dr. Jonathan Keith, MD, FACS is a board-certified and fellowship-trained Plastic Surgeon with expertise in Gender Affirmation Surgery. He is the first surgeon in New Jersey to offer the full range of gender-affirming procedures. His latest research in the field of Gender Surgery is focused on improving Top Surgery outcomes, identifying barriers in accessing gender-affirming care and navigating insurance policies.
Latest Research
Chest Masculinization Technique and Outcomes in 72 Double-incision Chest-contouring Procedures with Free Nipple Grafting. [FULL TEXT]
Alexandra I. Naides, BFA, Jerette J. Schultz, MD, Nikita O. Shulzhenko, MD, and Jonathan D. Keith, MD, FACS. Plast Reconstr Surg Glob Open. 2021 Mar; 9(3): e3459.
The authors present the outcomes of 72 consecutive chest masculinization cases using the double-incision technique with free nipple grafting.
A Three-Step Technique for Optimal Nipple Position in Transgender Chest Masculinization.
Ayyala, H. S., Mukherjee, T. J., Le, T. M., Cohen, W. A., Luthringer, M., & Keith, J. D. (2020). Aesthetic surgery journal, 40(11), NP619–NP625.
The ideal position of the nipple-areola complex (NAC) in the transgender population can be a challenge to determine. The authors sought to determine the best location and aesthetics of the female to male NAC. The triple confirmation technique is an easy, reproducible method to guide the surgeon in relocation of the NAC.
Crowdsourcing the Ideal Nipple-Areolar Complex Position for Chest Masculinization Surgery. [FULL TEXT]
Cohen, W. A., Maisner, R. S., Hazim, N., Ayyala, H. S., & Keith, J. D. (2020). Plastic and reconstructive surgery. Global open, 8(8), e3070.
Chest masculinization surgery is increasing in prevalence. However, the ideal location of the nipple-areolar complex (NAC) is unknown. Our purpose was to determine the most aesthetically favorable male NAC position for use in chest masculinization through crowdsourcing. Ultimately, NAC localization during chest masculinization will be the result of shared decision-making between the patient and the surgeon to fulfill each patient’s aesthetic goals.
Barriers To Finding A Gender Affirming Surgeon.
Cohen, W., Maisner, R. S., Mansukhani, P. A., & Keith, J. (2020). Aesthetic plastic surgery, 44(6), 2300–2307. https://doi.org/10.1007/s00266-020-01883-z
Gender affirmation surgery is increasingly prevalent; however, finding a surgeon continues to be difficult. Additionally, the majority of transgender patients utilize the internet for information before elective surgery. The authors sought to use the Internet to search for gender affirming surgeons practicing in the USA, and therefore, reflect the process that patients potentially undergo. We highlight the barriers to information and care that we encountered.
Navigating Insurance Policies in the United States for Gender-affirming Surgery. [FULL TEXT]
Cohen, W. A., Sangalang, A. M., Dalena, M. M., Ayyala, H. S., & Keith, J. D. (2019). Plastic and reconstructive surgery. Global open, 7(12), e2564.
Many patients with gender dysphoria want gender affirmation surgery but often struggle with getting insurance to cover it. A recent study looked at the insurance policies of the top companies in the U.S. to see how they handle coverage for these surgeries. Out of 150 insurance companies, 124 had policies about gender-affirming surgery. Most (98%) covered chest masculinization, but only 20% covered nipple-areola reconstruction. For chest feminization, 29% provided coverage. A large majority (97%) covered vaginoplasty, but only 21% covered vulvoplasty. Phalloplasty and metoidioplasty had high coverage rates (95% and 93%, respectively), while about 60% covered penile prosthesis. The findings show that while more insurance companies are offering coverage, the rules differ greatly between companies and states. Creating standard policies could help more people access the surgeries they need.
Female-to-Male Transgender Chest Contouring: A Systematic Review of Outcomes and Knowledge Gaps.
Cohen, W. A., Shah, N. R., Iwanicki, M., Therattil, P. J., & Keith, J. D. (2019). Annals of plastic surgery, 83(5), 589–593.
Although much has been published on various techniques and outcomes, there is no consensus on how to approach transmale top surgery. Future research is needed to improve patient selection, surgical decision making, and patient-reported outcomes for different chest contouring techniques. In addition, there is a significant knowledge gap for the ideal nipple-areolar complex shape, size, and location.
Trends and Techniques in Gender Affirmation Surgery: Is YouTube an Effective Patient Resource?
Ayyala, H. S., Ward, B., Mukherjee, T., Paskhover, B., & Keith, J. D. (2020). Plastic and reconstructive surgery, 145(4), 893e–894e.
Peripheral Pruning: A Safe Approach to Thinning Extra-Large Anterolateral Thigh Flaps.
Viviano, S. L., Liu, F. C., Therattil, P. J., Lee, E. S., & Keith, J. D. (2018). Annals of plastic surgery, 80(4 Suppl 4), S164–S167.
Thinning of anterolateral thigh (ALT) flaps has been described to achieve optimal contouring. Previous studies caution against thinning large flaps owing to the risk of vascular compromise leading to partial or total flap necrosis. This is the first study to demonstrate a reliable technique for primary thinning of extra-large ALT flaps in the Western population. No complications related to thinning were observed. Peripheral pruning of sub-Scarpa’s fat is a safe and reliable method of thinning extra-large ALT flaps without increasing the risk of flap necrosis.
