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Kant et al. Plast Aesthet Res. 2026;13:4 Page 3 of 20

multidisciplinary teams can play an important role in assessing and aiding in comprehension about the likely
impacts of these surgeries, ascertaining and addressing misconceptions, and facilitating communication
between patients and their medical providers [3,15-17] . While there is no specific level of training required for a
behavioral health provider on a surgical team, providers should ideally be highly trans competent and have a
good understanding of the issues involved in accessing gender-affirming care, as well as the specific types of
care offered by the team. Surgeons should also consider the specific role they would like a potential
behavioral health provider to fulfill, such as pre- and post-operative supportive counseling, and hire
accordingly. Embedded behavioral health providers can also play a role in educating patients’ individual
therapists on how best to support their clients through this process. This function can facilitate the
development of a comprehensive aftercare plan that addresses potential unexpected complications .
[3]
It is also important to acknowledge that, unlike other genital reconstructive surgeries - about which public
awareness and opinion are generally limited - gender-affirming surgery has been thrust into broader public
debate around gender-affirming care, including being prominently featured in the 2024 U.S. presidential
election. This raises concerns about decreased access and increased risks related to negative perceptions of
this care, how it is accessed, and its short- and long-term effects on people’s lives [18-21] . This is another factor
that behavioral health providers may be called to address in their work with patients considering genital
affirmation surgery, undergoing it, or recovering from it - even in the more distant past.

Finally, there continues to be a need for additional research on behavioral health needs relative to surgery
and the perisurgical period. While we have provided citations where available, this paper also highlights the
need for surgical fields to more systematically consider behavioral health needs as part of comprehensive,
multidisciplinary care. Behavioral health support has the potential to improve patient outcomes in many
domains across medicine, and embedded providers can also help prepare allied helping professionals - such
as outpatient therapists and psychiatric practitioners - to support their own patients who are seeking
procedures where mental health concerns may compromise recovery.

ASSESSING SURGICAL READINESS BEYOND GENDER HISTORY
Although much of the discussion of multidisciplinary assessment prior to gender affirming surgery has
historically been on the individual’s gender history, the focus of assessment now is more on practical
questions about the patient’s social environment and ability to recover safely and successfully [Table 1]. In
part, this is because patients are unlikely to have presented to surgical assessment without significant
documentation of their gender history and - particularly in the case of genital gender-affirming surgery - are
likely to be far enough along in their gender affirmation process that their identity is well established.

There is, however, one area of assessment that is often best addressed by a behavioral health provider
embedded within the surgical center - whether the patient’s expectations are reasonable with respect to
surgical outcomes. Providers should assess not only the patient’s goals for surgery - e.g., being able to stand
to pee, have vaginal intercourse, or stop experiencing menstruation - but whether those goals are realistic
given the surgeon and the procedure in question. Ideally, patients should be shown pictures of surgical
outcomes so that they have a clear understanding of the expected aesthetic results of their surgery, informed
about the risk of complications and side effects seen in the practice, and given an opportunity to discuss any
doubts or concerns. They should also be asked to describe how they expect their body to function after
surgery, so that any misconceptions can be addressed in advance.

After ensuring that the patient’s surgical expectations are realistic, the most salient aspect of assessment is
their ability to undergo and recover from surgery - psychologically, financially, and practically. While many