Gender-affirming surgeries have risen markedly over the past fifteen years, yet reversing those procedures remains a poorly understood and, above all, poorly framed field. A new case report in Annals of Plastic Surgery calls for carefully distinguishing three concepts that are frequently conflated: surgical reversal, detransition, and regret.
The article describes the breast reconstruction of a person who, after undergoing gender-affirming mastectomy, decided to reverse the procedure. The reconstruction was carried out with autologous fat grafting alone, staged in two sessions, a less invasive technique than other options. What matters to the authors is not just the aesthetic result but the narrative: in this case, reversal was not accompanied by regret.
Reversal is not always detransition
The distinction matters. Surgical reversal is a concrete medical act, detransition describes a broader process of returning to a previous identity or presentation, and regret is a subjective emotion that does not always accompany the other two. Assuming that someone who reverses a surgery is “getting it wrong again”, or that reversal necessarily implies a negative view of transition, oversimplifies a far more nuanced clinical reality.
The authors advocate patient-centered care: openly discussing motivations, clarifying expectations, and validating each patient’s experience without labeling it in advance. The prevalence of reversal and regret after gender-affirming surgery remains low, but these phenomena have gained media and political attention, making a rigorous approach more urgent than ever.
Why it matters for gender dysphoria
This kind of work helps us understand that gender identity is an individual process, not a straight line. Documenting cases of reversal without regret, with the same rigor used to document transitions, supports healthcare that accompanies people at any point in their journey, without judgment and on the basis of clinical evidence.
The surgical team’s message is clear: affirming surgery should also include the possibility of reversal as part of comprehensive, compassionate care, not as a taboo subject.
Source: Annals of Plastic Surgery, August 4, 2026.
