Dr. Giulia Lo Russo
Member of the ISAPS Transgender Surgery Focus Group
This month, it’s Pride Month, and we’re pleased to feature an interview with Dr. Giulia Lo Russo, a member of the ISAPS Transgender Surgery Focus Group. This group advises the ISAPS Patient Safety Committee and helps set high standards for developing and publishing guidance on patient safety for transgender surgeries.
Dr. Giulia Lo Russo shares her insights and perspectives on this topic.
ISAPS: According to the ISAPS Global Survey 2024, gender affirming surgery remains a niche within aesthetic plastic surgery. What factors motivated your decision to focus your expertise in this area?
LO RUSSO: The very first congress I attended, during my fifth year of medical school, was on gender-affirming surgery. It was called “Gender Identity Disorders” at that time; vocabulary has changed a lot since 1995. Because of that congress, I became interested in the topic and thought it would be a very rewarding field to specialize in. So, I started dealing with gender affirming surgery while working in Florence’s University hospital. Then, in 2016, I was responsible for trans men's chest-wall contouring surgery. Since then, I have worked with an interdisciplinary team related to trans people care.
I have defined my personal technique, while sharing many of those details in various publications over the years.
Now I think I felt drawn to transgender patients because I truly respect people who decide to embark on a path of self-discovery. It was a very spontaneous choice for me, and it has given me great satisfaction and joy.
ISAPS: As AI becomes more influential in our daily lives, do you see it impacting aesthetic plastic surgery, specifically gender-affirming surgery?
LO RUSSO: I will share my personal experience on the matter. As of today, AI has still not influenced my work. From meeting patients to performing surgery to following their recovery during the controls, my job has relevant human and manual aspects that won’t benefit from AI use.
Even with the goal of the best aesthetic result, I choose to rely on my personal taste, my technical skills, and my patients’ desires.
I have always distrusted all those applications that generate images of ideal post-operative results. In fact, I even find them dangerous and harmful because they create unrealistic expectations. When AI software provides an image, it doesn’t take into consideration many specific and practical aspects that we, as surgeons, know very well.
I confess that I have even refused to operate on some patients who have brought to me photos of themselves modified by using applications or filters, telling me, for example, they wanted “that exact nose”. In these cases, the result could never match their expectations, so I find that there wouldn’t be the objective foundations for a healthy surgeon-patient trusting relationship.
Regarding gender affirming surgery, I can’t really imagine how AI could play a useful role.
ISAPS: From a purely surgical standpoint, what has changed most significantly in recent years?
LO RUSSO: I intend to soon publish an overview of my 10 years’ experience in chest-wall contouring. In this time frame, I have operated on more than 700 transmasculine (trans-masc) patients, implementing many technique details, from the pre-operative drawing, to surgery, through post-operative recovery. The constant practice has definitely improved my performance. I started by studying Professor Monstrey’s algorithm, and then I decided to develop my own. Thanks to my research, I know which technique will work the best, depending on anatomical characteristics.
But I have also noticed that my patients are changing. Considering that society has been improving in accepting and dealing with the theme of gender identity, it is now easier for young trans people to come out and be supported by their family. This means that they can access care and surgery sooner. Because of that, my patients are now younger and healthier than when I first started. Their skin is generally more toned, and their muscles are more developed. This leads to better, longer-lasting surgical results.
ISAPS: You are speaking about male chest procedures at the World Congress later this year. Can you share a little about the methods and techniques you will be covering?
LO RUSSO: At this year’s World Congress, I will review my patient cohort and share tips and tricks I have gathered over the last 10 years of experience. The three techniques I perform are hemi-peri-areolar, peri-areolar, and double-incision, so I will talk about how my algorithm helps me choose between them.
My presentation will also be about secondary surgeries, which are unfortunately more and more frequent. The goal in gender affirming surgery is not only to remove the breasts, but to create a pleasing masculine-looking chest that will feel authentic to the patient’s personal identity.
And because I believe in a practical approach, I’ve decided to do that by sharing many surgery videos, hoping the audience will find them useful and entertaining.
ISAPS: How has ISAPS shaped you as a plastic surgeon, and why is it important to be a part of the worldwide #ISAPSFamily?
LO RUSSO: Since the first ISAPS Congress I attended, I’ve been attracted to the sense of family that I found there. I have felt naturally included, from the start, as an Italian surgeon in an international group. I don’t see it only as a World Congress, but also as an annual reunion of friends. This is why I keep coming back, increasingly convinced, every year.
Another thing I really love about ISAPS is the fact that, for the first time, I saw the topic of gender-affirming surgery being addressed during such a relevant event.
I’m also very grateful and motivated because I’ve been included in the ISAPS Patient Safety Committee, whose purpose is to have better, always-growing, gender-affirming surgical care around the world. This definitely keeps shaping me as a surgeon, because I always say that working together as a team, sharing our passion and knowledge, makes all of us better doctors who can actually make a change.
ISAPS: As you prepare for the World Congress in Cancun, aside from being part of the program, what are you most excited about?
LO RUSSO: I always find it very exciting to represent Italy in an international context. This year I’m also a member of the Italian Association of Aesthetic Plastic Surgery’s (AICPE) board of directors and, as I previously stated, I’m always very happy to network. I’m sure it will be an enriching and rewarding experience, as it always is.
