Safe Labia Minoraplasty: A Systematic Review and Meta-analysis of the Surgical Management for Labia Minora Hypertrophy

Abstract

PURPOSE: In line with the figures reported by the American Society of Aesthetic Plastic Surgeons, the requests for labiaplasty have increased by 217.2% from 2012 to 2017. This considerable increase in labia minoraplasty demands plastic surgeons to be up to date with the surgical techniques and their respective indications, complications, and satisfaction rates. Therefore, we systematically reviewed the available evidence on labia minoraplasty for functional, psychological, or aesthetic indications. Additionally, we performed a meta-analysis to evaluate the effectiveness of the most commonly used techniques in terms of safety and patient satisfaction. METHODS: A comprehensive search across PubMed, Web of Science, SCOPUS, and Cochrane CENTRAL was performed from January 2000 through October 2020. The pooled satisfaction rate and the pooled incidence of complications was calculated using meta-analysis with Stata/IC 16.1 (StataCorp LLC, College Station, Tex.). RESULTS: Forty-three studies, including 3804 patients, fulfilled the inclusion criteria and were included in the meta-analysis. The age of patients ranged from 10 to 72 years, and the postoperative follow-up from 0.25 to 109 months. The most common indications for labia minoraplasty were aesthetic dissatisfaction, discomfort in clothing, discomfort while practicing sports, hygiene problems, and sexual discomfort or dysfunction. Eight different techniques were reported: Deepithelialization (n = 4), Edge linear resection (n = 19), Laser-assisted edge resection (n = 3), W-shaped edge resection (n = 3), Wedge resection (n = 21), Wedge resection with preservation of the central blood vessels and nerve bundle (PCBVNB) (n = 2), and Composite reduction (n = 3). Several procedures were performed in addition to labia minoraplasty. The most common were clitoral hood resection (n = 138); vaginoplasty or/and perineoplasty (n = 107); labia majora augmentation (n = 80); and clitoropexy (n = 35). The overall pooled satisfaction rate following labiaplasty was 99% (95%CI: 97%–99%; Fig. 8). Substantial heterogeneity was present across studies (I2 = 63.09%, P < 0.001). The funnel plot graph suggested no evidence of publication bias regarding the satisfaction rate, which was further supported with an Egger’s test meta-regression model (P = 0.69). Subgroup analysis revealed a higher pooled incidence of dehiscence for laser-assisted labiaplasty (5%, 95%CI: 2%–8%), W-shape resection (3%, 95%CI: <1%–15%), wedge resection (3%, 95%CI: 1%–5%), and when the surgical technique was not specified (8%, 95%CI: <1%–27%). The pooled incidence of infection was less than 1% for all techniques. Subgroup analysis revealed a higher pooled incidence of hematoma for W-shape resection (8%, 95%CI: <1%–23%), and a higher pooled incidence for bleeding with W-shape resection (2%, 95%CI: <1%–15%) and composite reduction labiaplasty (1%, 95%CI: <1%–6%). Subgroup analysis revealed a higher pooled incidence of pain or discomfort for deepithelialization (2%, 95%CI: <1%–23%) and W-shape resection (2%, 95%CI: <1%–15%). Finally, a higher pooled incidence of labia asymmetry was reported after composite reduction labiaplasty (3%, 95%CI: 1%–7%). CONCLUSIONS: Overall, labia minoraplasty is a safe procedure. However, serious complications requiring formal surgical interventions have been reported. In this sense, adequate patient selection, proper knowledge of the female genital anatomy, a thorough technique selection, and an experienced surgeon are mandatory in order to reduce complications and improve patient satisfaction.