Chronic opioid use after facial feminization surgery

Publication date: 3/2/2025

Facial feminization surgery (FFS) can involve a relatively painful operation. Most patients will receive a finite amount of narcotic pain medications following this procedures and some patients are concerned that this may start a bad habit of dependence on opioid medications. Although there are no studies that focus on this question exactly, a study did come out of Austria recently that looks at new persistent opioid use after surgery.¹

The primary outcome of this study was the incidence of new persistent opioid use up to 6 months after surgery. The authors reviewed patients who underwent abdominal surgery, cardiac surgery, head and neck surgery, spine surgery, breast surgery, and arthroplasty. Facial feminization surgery was not one of the main categories, thereby limiting the applicability to FFS. Nonetheless, new persistent opioid use was documented in 1.7% of patients. They found specific procedures (spinal surgery, arthroplasty, and head and neck surgery) and certain patient characteristics such as previous opioid use that was discontinued prior to surgery, and the frequency of previously filled opioid prescriptions to be associated with new persistent opioid use. The authors also note that chronic pain and psychiatric comorbidities, particularly mood disorders and substance sue disorders, were associated with new persistent opioid use after surgery.

One caveat is that new persistent opioid use is more common in North America than it is in Austria. However, the individual factors that may influence new persistent opioid use are likely similar. According to a reference in their paper, the overall incidence of new persistent opioid use in the US is estimated to exist between 4.1-7.1%.

The primary takeaway from this study seems to be that persistent opioid use after any type of operation is low, but it does exist. This is likely true with FFS as well. There are certain patient factors that place patients at higher risk of addiction, so it is important to enter surgery with a prepared and mindful approach and to discuss any concerns with your surgeon.

Citations

1. Bologheanu R, Bilir A, Kapral L, Gruber F, Kimberger O (2025) New Persistent Opioid Use After Surgery. JAMA Netw Open 8 (2):e2460794. doi:10.1001/jamanetworkopen.2024.60794 https://pubmed.ncbi.nlm.nih.gov/39976966/