We people in India are taught the idea that everyone’s either born a boy or a girl, or expected to identify a certain way based on the organ present in you at the time of birth. But that actually isn’t true for everyone, and overlooks a diverse interesting world of people who are gender diverse.

GENDER, BODY AND SEXUALITY

Gender can be phrased as a person’s internal sense of self. It is generally classified into female and male but can also be neither, a combination of the two, or exist completely outside that. Many people confuse gender with body or think that having a certain body type means you are bound to be of that gender. In reality, anyone of any gender can have any body organ or body type of their choice. Likewise, sexuality is also a whole different concept.

Gender Dysphoria

Gender dysphoria is an extreme unease a Trans person may feel about his/her physical attributes, or the way they’re categorised by others. Gender dysphoria can be about the reaction of the society, how we feel physically or even how it affects our emotional state.  The Dysphoria can be really overwhelming sometimes, and they may feel trapped inside their own body having to give off an expression that they are not comfortable with. This can really impact their health, and interfere with their normal functioning in a society.

Transitioning

Transitioning is when someone starts accepting their unique sexuality or gender and takes the requisite steps to socially or physically feel more aligned with their gender identity. It’s not about being noticeable to other people, or trying to look like a certain group of people, but rather doing what feels right for yourself which may be different for different people. Cis gender, or cis for short, is when you exclusively identify as the gender you were assigned at birth. Transition is a gradual thing, and people might change their mind about what works best for them. Transitioning can take place in two broad phases.

Social Transitioning

Socially transitioning involves the way people interact with other people in a society. For example, coming out as transgender, asking people to use different pronouns to describe us, or changing the way we interact in assigned public spaces, like the bathroom we use.

Physical Transitioning

Physical transitioning usually involves a person altering their appearance or body type to what feels right for them, like dressing style, makeup and hair, or seeking medical treatment like hormones or surgery.

There have been many scientific breakthroughs to tackle such present day circumstances. While many foreign developed and developing nations have gone the mile to normalise the process of such transitions India is a wee bit behind in this field. Nevertheless, this transitioning process is being revolutionised in India by the advent of Sex Reassignment Surgery.

Gender Reassignment Surgery

Gender reassignment surgery can also be called sex reassignment surgery, gender confirmation surgery or sex change operation. People with gender dysphoria, find it really essential to lead a normal life.

The objectives of surgery may vary with the wants and needs of the individual but usually include one or more of the following:

Physical health rationales:

• to improve the potential for fertility
• to provide an outlet for menstruation
• to lessen the risks of urinary tract infectionsor obstruction
• to close open wounds or exposed internal organs
• to improve urinaryor faecal continence.

Psychosocial rationales:

• to make the look of the individual more acceptable, appreciable and normal for the person's sex of rearing
• to reduce effects of any confusion regarding gender identity
• to improve the potential for adult sexual relationships

Gender reassignment surgery can be categorised into four main categories:

• The face
• the chest
• the body
• the genitalia

The face alone could involve many surgeries, like rhinoplasty, cheek augmentation, and upper lip reduction or enhancement.  The price of facial feminization or masculinisation surgery is maybe the most widely variable of all the categories. Furthermore, whether you opt for work on your brow, cheeks, chin or nose depends on your face cutting and other features.

As a process of complete physical transition, m en transitioning to women are also likely to get a breast augmentation, while women transitioning to men will get a mastectomy (breast removal). Either surgery may or may not be accompanied by nipple adjustments. The body may involve buttock and hip surgeries to make the bottom body structure more masculine or feminine. It may also involve surgeries less essential to gender reassignment, such as liposuction.

Genital surgery is another aspect of gender reassignment surgery. Genital surgery involves fashioning the sex organs out of existing tissue and tissue grafted from other parts of the body to meet the sexual and other needs of the Trans.

This surgery has two aspects.

One, maybe transition from male to female and the other, from female to male.

It is given that these surgeries will cause extraordinary changes in body and is advised for healthy individuals only. People with health conditions may take the help of detailed discussion with their surgeon before going ahead with this surgery.

Also, before the actual operation, a psychiatric evaluation maybe done for the Trans people wanting to undergo sex reassignment surgery. In this test, the psychiatrist tries to assess the mental condition of patient.

Transition from male to female requires the removal of male sex organs (penis and testes). The urethra is cut and the extra skin is used to create labia and vagina. Other regions like thighs are reshaped to appear more feminine. The prostate gland is retained. After surgery, female hormone oestrogen is induced to stimulate breast growth, reduce facial hair and increase voice pitch.

Female to male conversion are successful as compared to the vice versa condition. It is because female anatomy is by nature complex. If all these techniques are successful enough, only then male hormones are induced to stimulate facial and chest hair followed by voice change.

Gender Reassignment Surgery Cost in India

Although the overall cost of the surgery is highly variable and personalised because it depends on the person about what all the changes he or she wants in himself or herself, here is an approximate estimate of the cost in various cities of India.

COST OF SEX REASSIGNMENT SURGERY IN OTHER COUNTRIES

In Thailand it costs between $18k and $24k (US) and in the US it is between $24k and $40k.

A male to female sex change operation could cost up to $30,000 (AUD).

In some countries or regions, it may also be a hard job to find a qualified and experienced surgeon for sex change operations. But fortunately due to the initiative and innovation of many likeminded people these services are easily accessible or mainstream in India now. One can avail these services any time to enhance or broaden their area of self expression. The world is changing and freedom of sexuality and self expression is its pioneer.

The SRS Surgery information on this website is intended for general and education purposes only and should not be considered as expert advice. For any expert opinion you should consult a qualified medical practitioner, such as your own General practitioner.

While every effort has been made to ensure that the information contained on this website is correct and up-to-date, this cannot be guaranteed. Sex Reassignment Surgery Website takes no responsibility for any harm, loss or damage suffered as a result of using the information published on this websites. Images used on this site are only for reference purpose.

Gender reassignment surgery goes by many names: sex reassignment surgery, gender confirmation surgery or sex change operation. For someone with gender dysphoria, it is an absolute must if they want to lead a normal life.

Gender reassignment surgery can be broken down into four main categories: the face, the chest, the body and the genitalia.

The face alone could involve a dozen surgeries, including rhinoplasty, cheek augmentation, and upper lip reduction or enhancement. Facial feminization or masculinization surgery is quite possibly the most widely variable of all the categories in terms of cost. Furthermore, whether you opt for work on your brow, cheeks, chin, nose or neck depends on your baseline features.

The chest is a little more clearly defined. Men transitioning to women will likely get a breast augmentation, while women transitioning to men will get a mastectomy (breast removal). Either surgery may be accompanied by nipple adjustments.

The body may involve buttock and hip surgeries to make the waistline more masculine or feminine. It may also involve surgeries less essential to gender reassignment, such as liposuction.

The genitalia is the most complex and, for many, an essential aspect of gender reassignment surgery. Genital surgery involves fashioning the genitalia for the target gender out of existing tissue and tissue grafted from other parts of the body. The process involves some key changes and, sometimes, some à la carte additions, making it almost as variable as facial surgery in terms of cost.

Two aspects

This surgery has two aspects. One is the conversion from male to female and the other is from female to male. Both are complex procedures dealing with essential genital organs of body. It is evident that these surgeries cause drastic changes In body and therefore is advised for healthy individuals only. People with other acute health conditions may seek elaborate discussion with surgeon before going ahead with this surgery.

Prior to operation, a psychiatric evaluation is done for patients who desire a sex change. In this test, the psychiatrist tries to identify the mental stress of patients; arising from the feeling of being in a body with a “wrong” gender. Severe cases are recommended to go for surgical treatment. Rest of the cases are initially treated with psychiatric counseling.

Anatomy conversion from male to female requires the removal of penis and testes. The urethra is cut for this purpose and the extra skin is used to create labia and vagina. Genital tissues are reshaped to appear more feminine. The prostate gland is however retained. After the surgical treatment, female hormone estrogen is induced to stimulate breast development, reduce facial hair development and increase voice pitch.

Female to male conversion show lesser success as compared to the vice versa condition. It is due to the natural complexity of female anatomy, that makes It difficult to be accomplished with ease. As for example, clitoral tissues of female genitals are too small for penis development. Therefore, hormones are injected to enlarge these tissues. Further, complex breast reduction techniques need to be followed to remove breast tissues. If all these techniques are successful enough, only then androgens are induced to stimulate facial and chest hair followed by voice change.

Cost

The question of how much gender reassignment surgery costs is a complicated one. For one thing, gender reassignment surgery is not a single, clearly defined plastic surgery. Transitioning can involve several distinct procedures — how much your surgery costs depends on what you decide to have done.

Cost of sex change surgery in India ranges between INR 1,00,000 to INR 7,00,000 depending on conversion type and hospital you choose. For approx cost of SRS Surgery please fill the form.

To ensure quick recovery, high protein diet is recommended. Patients are also required to follow liquid diet for few days. It is because, early bowel movements may result to complexities. Pain relief medicines are prescribed that need to be taken so as to avoid severe post operative pain.

Trachea (or Adam’s apple) shaving

There are 4 phases of gender transition after a diagnosis of Gender Identity Disorder has been made. Information on these phases, which can help assess a person’s readiness for gender reassignment surgery, is provided below.

There are 4 phases of gender transition after a diagnosis of Gender Identity Disorder has been made:

• real life experience in the desired role
• hormones of the desired gender
• surgery to change genitalia and other sexual characteristics
• post-transition monitoring.

It is important to note that not everyone with Gender Identity Disorder will need or desire all these elements of transitioning. Similarly, it is also important to understand there is a difference between eligibility for a phase and readiness to undertake it.

Real life experience

Who’s involved

This phase is assisted and assessed by the psychiatrist and psychologist.

Eligibility

Living and working full time for at least 2 years as a woman/man.

Readiness

Demonstrating further consolidation of the evolving female/male gender identity with consequent improving mental health.

Hormone therapy

Who’s involved

This phase is assisted and assessed by the endocrinologist and GP.

Eligibility – for people over 18 years old

• Demonstrating knowledge of what hormones can and cannot do, as well as their risks and benefits.
• Documented real-life experience of more than 3 months and/or counselling for at least 3 months.

Readiness – consolidation of gender identity during real life experience

• Progress in mastering other identified mental health issues.
• Will take hormones in a responsible manner.

The maximum physical response to hormones may take up to 2 years of continued use, and the degree of effect obtained varies widely from person to person. Medically unmonitored hormone therapy is dangerous and can jeopardise or preclude transitioning surgery as can self harming and mutilation.

For some people hormone therapy is adequate for social functioning and surgical intervention becomes unnecessary.

It may be of use to talk about sperm banking with the endocrinologist or GP prior to undertaking hormone therapy.

Gender reassignment surgery

Transitioning in general and surgery in particular, has profound personal, social and medical consequences that need very serious consideration. These impact on all aspects of life – family, vocational, interpersonal, educational, economic and legal. Therefore surgery is only undertaken after comprehensive multidisciplinary evaluation.

A person’s suitability for Gender Reassignment Surgery can be assessed using the internationally accepted World Professional Association for Transgender Health’s Standards of Care.

These standards are minimum requirements and therefore it is also important to be mindful of other factors not related to gender identity that may preclude surgery (for example co-existing medical conditions or surgical risk). Similarly, although someone may be eligible to be considered for Gender Reassignment Surgery, both non-medical and medical considerations may impact on their suitability for surgery beyond what is described below.

The journey towards Gender Reassignment Surgery is complex. The decision to offer surgery is by consensus and just undertaking the pre-requisites for surgery does not necessarily mean an operation will be offered.

Who’s involved

This phase is assessed and performed by the anaesthetist and surgeons.

Eligibility – for people over 18 years old

• More than 12 months of continuous hormonal treatment .
• More than 2 years of successful and continuous real life experience as a woman/man.
• 2 psychiatric reports by senior psychiatrists with some experience in this field, 1 of which is by an evaluating (not treating) doctor.
• 1 psychologist’s report by a senior psychologist or social worker with experience in this field.

Readiness

• Demonstrated progress in transitioning including consolidation of gender identity, dealing with work, family and interpersonal issues as well as significant improvement/stability in mental health
• No other medical conditions that constitute a surgical or anaesthetic risk
• Able to have a full understanding of the procedure with its risks and expected outcomes to allow for the most informed consent.

FOR TRANS MEN SURGICAL OPTIONS MAY INCLUDE:

Chest surgery/ breast removal (double mastectomy)

Removal of the womb (hysterectomy)

Removal of the ovaries (oophorectomy)

Removal of the vagina (vaginectomy)

Construction of a phallus (phalloplasty) or ‘micropenis’ (metoidioplasty)

Creation of a scrotum with testicular implants (scrotoplasty)

Male to Female SURGICAL OPTIONS MAY INCLUDE:

Breast implants

Removal of testicles (orchidectomy)

Removal of penis (penectomy)

Creation of a vagina (vaginoplasty)

Creation of a clitoris (clitoroplasty)

Creation of labia or ‘lips’ of the vagina (labioplasty)

Facial feminisation surgery

Post-transition follow-up

Postoperative follow-up is one of the factors associated with a good outcome and therefore the ability and readiness of someone to commit to this forms part of their evaluation.

After surgery the person is asked to:

• stay in regular touch with a doctor for the ongoing prescribing of hormonal therapy
• be monitored for possible conditions consequent to the medical and surgical interventions
• continue with normal screening (eg, for prostate cancer)
• be open to further mental health input that would assist with any problems adjusting after operation.

Follow-up is helpful to the person, but it also improves the understanding of the limits and benefits of this type of surgery so as to enable the best possible counselling and assessment of others who might follow.

Male to Female

Orchidectomy

Orchiectomy involves removal of the testicles, to considerably reduce the production of testosterone.

What is an Orchiectomy?

An orchiectomy (spelled orchidectomy in British English), is the medical term for the surgical procedure to remove one or more of the testicles. A bilateral orchiectomy is the removal of both testicles and is commonly referred to as castration.

An orchiectomy doesn't remove the penis, which would be a penectomy. It is also different from a vasectomy, which leaves the testicles and their function intact while still causing sterilization. While sex reassignment surgery (SRS) for male to female transsexuals also removes the testicles and penis, it is different because it also creates a functional vagina in the process.

What Are the Effects of an Orchiectomy?

The effects of an orchiectomy are caused by the reduction of testosterone. They can vary based on the age of the person and on the number of testicles removed.

If castration is done prior to puberty then the person won't develop male secondary sex characteristics without testosterone replacement therapy.

These Include:

Deep voice
Male body hair
Balding
Facial hair
Muscular frame
Reduced or complete lack of sex drive
Possible slight breast growth

If Castration is Done After Puberty:

Loss of body hair
Loss of muscle mass
Increased body fat
Possible reduced sex drive
Possible slight breast growth
Prevent or stop baldness

In most cases of castration after puberty facial hair growth is slowed but not stopped, libido is reduced but still exists and the voice remains deep.

If only one testicle is removed, the other testicle increases testosterone production and there won't be too much of a change.

Alternatives:

Antiandrogens such can be taken to block testosterone. A more expensive option are releasing hormone (GnRH) agonists that block testicular function.

Why Do Some Trans Women Get Orchiectomies?:

Male to female (MTF) transsexuals, as well as some other transgendered people, sometimes undergo orchiectomy. An orchiectomy can be done before or instead of sex reassignment surgery (SRS). This is an option for those that either can't afford, aren't in good enough health or do not want to have SRS.

It is often recommended to get a bilateral orchiectomy when antiandrogens such as  cause unwanted and dangerous side effects. Kidney, liver, and thyroid damage are common after long term use. There is also an increased risk of blood clots, hyperkalemia and some people are allergic to the medications.

Benefits of an Orchiectomy for Trans Women:

The Benefits for Transgendered Women Are:

1. Ability to stop taking antiandrogens and reduce estrogen

2. Increased health from reduction of medications

3: Saves money on medications

4: Might be able to legally change sex with an orchiectomy

5: Easier to "tuck" and hide genitals

6: Taken more seriously by society

7: Increased body image

8: Improved and faster feminization

9: Can no longer have testicular pain

10: Never detransition even if you can't take medications

There are also some possible downsides to getting an orchiectomy if you are planning on later sex reassignment surgery (SRS). The scrotal skin could possibly shrink resulting in less for later, and the money could have been saved for SRS. However, if you aren't close to affording SRS then you can save on medication costs. If an orchiectomy is done improperly then there is the chance of scar tissue.

Some surgeons might charge more for sex reassignment surgery if you have had an orchiectomy. Doctor  is well known for refusing patients or charging a fee if you have been castrated.

Who Else Gets Orchiectomies?:

The most common reason for an orchiectomy is as a treatment for testicular cancer. If only one testicle is found to be cancerous then only that one is removed. Even if both testicles are removed, male sexual function can be restored and maintained through the use of testosterone injections or patches. However without testicles there is no production of sperm and so the person will be infertile.

Some men seek this procedure in order to remove what they consider uncomfortable, uncontrollable or dysfunctional sexual urges. Others may seek it in order to fulfill a fetish or fantasy. The most common reason for control of sexuality is as part of rehabilitation for sex offenders.

There are also eunuchs, which get castrated for religious or alternative gender identities.

The Different Types of Orchiectomies:

Simple Orchiectomy:

A simple orchiectomy is one in which the incision is made down the center of the scrotum. It can be done under general or local anesthesia. The various layers of muscle and fasciae are cu into and the testicles are extracted. The spermatic cord is tied off with two triple square knots using non-dissolving sutures and cut.

I had this version of an orchiectomy with Doctor  while under general anesthesia.

Operating time is generally 30 minutes to a hour in an outpatient setting with a checkup within 24 hours.

Radical, or Inguinal Orchiectomy:

An inguinal (groin area) orchiectomy may be either unilateral, involving only one testicle, or bilateral, involving both.
The reason for complete (radical) removal, in the cases of cancer treatment, is that testicular cancers frequently spread from the spermatic cord into the lymph nodes near the kidneys.

For trans women, an inguinal orchiectomy is often chosen to prevent scrotal scar tissue which may interfere with future sex reassignment surgery. A long non-absorbable suture is left in the stump of the spermatic cord for later surgeries.

A 2.5 inch (about 6 cm) incision is made above the pubic bone on the side above the testicle that is being removed. If you are getting both removed then an incision will be made on both sides.

The testicle is then pulled up through the inguinal canal, the spermatic cord is clamped off in two places to prevent blood loss and then cut between the clamps.

After the cord and testicle have been removed, the surgeon washes the area with saline solution and closes the various layers of tissues and skin with various types of sutures. The wound is then covered with sterile gauze and bandaged. The procedure is usually finished in 45 minutes to an hour and a half.

The full recovery time after a bilateral inguinal (radical) orchiectomy is usually between 2 to 8 weeks. Some light activity may be resumed after about 3 to 4 days.

Medical Consequences:

Someone that has been castrated will no longer produce enough testosterone to prevent osteoporosis. They will need to take hormone replacement therapy (HRT) for the rest of their lives. Either estrogen or testosterone will prevent osteoporosis and rapid aging.

If castration is done before puberty then the person will be taller than average, since the sex hormones in puberty stop long bone growth.

Recovery After an Orchiectomy:

The recovery time for an orchiectomy is usually anywhere from a week to two months. Complications increase the length of healing time. The most common complications for an orchiectomy include bruising on or around the scrotum, spotting of blood, swelling and scrotal and abdominal pain.

A slightly less common complication is a hematoma, which is the pooling and swelling of the blood in the scrotal skin. It can cause a lot of swelling and changes the skin color to black and purple. I got a hematoma from my orchiectomy. It takes weeks to go away, but  which greatly increased the speed of healing.

Warning:

Castration should not be done without a doctor's care. Those who have done self cutting have generally regretted the outcomes or have had a difficult SRS due to scar tissue. Some have even died from the blood loss. If you choose to have this done by some that isn't medically trained, it can result in major health problems due to blood loss, excessive scar tissue formation or life threatening infections.

Another article on same subject

What is an orchiectomy?

An orchiectomy is surgery in which one or more testicles are removed.

The testicles, which are male reproductive organs that produce sperm, sit in a sac, called the scrotum. The scrotum is just below the penis.

There are two common orchiectomy procedures for transgender women: bilateral orchiectomy and simple orchiectomy. In a bilateral orchiectomy, the surgeon removes both testicles. During a simple orchiectomy, the surgeon could remove either one or both testicles.

Bilateral orchiectomy is the more common type of orchiectomy for transgender women.

Orchiectomy vs. scrotectomy

During an orchiectomy, the surgeon will remove one or both testicles from the scrotum. During a scrotectomy, the surgeon will remove the entire scrotum or a portion of it.

If your transition will eventually include a vaginoplasty, the scrotal tissue may be used to create the vaginal lining. A vaginoplasty is the construction of a vagina using skin grafts. In these cases, a scrotectomy may not be recommended.

If there’s no scrotal tissue available for a vaginoplasty, the next option for constructing the vaginal tissue can often include skin grafts from the upper thigh.

It’s a good idea to talk to your doctor about all of your options. Be open with them about future surgeries you may plan to have. Before the procedure, talk to your doctor about fertility preservation and impact to sexual functioning.

Who’s a good candidate for this procedure?

An orchiectomy is a relatively inexpensive surgery with a short recovery time.

The procedure may be a first step if you’re heading toward vaginoplasty. In some cases, you may be able to have the orchiectomy at the same time you have a vaginoplasty. You can also schedule them as independent procedures.

Other procedures you may consider, especially if you’re planning a vaginoplasty, include:

• Partial penectomy.A penectomy is a surgical procedure that involves removing a portion of the penis. It’s commonly used as a treatment option for penile cancer.
• A labiaplasty is a procedure used to construct labia using skin grafts.

Orchiectomy may also be a good option for people who don’t react well to feminizing hormones or want to reduce the health risks and side effects from these medications. That’s because once the procedure is complete, your body will usually produce less endogenous testosterone, which can lead to lower doses of feminizing hormones.

Additionally, research indicates that orchiectomy procedures may be metabolically protective for transgender women.

Orchiectomy and fertility

If you think you may want to have children in the future, talk to your doctor about storing sperm in a sperm bank before starting hormone treatments. That way you’ll have ensured you protected your fertility.

What can I expect before and during the procedure?

To prepare for the procedure, your doctor will likely require proof that:

• You’re experiencing gender dysphoria.
• You’re able to consent to treatment and make a fully informed decision.
• You don’t have any unmanaged mental health or medical problems.
• You’ve reached the age of adulthood in the country that the procedure will take place

Generally, a doctor will ask you to provide letters of preparedness from two different mental health professionals. You’ll also likely need to complete one year (12 consecutive months) of hormone therapy before you undergo an orchiectomy.

The procedure will take 30 to 60 minutes. Before surgery begins, your doctor will use local anesthesia to numb the area or general anesthesia to make you fall asleep so you don’t feel anything. A surgeon will then make an incision in the middle of the scrotum. They’ll remove one or both testes and then close the incision, often with sutures.

The surgery itself is an outpatient procedure. This means that if you were dropped off in the morning for the procedure, you’ll be able to leave before the end of the day.

What’s recovery like?

Physical recovery from the procedure will last anywhere between a few days to a week. Your doctor will likely prescribe pain medications to manage pain and antibiotics to prevent infection.

Based on your reaction to the orchiectomy, your physician may reduce your estrogen dose and taper off any preoperative androgen blocker medication.

Are there side effects or complications?

You may experience side effects and complications that are typical to surgery. These may include:

• bleeding or infection
• injury to surrounding organs
• scarring
• dissatisfaction with results
• nerve damage or loss of feeling
• infertility
• decreased libido and energy
• osteoporosis

Transgender women who undergo an orchiectomy are also likely to experience a number of positive side effects, including:

• a drastic decrease in testosterone, which may allow you to reduce your dose of feminizing hormones
• reduced gender dysphoria as you take a step closer to matching your physical appearance with your gender identity

What’s the outlook?

An orchiectomy is a relatively inexpensive outpatient surgery in which the surgeon removes one or both testicles.

The surgery can be part of a treatment plan for someone with prostate cancer, but it’s also a common procedure for a transgender woman undergoing gender confirmation surgery.

One major benefit to this surgery is, once completed, your doctor may recommend reducing your dose of feminizing hormones.

An orchiectomy is also often considered an important step toward a vaginoplasty, in which the surgeon constructs a functioning vagina.

Recovery from the procedure — if it’s done independently of the vaginoplasty — may take between a couple days to a week.

Vaginoplasty

VAGINOPLASTY

Vaginoplasty is a surgery that allows one to obtain the most natural female genitalia possible.

Our team of surgeons uses a surgical technique comprised of a single step: penile inversion (the skin of the penis is grafted to the interior of the vagina) coupled with an autograft of a neurovascular flap of the glans that will serve to create a sensitive clitoris. By improving this technique, Doctor has redefined the standards of vaginoplasty, earning GRS Montréal consideration as one of the world’s best centres in the field of male-to-female gender affirming surgery.

Vaginoplasty surgery can be performed at the same time as other procedures.

Expected results:

• A vagina with enough depth to allow for sexual relations with penetration;
• A clitoris made with the sensitive skin of the glans;
• A clitoral hood;
• A vulva equipped with labia minora;
• Erogenous zones (clitoral and vaginal) with the possibility of sexual pleasure.

Vaginoplasty requires care that you will integrate into your daily routine for the rest of your life. This care includes a regular routine of vaginal  dilations and hygiene. Following this routine will have a significant impact on the results of your procedure.

Highlights of the surgical technique used:

The surgeon will verify that there is enough penis and scrotum skin to create a fairly deep vaginal cavity. If the total amount of skin from the current genitals is insufficient to line the inner wall of the vaginal cavity, an additional skin graft can be taken from another body part (back, thigh, buttock) and grafted into the vagina. Your surgeon will advise you following your physical examination if it will be necessary to have a skin graft. The area of the skin graft may show slight discolouration once healed.

During the procedure, the surgeon will:

• Remove the scrotal skin, which will be thinned and freed of hair through cauterization of the roots;
• Remove the testicles;
• Dissect the penis – the skin will be inverted to be grafted to the interior of the vaginal cavity;
• Dissect the internal structures of the penis taking care to separate the urethra, the corpus cavernosum, and at the same time release a flap consisting of blood vessels and nerve endings:
  1. The corpus cavernosa will be removed;
  2. The distal end of the retained flap, in the form of a “custom-made” island, will be removed directly from the glans to form the clitoris. The size of the clitoris can therefore be adjusted according to the patient’s preference. The flap and the clitoris will be positioned and fixed;
  3. The urethra will be dissected; the remaining tissue will be preserved to coat the inside of the labia minora, providing a more natural result than with a skin graft.
• Create the labia majora;
• Create the vagina by dissecting, to a depth of 5 to 6 inches, the tissue below the meatus and along the Denonvilliers fascia (the space between the prostate and the rectum). The prostate is left in place: to remove it would cause irreversible urinary incontinence;

It is possible to perform a vaginoplasty without creating a vaginal cavity.

Benefits of this surgical technique:

• A surgical technique in one single surgery;
• In the case where skin removed from the penis and scrotum is in sufficient quantity to create the vaginal cavity, no skin graft will be taken from a visible part of the body, such as the abdomen, thigh, or buttock;
• The addition of the scrotal skin to the skin of the penis provides a deeper vaginal cavity;
• The use of existing tissue to construct the minutiae of the vulva (labia, clitoris, clitoral hood) eliminates strain on the tissue forming the new genitals.

* Due to multiple factors that are unique to each individual, results may vary from one person to another. Be assured that our surgical team works with each patient individually to achieve the best results possible. In some cases, our surgeons can offer a corrective surgery if certain results do not meet your expectations.

Postoperative care:

During your convalescence, you will be provided with the document Information and Postoperative Care – Vaginoplasty. This document contains your surgeon’s instructions and will serve as a guide.

Male to Female FAQ | Vaginoplasty

1. Can I have children after my surgery?

No, a vaginoplasty will not allow you to have children. The main objective of this surgery is to obtain the most natural as possible female external genitals. To have children, it would be necessary to implant internal female structures in your body like a uterus, ovaries, and egg cells, which is not possible at this time.

2. Which methods are used to make having biological children possible?

Depending on your goals and expectations, your doctor will be able to provide you with information and resources. Discuss your options with your doctor before surgery.

3. Why must I stop taking hormones 3 weeks before and for 2 weeks after surgery?

Feminizing hormones predisposes you to the formation of small clots. Because of the position you’ll be in during the procedure and because you will be less mobile during your recovery, taking hormones in the weeks before and after surgery increases the risk of venous thrombosis and pulmonary embolism.

4. Does this surgery necessarily involve the creation of a vaginal cavity?

No, it is possible to have a vaginoplasty without vaginal cavity. Should you choose this option, it is always possible to create a vaginal cavity in the future.

5. Does the length of my penis and the size of my scrotum determine the depth of my vaginal cavity?

No, it rather indicates if there is enough skin to completely cover the vaginal wall. In the event that the amount of skin present is insufficient, the surgeon will take a skin graft in the back, the buttock, or thigh in order to construct a vaginal cavity of satisfactory depth.

6. How can I know if the skin of my penis and scrotum are sufficient to avoid a skin graft?

Skin grafts are rarely necessary. However, following your physical evaluation prior to surgery, the surgeon will determine if a skin graft is necessary or not.

If you have had an orchiectomy before vaginoplasty surgery, a skin graft will be most likely necessary as the scrotal skin may have contracted with time and therefore be insufficient.

7. If I am circumcised, is this a problem?

Circumcision has no effect whatsoever on surgery.

8. Will I have to undergo electrolysis and/or laser treatments to remove the hair on my scrotum before vaginoplasty?

No, it is not necessary to have your hair removed from you scrotum because, during surgery, the surgeons will meticulously cauterize the hair from the skin that was taken from the scrotum in order to prevent hair regrowth in the vaginal cavity. Hair regrowth in the vagina is generally eliminated. Very small, non-visible hairs may not be cauterized, however, and could therefore grow back after surgery.

*Should you still wish to proceed with permanent hair removal treatments by laser and/or electrolysis before surgery, your esthetician can inform you of the approximate number of treatments needed. Permanent hair removal treatments must be completed at least 3 months before the procedure to ensure that all hair is removed.

9. Do I have to remove my sutures after surgery?

Two types of sutures are used. The first will be removed during your convalescence by the nursing staff at Asclépiade. The other sutures are “dissolvable stiches” and take 30 to 90 days to dissolve completely.

10. If hair grows in my vagina after surgery, how do I remove them?

Should hair regrow in the vaginal cavity, your doctor can, one year after surgery, remove them with a long pair of tweezers during your speculum examination. If regrowth is extensive, a gynecologist can burn the hairs with a surgical cautery. This procedure is usually performed under local anesthesia.

*GRS Montréal surgeons do not practice hair cauterization in the vaginal cavity.

11. Which medications will be administered to me after surgery?

Following surgery, you will be prescribed medications such as antibiotics, anti-inflammatories, and medication to relieve your pain. Your medication will be adjusted and modified according to your medical situation.

12. What is the dilation routine?

The routine includes 4 dilations per day for the first month after surgery. Afterwards, this decreases to 3, then 2, and finally, about 1 year after surgery, you will perform 1 dilation per week. It is important to know that regular dilations will be necessary for the rest of your life. Without them, the vaginal cavity will close. Vaginal dilation is one of the most important treatments after surgery.

13. Will the dosage of my feminizing hormones remain the same after surgery?

You will need to schedule an appointment with your endocrinologist or your hormone therapy’s prescribing physician 2 months after surgery in order to follow-up on the dosage of your medication.

14. How soon after surgery can I begin to simulate my clitoris?

You can begin to explore the clitoral area with your fingers about 8 weeks after surgery. The nerve endings will have been affected during surgery and sensations may feel different or diminished. Take time to explore your new genitals to discover these new sensations. Nerve stimulation through touch and massage contribute to the reconnection of nerve endings, allowing you to rediscover sensations.

15. How soon after surgery can I have sexual relations with penetration?

You should normally wait approximately 12 weeks after surgery before engaging in oral sex or sex with vaginal or anal penetration. Please note, however, that any physical effort involving the muscles that were affected by surgery may cause pain.

16. After surgery, is it possible for the vaginal cavity to tear during sexual relations with vaginal penetration?

No, the vaginal cavity cannot tear.

17. Is it possible to produce natural vaginal lubricant after surgery?

Yes, because the Cowper’s glands are preserved, it is possible that your vaginal cavity will lubricate naturally. These glands are responsible for the secretion of pre-ejaculatory fluid. Therefore, natural lubrication may occur during sexual arousal. The presence of pre-ejaculate varies greatly from one person to another. It is not possible to know before surgery whether there will be natural lubrication. In the absence of natural lubrication, or if natural lubrication is insufficient, you can use a water-based lubricant during sexual relations.

18. Which type of lubricant should I use after my vaginoplasty?

GRS Montréal surgeons strongly recommend using an unscented, alcohol-free, water-based lubricant

19. Following surgery, is it possible to remove hair from the genital region by shaving, laser, electrolysis, and/or hair removal cream?

About 6 weeks after surgery, and if your wounds are completely healed, you can begin using a razor and hair removal cream. As for laser hair removal treatments, you must wait at least 8 weeks after surgery and ensure that your wounds have completely healed.

20. Do I need to have gynecological examinations after vaginoplasty?

It is recommended to have a first gynecological examination 1 year after surgery, and annually thereafter, unless your surgeon or doctor prescribes a different frequency. A speculum examination of your vaginal cavity allows for an examination of the inner wall and to verify its integrity. If an examination reveals an abnormality, your doctor can communicate at all times with the surgical team at GRS Montréal by fax or email.

It is not recommended to use a speculum for a vaginal examination before at least 1 year after surgery, unless otherwise directed by your surgeon.

21. Should I ask my doctor to examine my prostate after vaginoplasty?

Because the prostate is not removed during surgery, it is important to continue with annual prostate examinations with your doctor. After surgery, the prostate will have to be examined via the vaginal cavity.

22. Is it possible to get vaginitis after a vaginoplasty?

Yes, it is possible to get vaginitis after surgery because the condition is an inflammation caused by an infection in the vaginal cavity. The nursing staff will inform you how to prevent vaginitis as well as of its signs and symptoms so that you may be able to recognize it.

Good vaginal hygiene contributes significantly to preventing this infection. A proper hygiene routine will be explained during your postoperative care.

General FAQ’s

• Do I have to have genital reconstructive surgery before changing my gender status on my legal documents?

No, if you are a resident of Quebec, it is no longer mandatory to have genital reconstruction surgery in order to change your gender status in legal documents.

For more information, visit the Directeur de l’état civil’s

If you are not a Quebec resident, you can find information in the Being Trans section of our website or from your provincial or state government.

*If necessary, we will provide you with the official documents (affidavit) required to support your efforts.

• Will my surgery be reimbursed by my province’s health insurance?

Most Canadian provinces cover the cost of gender reassignment surgery. However, feminizing surgeries considered cosmetic, such as breast augmentation, voice surgery, Adam’s Apple reduction, and facial feminization, are not currently covered by all health insurance programs. Each Canadian province has its own reimbursement program. You can find information specific to your province in the Être trans section of our website or of your provincial government.

If you are a U.S. citizen or from elsewhere in the world, check with the health department of your state or provincial government andor your own insurance company.

*Some health insurance programs cover certain fees associated with your surgery while others do not.

• From what age can I have gender reassignment surgery?

According to WPATH's Standards of Care, an individual must be of the age of majority in the country of reference (Canada) to be allowed to undergo gender reassignment surgery. Therefore, the required age for genital reconstructive surgery is 18 years of age and 16 for masculinization of the torso surgery (mastectomy).

• What documents do I need to provide if I want to have surgery?

The documents required are linked to the type of surgery you are interested in undergoing. The basic required documents are those that allow surgeons to confirm that you have met WPATH’s Standards of Care. Additional documents, like proof of good health from your doctor, will be requested to ensure safe surgical proceedings.

Consult the WPATH document for more information.

• I am intersexed and would like to undergo gender reassignment surgery. What documents do I need to provide?

The documents required are the same set out by WPATH’s Standards of Care. GRS Montréal surgeons may ask you for additional documentation andor test results in order to ensure safe surgical proceedings.

• My file is complete; I am following WPATH’s Standards of Care and I have provided all of the documents requested by my surgeon. How long will I have to wait to be given a surgery date?

Once your preoperative medical file has been confirmed, a GRS Montréal staff member will contact you to provide you with a preliminary surgery date, taking into account your own availability and that of the operating room.

Although you will have been assigned a date, you must send us the required lab results by the deadline you will be provided with. Once the results of these tests have been validated, your surgery date will be confirmed.   

• How long before surgery do I have to provide my lab results?

GRS Montréal must receive your results 2 months before your surgery date in order to confirm this date and avoid a postponement.

• What are the possible complications involved with my surgical procedure?

It is important to keep in mind that complications rarely occur. Generally, minor problems are the most common. Complications may make recovery time longer, but they do not necessarily affect final results.

While risk is involved in all surgeries, GRS Montréal physicians work continually to prevent them through the development and maintenance of safe surgical practices. Additionally, pre and postoperative treatment and follow-up plans allow for early detection and management of complications that may arise. In the case of complications, our doctors will provide you with all of the necessary information to help you eliminate all problems as quickly as possible.

Risks and complications are not directly related to the scale of the surgical procedure involved and are sometimes difficult to prevent despite precautions taken. Severe allergic reactions to medication, cardiac arrhythmia, hypertension, hemorrhage, embolism, the reopening of wounds or slow healing, injuries to other parts of the body, loss of feeling, bruising and swelling, wide and thick scars, and unsatisfactory outcomes are common complications in all surgeries. You will be provided with all details related to the complications specific to your surgery.    

• Will I lose the ability to achieve orgasm after surgery?

The majority of patients retain their ability to achieve orgasm after surgery, but there is still a risk that sexual function or the ability to have an orgasm will be affected. GRS Montréal surgeons are very experienced and use techniques that allow the patient to retain her or his sensations of sexual pleasure. Your health history (smoking, diet, alcohol, etc.) can also affect healing and, in this way, alter the sensitivity of your genitals.

• I don’t speak French. Do the physicians and staff at GRS Montréal speak English?

Our staff speaks French and English. We are also able to provide you with documents concerning your surgical procedure in these two languages.

If you do not speak French or English, it is still possible to have surgery at the CMC. In the past, we have accompanied deaf and mute patients, as well as patients whose mother tongue is neither French nor English. From the beginning of the preoperative period, we will accompany you in the process to obtain an interpreter or translator.

• Will I have an opportunity to speak with the GRS Montréal team before my surgery?

You can contact us at any time in order to communicate confidentially with a member of the GRS Montréal team. Once your file is complete, a member of the nursing staff in the preoperative clinic will contact you.

• My blood is infected with HIV. Can I still have surgery?

Yes, it is possible to have surgery as HIV is not a contraindication to surgery. However, it is important to mention your infection to us and to provide us with the results of your viral load when you want to plan your surgery. Your viral load lab results must be labelled “undetectable”. Antivirals are the only way to achieve this label.

• If I have an STI, can I still have surgery?

Yes, surgery is possible even if you have contracted an STI in the past. However, if you currently have an STI, it is recommended you be healed before having surgery. Your symptoms must be treated. if a fever is present, surgery will be postponed.

• Can I contract or transmit an STI even if I have undergone genital reconstructive surgery?

After surgery, you remain at risk of contracting or transmitting infections transmitted sexually and by blood. Consult your family doctor for information about available contraception.

Resources: http:www.sexualityandu.caen

• Can I be operated on if I am overweight?

Your weight and diet can significantly influence your healing, the results of your surgery, your ability to take care of yourself. It is preferable to have attained a healthy weight by the time of your surgery (a BMI between 18.5 and 25). If your BMI is below or above the normal range, your situation will be assessed and you will be informed of your possibilities for surgery. GRS Montréal can direct you to resources that can help you achieve your weight loss or weight gain goals.

Calculate your BMI

• Can I undergo surgery if I take drugs?

Access to our establishment is forbidden to anyone with drugs or alcohol in their possession, or are under the influence of these substances.

Drug use can affect patient safety during surgery. All drug use should be reported to us during the planning stages of your surgery. Your surgeon and anesthesiologist must have this information to ensure the surgery is safe for you.

• How long before and after surgery do I have to stop consuming alcohol and stop smoking?

Alcohol: You must avoid drinking alcohol during the 2 weeks before surgery. Mixing alcohol and medications can cause unpredictable and undesired reactions.

Access to our establishment is forbidden to anyone with drugs or alcohol in their possession, or are under the influence of these substances.

Tobacco and nicotine substitutes: We highly recommend you stop smoking or using nicotine substitutes during the 6 weeks before and after the procedure, with the exception of phalloplasty surgery, for which you must stop smoking 6 months before and after the procedure in order to optimize the vascularization of the graft of the phallus as well as nerve regeneration. Toxic substances found in tobacco can:

• Tighten small blood vessels and thus negatively affect the results of your surgery and the healing of your wounds;
• Cause nausea upon waking up, vomiting, and excessive coughing, which increase the risk of bleeding after surgery;
• Resource http:defitabac.qc.caen

According to the law to provide a healthy environment, it is strictly prohibited to smoke on the premises, with the exception of specifically designated smoking areas. These areas are located at least nine (9) meters from all of the facility’s doors. Violating this rule can make you subject to fines ranging from $250 to $750 for a first infraction and from $500 to $1500 for a recurrence. Cigarette butts must be disposed of in designated metal containers.

• Should I stop taking my hormones before surgery?
  • Feminizing hormones, antiandrogen drugs like progesterone : you must stop taking these 3 weeks before surgery in order to reduce the risk of thrombophlebitis (blood clot). You can resume taking these after surgery, as directed by your surgeon.
  • Masculinizing hormones such as testosterone: you should continue taking these according to your usual schedule.
• Will the dosage of my hormones need to be adjusted after surgery?

If you are taking feminizing hormones and antiandrogen drugs, make an appointment with your prescribing physician 2 months after a genital reconstructive surgery such as vaginoplasty, vaginoplasty without vaginal cavity, and orchiectomy.

If you are taking masculinizing hormones, you do not need to make a follow-up appointment.

• How do I prepare for surgery?

Once your surgery date has been confirmed, we will provide you with documentation containing all the details required to be well-prepares for your surgical procedure and your stay.

• How do I plan my transportation to and from my procedure?

If you are traveling by train or airplane, a transportation service is available at no additional cost. If you are not hospitalized (day surgery), you must be accompanied at the time of departure.

*If it is impossible for you to be accompanied, please let us know as early as possible so that we may put necessary resources in place.

If you are hospitalized, you must leave your room by 8:00 am on the day of your departure so that we can make it available to the next patient. For this reason, we ask that you plan your flight or train departure for the morning. If you are not hospitalized (day surgery), the nurse will tell you when you can leave the facility.

• I am afraid to experience pain after my surgery. Will I be given medication?

The majority of patients experience pain after surgery. Its intensity varies from one person to another and the experience of pain is unique to each person. To relieve pain, surgeons prescribe a daily medication such as an anti-inflammatory and a non-opioid analgesic. If your pain persists, take a narcotic analgesic in addition to your regular medication. We cannot predict how long the pain will last, but it should decrease in intensity as your healing progresses.

Depending on the type of surgery, your surgeon will, when needed, renew your narcotic analgesic prescription during your medical leave. Should you require more medication, make an appointment with your family doctor.

• Why do I need to stay for a few days at the Asclépiade convalescent home after my surgery?

Your stay at Asclépiade is necessary because you will receive the majority of your care and postoperative treatments there. Your convalescence allows you to recover under 24-hour a day surveillance by the nursing staff. If complications arise, your surgeon will immediately take charge of you. Finally, the nursing staff will also teach you all that you will need to know to continue your care yourself when you return home.

• If my recovery is difficult, can I get psychological support at your hospital?

The nurses at the CMC and Asclépiade can provide frontline psychological support and decide with you if additional support is necessary. We do not have any mental health professionals in place in our facility. It is therefore important to maintain contact with health professionals involved with your care and bring their contact information with you.

• I would like to undergo surgery at GRS Montréal. Should I be accompanied during my stay?

We highly recommend that you be accompanied by a family member or friend during your stay to support and comfort you during this unique event. Our staff will work with you and your companion to create the most positive experience possible. In addition, the presence of a companion during teaching periods can facilitate the understanding and integration of care into your daily routine.

• What are the rules regarding visitors?

At the CMC:

• Visiting hours are from 8 :00 am to 8 :00 pm;
• In order to ensure the rest, comfort, and tranquility of all of our clients, we ask you to limit your visitors to 2 at a time. Young children are not allowed to visit;
• Visitors are not authorized to enter the operating or recovery rooms;
• In order to prevent infections, visitors are not allowed to sit on patients’ beds;
• In order to avoid interference with medical equipment, cellphone use is prohibited between 6:00 am and 5:00 pm. Outside of these hours, we ask that you put your device on vibrate, speak quietly, and avoid long conversations.

At Asclépiade:

• Visiting hours are from 2:00 pm to 8:00 pm;
• In order to respect the privacy of patients and to prevent infections, visitors are prohibited from entering the rooms;
• Cellphones are permitted at all times but we ask that you put your device on vibrate, speak quietly, and avoid long conversations.

• Will I have access to entertainment during my stay?

Yes, each room has its own television, and wireless internet service is offered for free. In order to respect the other patients in convalescence, we ask that you bring a pair of earphones with you for your own personal use.

If you wish, you may bring music, your laptop, books, or other forms of entertainment.

• Will I require the aid of a nurse after my surgery?

Usually, no. All patients who undergo surgery receive a personalized follow-up service by email or telephone to ensure that their recovery, as well as the management of their health, is going well. You will also receive educational guides for your reference at home.

If nursing care at home is required, the Nurse Navigator can make the request for you or communicate with your treating physician about how to ensure the continuity of your care. The GRS Montréal team is always available to work with the health professionals involved in order to facilitate the management of your care.

• Once I am back home after surgery, what should I do if I need help?

Once you are back at home, you can communicate with your surgeons through the nurse at Asclépiade.

In case of medical emergency, you must go to the emergency room of your nearest hospital or call the emergency telephone number in your area. The emergency doctor can communicate with your surgeon through Asclépiade so that you can be cared for properly and effectively. The GRS Montréal team is ready to work in tandem with other health professionals involved in your medical care.

• Can I drive my car after surgery?

For genital surgeries and surgeries of the torso, we recommend that you wait 2 weeks before driving a motor vehicle. After surgery of the torso, you must be able to perform unpredictable arm movements in an unconstrained manner. For genital surgeries, you must avoid placing too much pressure on your genitals, which may cause pain. Once you resume driving, begin with short distances. If you must drive a long distance, make frequent stops to walk a little and to urinate. Walking and emptying your bladder reduces pressure on the genitals.

It is prohibited to drive a motor vehicle after surgery if you are taking narcotic analgesics.

• How long will my convalescence last after surgery and when can I return to work?

For more information about the recovery time involved in each surgery, visit the Surgeries section of our website. Your surgeon can provide you with a sick leave letter for your employer and your insurance company.

*Please note that recovery time depends on the progress of your healing and the type of work that you do. Estimated convalescence times are for informational purposes only. 

• When can I start to swim again after my surgical procedure?

You can resume swimming when your wounds related to your procedure are completely healed. Normally, it is necessary to plan for a complete healing time of about 4 to 6 weeks.

VAGINOPLASTY WITHOUT VAGINAL CAVITY

Vaginoplasty without vaginal cavity is a surgical procedure that provides the most natural external female genitalia possible, but without creating a vaginal cavity.

The decision to undergo a vaginoplasty with or without a vaginal cavity is a personal one, and must be made in accordance with your needs and expectations.

Our team of surgeons uses the same surgical technique as that used in a vaginoplasty, but without constructing a vaginal cavity. Vaginoplasty without vaginal cavity is done in one surgery including the autograft of a neurovascular flap of the glans that will serve to create a sensitive clitoris. By improving this technique, Dr. Brassard has redefined the standards of vaginoplasty, earning GRS Montréal consideration as one of the world’s best centres in the field of male-to-female gender affirming surgery.

Vaginoplasty without vaginal cavity surgery can be performed at the same time as other procedures.

Expected results:

• A clitoris made with the sensitive skin of the glans;
• A clitoral hood;
• A vulva equipped with labia minora;
• Clitoral erogenous zones with the possibility of sexual pleasure.

During the procedure, the surgeon will:

• Remove the scrotal skin;
• Remove the testicles;
• Dissect the internal structures of the penis taking care to separate the urethra, the corpus cavernosum, and at the same time release a flap consisting of blood vessels and nerve endings:
  1. The corpus cavernosa will be removed;
  2. The distal end of the retained flap, in the form of a “custom-made” island, will be removed directly from the glans to form the clitoris. The size of the clitoris can therefore be adjusted according to the patient’s preference. The flap and the clitoris will be positioned and fixed;
  3. The urethra will be dissected; the remaining tissue will be preserved to coat the inside of the labia minora, providing a more natural result than with a skin graft.
• Create the labia majora.

*A vaginoplasty without vaginal cavity is an option if you have had a prostatectomy following prostate cancer. 

Benefits of this surgical technique:

• A surgical technique in one single surgery;
• The use of existing tissue to construct the minutiae of the vulva (labia, clitoris, clitoral hood) eliminates strain on the tissue forming the new genitals.

* Due to multiple factors that are unique to each individual, results may vary from one person to another. Be assured that our surgical team works with each patient individually to achieve the best results possible. In some cases, our surgeons can offer a corrective surgery if certain results do not meet your expectations.

Postoperative care:

During your convalescence, you will be provided with the document Information and Postoperative Care – Vaginoplasty without vaginal cavity. This document contains your surgeon’s instructions and will serve as a guide.

BREAST AUGMENTATION

Male to Female Breast Augmentation

What is male to female breast augmentation?

Today almost every transitioning woman has heard of breast augmentation or has even known someone who has had the surgery. Transitioning women often seek breast augmentation if they desire a larger bust size than what has been achieved through hormone therapy. Selecting a surgeon that is experienced with transgender patients and who is also well trained is the most important part of having surgery. Breast augmentation, technically known as augmentation mammoplasty, is a surgical procedure to enhance the size and shape of a woman’s breast for a number of reasons:

• To enhance the body contour of a woman who, for personal reasons, feels her breast size is too small.
• To achieve better symmetry when breasts are moderately disproportionate in size and shape
• To improve the shape of breasts that are sagging or have lost firmness, often used with a breast lift procedure
• To provide the foundation of a breast contour when a breast has been removed or disfigured by surgery to treat breast cancer
• To improve breast appearance or create the appearance of a breast that is missing or disfigured due to trauma, heredity, or congenital abnormalities

By inserting an implant behind each breast, we are able to increase a woman’s bust line by one or more bra cup sizes.

Are you a candidate for breast augmentation?

Breast augmentation can enhance your appearance and your self-confidence. The best candidates for breast augmentation are women who are looking for improvement, not perfection, in the way they look. If you’re physically healthy and realistic in your expectations, you may be a good candidate. Before you decide to have surgery, think carefully about your expectations and discuss them with ua. At your consultation we will evaluate if you are a good candidate for breast augmentation surgery. We will have a thorough discussion about your desired outcome, along with your past and present health condition. After this appointment you will leave knowing if you are a candidate for breast lift surgery, a clear understanding of how breast augmentation is performed, the recovery, and much more.

How is a breast augmentation performed?

The method of inserting and positioning your breast implant will depend on your anatomy and preferences, and our recommendation. The incision can be made either in the crease beneath the breast, around the areola (the dark skin surrounding the nipple). The choice of incision is based on your own preference in combination with the recommendation given by the Doctor, according to your individual anatomy and the type of breast implant used. Breast augmentation surgery is done under general anesthesia at an accredited surgery center; you will be completely asleep during this procedure. During surgery we will lift your breast tissue and skin to create a pocket, either directly behind the breast tissue (sub-mammary or sub-glandular placement) or may be placed beneath the pectoral muscle and on top of the chest wall (sub-muscular placement). Once the implant is positioned within this pocket, the incisions are closed with sutures, skin adhesive and/or surgical tape. A gauze bandage will be applied over your breasts to help with healing. The surgery usually takes one to two hours to complete.

The Results

For many women, the result of breast augmentation can be satisfying, even exhilarating, as they learn to appreciate their fuller appearance. Your decision to have breast augmentation is a highly personal one that not everyone will understand. The important thing is how you feel about it. If you’ve met your own personal goals, then your surgery is a success. We use dissolvable stitches to close the incisions, which will also be taped for greater support. A surgical bra is recommended, and will be provided for you after the surgery. Your scars will be firm and pink for at least six weeks. After several months, your scars will begin to fade. You’re likely to feel tired and sore for a few days following your surgery, but you’ll be up and around in 24 to 48 hours. You should be able to return to work within a few days, depending on the level of activity required for your job.

What are the risks of breast augmentation?

As with any surgical procedure, mild swelling and discomfort may follow the surgery. Some women have reported alteration in nipple or skin sensation. These symptoms usually disappear within time, but may be permanent in some patients. With any surgery there are incisions, when undergoing breast augmentation however, we are very meticulous about our incision placement and closure technique to give each patient as minimal of a scar as possible. Every person’s ability to heal varies on genetics and physical characteristics. If you’re worried about scarring we will speak with you about many scar-minimizing techniques that can be used after your surgery.

What is the recovery process for breast augmentation?

The recovery process will vary from person to person. After surgery you will return home the same day of surgery. Still, there are some basic precautions and instructions that you can take to help this recovery go as smoothly as possible, including:

• Arrange for someone to help you get around the house and help you with your medication for at least the first 24 hours after your breast augmentation. You may need medication for the pain and to control nausea caused by the pain medication.
• Avoid heavy lifting, contact sports and jogging for up to six weeks.
• Call us immediately if you notice an increase in swelling, pain, redness, drainage, bleeding in the surgical area or if you develop fever, dizziness, nausea or vomiting. Other red flags include shortness of breath, chest pains and unusual heartbeat.
• Wearing a sports bra for 4-6 weeks may be required.

ADAM'S APPLE REDUCTION

Transgender MTF Adam’s Apple Surgery

The Adam’s apple is one of the most characteristically male features on the body. Therefore it is one of the most common and recommended procedures performed in facial feminization. The Adam’s apple is the result of prominent thyroid cartilage that enlarges at puberty. The goal in Adam’s apple reduction surgery is to reduce the prominence of the thyroid cartilage by shaving and removing the excess cartilage. Age, Adam’s apple prominence and proximity to the vocal chords will be the major factors in determining the extent to which the Adam’s apple may be reduced. In some individuals the Adam’s apple may be too large to completely remove, but a tracheal shave can help angle the cartilage to a more feminine angle.

Before Adam’s Apple Reduction Surgery

Prior to Adam’s apple surgery a complete medical history and thorough examination is taken in order to evaluate your general health. Your surgeon will describe the type of anesthesia to be used, the procedure, what results might realistically be expected, and possible risks and complications.

Preoperative instructions are important and include avoiding certain drugs, like aspirin that can cause excess bleeding. Antibiotics will be prescribed to prevent infection. Photographs are taken before and after surgery in order to evaluate the final results.

The Adam’s Apple Reduction Procedure

Adam’s Apple Reduction surgery is usually performed under general anesthesia with the patient asleep. It can be performed in one of two ways:

The more traditional method is making a small incision (about 1 inch) along the natural crease of the neck. The thyroid cartilage is exposed, marked and reduced by shaving at the most prominent area and the upper rim. Once the shaving is complete, the incision is closed with sutures. Surgery lengths will vary depending on the hardness of cartilage, which is usually correlated with age.

If liposuction if performed at the same time, the incision can be placed more inconspicuously under the chin. After the fat is removed, the surgeon can more easily dissect the skin and expose the thyroid cartilage. While this procedure is a little more difficult, it avoids the stigma of a scar indicating a tracheal shave.

After Adam’s Apple Reduction Surgery

The first 24-48 hours after the surgery you many experience some swelling. Some patients have mild voice weakness for the first few days following the surgery, but that usually subsides with time. Icing the throat for the first few days is recommended.

Antibiotics are prescribed to prevent infection. Pain is mild to moderate and is controlled with oral medication. Beware that pain medication can cause nausea and vomiting so do not take it unless needed.

Patients are usually able to return to normal activities within a week although vigorous physical activity is discouraged for several weeks.

Some swelling and discoloration can occur but usually disappear within a few weeks. Scars, which fade significantly with time, are, for the most part, inconspicuous because they are made within the natural creases of the body whenever possible.

Complications connected with this surgery are rare; however, changes in voice may occur in cases of over-dissection. Reducing the Adam’s apple too much may cause injury to vocal cords and it is likely that your voice change will be permanent. This can be avoided by shaving less of the Adam’s apple.

Male to female Voice surgery

What is Vocal Feminization Surgery?

Feminization laryngoplasty, also known as voice feminization surgery is a procedure designed to make a voice box smaller and vocal cords shorter in an attempt to raise the comfortable speaking pitch. This should allow the voice to sound more feminine.

Some surgeons also try to alter the resonance as well by adding in a thyrohyoid elevation at the same time. The thyrohyoid elevation shortens the pharynx (throat) to improve the resonance of the higher pitches.

Who This Surgery is For:

The surgery is intended for patients whose voice pitch is consistently interpreted as male, despite concerted efforts at altering pitch such as speech therapy and training.

For example, a woman might have no problem being identified as female in person, but is still typically perceived as male when on the phone.

The typical patient will be a male who has or is, or may yet be undergoing transgender surgeries and wishes to change the voice to sound more feminine. Many genetic females or intersex individuals could benefit from the procedure as well.

Having a previous voice surgery such as a cricothyroid approximation (CTA) does not preclude performing this procedure. Feminization laryngoplasty might be successful, even if the CTA procedure failed. It also can be used to correct complications from a tracheal shave where the pitch was inadvertently lowered.

Alternatives:

You should try to train your voice to sound female before getting surgery. Trans women Calpernia Addams and Andrea James have created the Transsexual Survival Kit Voice Pack: Finding Your Female Voice, which is highly recommended.

This surgery doesn’t always work and the results aren't always perfect. It is a new procedure that is still being improved upon. It carries with it some significant risks. A more common and traditional surgery would be a CTA.

Another alternative is to reduce the size of the vocal cord with a laser. A thinner vocal cord will vibrate at a higher pitch. Women’s vocal cords are both thinner and shorter than men's vocal cords. The surgery might also increase the tension of the cords from some pulling and retraction after the surgery and reduce the vocal quality.

Pitch elevation in both males and females involves changes in the diameter and length of the throat during speech, so there may be a way to surgically reduce the diameter or length of the throat (or pharynx) that would change the resonance of the voice.

Presurgical Consultation:

Most surgeons will evaluate your larynx with a videoendoscopy and have a PARQ conference with you.

An evaluation and examination of your voice box is essential. During the typical examination your vocal parameters are recorded and your vocal chords may be filmed. The complete examination of your voice usually takes about an hour.

PARQ is an acronym for Procedures, Alternatives, Risks and Questions. It means that your surgeon has discussed with you in full detail the reasons for the procedure, the alternative treatments to the procedure, the risks of the procedure and that you have been given ample time to ask questions and are satisfied with those reasons and answers.

Risks:

The general risks of surgery will be discussed on the informed consent page. The risks specific to this procedure are similar to those for a cricothyroid approximation though there are some additional ones as well.

Granulomas can form on the inside of your voice box. Granulomas can cause a soft whispery voice, depending on where it is located inside the voice box. They might be able to be coughed out, but the surgeon might need to inject them with steroids to make them fall off.

Infections are common after vocal feminization surgery. The infections can range from mild redness, to more prolonged infections that will require surgical removal of the infected area. If your throat swells too much, then you might need a tracheotomy to breathe for a few days.

Surgical Procedure:

The feminization laryngoplasty surgery is performed in an outpatient setting under general anesthesia. Once you are asleep, an incision is made parallel to or in a skin crease of your neck over the Adam’s apple. The front of the voice box is removed which will make the voice box smaller. This also removes the Adam's apple at the same time so it will not be necessary to have a separate tracheal shave procedure.

The vocal cords are then stretched and the front third to half of the cords are removed to shorten them. A tiny metal plate may be placed over the voice box to maintain tension on the vocal cords and also to hold the cartilage together during the healing period. It is a small plate that will remain in place even after everything is healed.

Some surgeons use a thyrohyoid elevation to try raising the voice box in the neck. This shortens the pharynx to feminize a portion of the resonance chamber (pharynx). A thyrohyoid elevation consists of passing sutures around the hyoid bone to hold the voice box in place in a higher position of the neck.

Recovery:

Voice feminization surgery is usually an outpatient procedure, so you should not have to stay in a hospital over night.I have not kept anyone in the hospital overnight. If you have a complication, it is usually an infection or swelling 3 days after surgery. It is recommended for you to stay in the area for a week to make sure that you don't have any problems.

Immediately after vocal surgery, your voice might be deeper than prior to surgery. This is caused by swelling of your voice box. Swollen vocal cords will vibrate at a lower pitch. Your voice might sound quiet, tight or effortful to use. It will usually get worse before it gets better and you may have a roughness that changes over several months. There will be initial pain and discomfort from the procedure. It is common to have a sore throat and to have difficulty with swallowing. Do not expect your voice to be approaching it's new pitch for at least 6 weeks.

Healing Instructions:

You can't use your vocal chords for two weeks after surgery, not even to whisper. There are only a few sutures holding the vocal cords in place and until your body's own scar tissue helps support the procedure, the sutures could pull out.

Sedentary work can be resumed about 3 days after surgery. Speaking can begin gradually after two weeks,but should sill be avoided until after 3 weeks.

Aerobic activity may be resumed after three weeks. You shouldn't lift anything heavy until after one month.

Summary:

Feminization laryngoplasty has more benefits than a criothryoid axproximation, but it also has more risks. It has the potential for a much more female sounding voice. However, with some complications the outcomes have been poor.

FACIAL AND BODY FEMINIZATION

Several feminizing surgical procedures are offered at the Centre Métropolitain de Chirurgie. Some of these procedures can be performed at the same time as another procedure. Talk to your surgeon about the possibilities.

Some of these procedures can be performed at the same time as another procedure. Talk to your surgeon about the possibilities.

Facial surgeries:

• Facial feminization
• Face lift (rhytidectomy)
• Forehead lift (forehead wrinkle reduction)
• Blepharoplasty
• Rhinoplasty
• Otoplasty

Body surgeries:

• Abdominoplasty
• Thigh lift (reshaping of the thighs)
• Liposuction
• Belt lipectomy
• Arm lift

Corrective surgeries

SECONDARY VAGINOPLASTY

A secondary vaginoplasty is for patients who have already undergone a first vaginoplasty and who are unsatisfied with their results.

Expected and desired results:

• Construction of a vaginal cavity or correction of the current vaginal cavity to obtain a satisfactory depth and to be able to engage in sexual relations with penetration.

During this procedure, it is also possible to improve the appearance of the current vulva, notably:

• Improve the definition and accessibility of the clitoris;
• Construct a clitoral hood.

Contact us to learn more about your surgeon’s advice.

Surgical technique used:

• Creation or correction of the vaginal cavity by dissection of the space between the prostate and rectum to a depth of 5 to 6 inches. The prostate is left in place because its removal would cause irreversible incontinence;
• A skin graft is taken from the back, thigh, or buttocks to be grafted inside the vaginal cavity;
• If applicable, implementation of corrections discussed and planned with your surgeon.

Secondary vaginoplasty surgery can be performed at the same time as other procedures.

*Due to multiple factors that are unique to each individual, results may vary from one person to another. Be assured that our surgical team works with each patient individually to achieve the best results possible.

After surgery:

• Specific care: Vaginoplasty requires care that you will integrate into your daily routine for the rest of your life. Following your dilation schedule and maintaining good vaginal hygiene will have a significant impact on the results of your procedure.

GENITAL SCAR REVISION

However, when scars are enlarged, scar revision surgery can be indicated to improve their appearance.

Our surgeons use the most advanced surgical techniques.

Complete healing of the initial surgery, such as vaginoplasty or vaginoplasty without vaginal cavity, can take up to one year. The surgeons at GRS Montreal therefore recommend waiting one year after your initial surgery before undergoing scar revision.

A genital scar revision can be performed at the same time as other corrective surgery or Male to Female surgery.

Expected results:

• Less visible scars.

* Due to multiple factors that are unique to each individual, results may vary from one person to another. Be assured that our surgical team works with each patient individually to achieve the best results possible.

VULVAR RECONSTRUCTION

Vulvar reconstruction surgery can correct various structures of the vulva so that its appearance can be as similar as possible to that of natural female genitalia.

Your surgeon can evaluate with you the areas that can be corrected.

Complete healing of the initial surgery (vaginoplasty or vaginoplasty without vaginal cavity) can take up to one year. The surgeons at GRS Montreal therefore recommend waiting one year after your initial surgery before undergoing vulvar reconstruction.

Vulvar reconstruction can be performed at the same time as other corrective surgery or Male to Female surgery.

Expected results:

• A vulva with an appearance as similar as possible to natural female genitalia.

*Due to multiple factors that are unique to each individual, results may vary from one person to another. Be assured that our surgical team works with each patient individually to achieve the best results possible.

LABIAPLASTY

When the labia majora are too large or are not symmetrical (the same size), a labioplasty allows for the reduction of the labia majora by removing excess tissue.

Complete healing of the initial surgery (vaginoplasty or vaginoplasty without vaginal cavity) can take up to one year. The surgeons at GRS Montreal therefore recommend waiting one year after your initial surgery before undergoing a labioplasty.

Labiaplasty can be performed at the same time as other corrective surgery or Male to Female surgery.

Expected results:

• Less voluminous labia majora;
• More symmetrical labia majora.

* Due to multiple factors that are unique to each individual, results may vary from one person to another. Be assured that our surgical team works with each patient individually to achieve the best results possible.

CORRECTION OF THE CLITORIS

Surgical correction of the clitoris allows the area of the clitoris to be modified in order to make it more visible or more attractive in appearance or easier to access.

Complete healing from the initial surgery (vaginoplasty or vaginoplasty without vaginal cavity) can take up to one year. Therefore, the surgeons at GRS Montréal recommend waiting one year after your initial surgery before undergoing a correction of the clitoris.

A correction of the clitoris can be performed at the same time as other corrective surgery or Male to Female surgery.

Expected results:

• A more attractive appearance of the area of the clitoris;
• Easier access of the clitoral erogenous zone.

* Due to multiple factors that are unique to each individual, results may vary from one person to another. Be assured that our surgical team works with each patient individually to achieve the best results possible.

Female to Male Surgical Options

Removal of the womb (hysterectomy) in F2M Surgery

Types of hysterectomy and Oophorectomy procedures
There are three main ways in which the uterus can be removed from the body: either through an incision in the abdomen, vaginally through an incision in the top of the vagina (sometimes assisted laparoscopically through small incisions in the abdomen), or through a combination of tissue removal through small incisions in the abdomen as well as through the vagina. The type of surgery chosen will depend on the patient's physical limitations as well as the surgeon's expertise.

Some surgeons who perform genital reconstruction surgery (GRS) may wish to do a hysterectomy/oophorectomy at the same time as GRS. If you are considering GRS, you may wish to fully research such options.

Total abdominal hysterectomy (TAH)
This is the removal of the uterus and the cervix via an incision in the abdomen. During the procedure, the surgeon will make an incision, either horizontally or vertically, in the abdominal wall. The abdominal muscles will be spread apart with retractors. The uterus and cervix are cut away from the surrounding ligaments and blood vessels, and then removed by cutting them off at the top of the vagina. The vagina is sewn closed at the top.

The surgical procedure lasts about 1 to 3 hours, and usually involves a hospital stay of 3 to 5 days. Recovery is usually a 6 to 8 week period of restricted activity. The procedure leaves a 4 to 6 inch scar on the abdomen, usually just above the pubic hair line.

Because of the advances in laparoscopic surgical procedures, surgeons will often recommend less invasive procedures such as LAVH or TLH, listed below, if the patient is a good candidate. Laparoscopic procedures generally involve smaller incisions, less scarring, shorter recovery time, and shorter hospital stays than abdominal hysterectomy.

Total Vaginal Hysterectomy (TVH)
This is the removal of the uterus and the cervix via an incision in the vagina; all operating procedures are performed through the vagina. The uterus and cervix are cut away from the surrounding ligaments and blood vessels, and then removed by cutting them off at the top of the vagina. The vagina is sewn closed at the top.

Because there are no incisions made in the abdomen during TVH, the surgeon cannot easily access the abdominal cavity. She/he cannot examine for and remove endometriosis, she/he cannot perform the procedure if adhesions are present, and certain complications may arise if also attempting to remove the ovaries. Additionally, because TVH is performed entirely through the vagina, it is best performed on individuals who have vaginal laxity (i.e. a wide enough and flexible enough vaginal canal, as often seen after childbirth).

The surgical procedure lasts about 1 to 3 hours, and usually involves a hospital stay of 1 to 3 days. Recovery is usually a 6 to 8 week period of restricted activity. This surgery is not recommended if your vaginal canal is restricted, as the surgeon will need space for instruments and for the removal of the organs. For a restricted vaginal canal, your surgeon may recommend TLH as an alternative option.

Laparoscopically Assisted Vaginal Hysterectomy (LAVH) 
This is similar to TVH above, but performed with the aid of laparoscopy. During the procedure, the surgeon makes several small cuts in the abdominal wall to provide access for a laparoscope (a tiny telescopic camera) and other small surgical instruments. The laparoscope is used by the surgeon to see inside the abdomen during the procedure. The surgeon may perform some of the cutting procedures by working through the abdominal incisions, but other surgical procedures will still be performed through the vagina. The uterus and cervix will be mainly removed through a cut at the top of the vagina, and then the vagina is sewn closed.

The surgical procedure lasts about 1 to 3 hours, and usually involves a hospital stay of 1 to 2 days. Recovery is usually a 4 to 6 week period of restricted activity. This surgery is not recommended if your vaginal canal is very restricted, as the surgeon will need space for instruments and for the removal of the organs. For a restricted vaginal canal, your surgeon may recommend TLH as an alternative option.

Total Laparoscopic Hysterectomy (TLH)
Is the removal of the uterus and the cervix by operating through several small cuts in the abdominal wall that provide access for a laparoscope (a tiny telescopic camera) and other small surgical instruments. The uterus is removed by passing the tissue out through the vagina or through one of the small abdominal incisions. Because there is no operating performed through the vagina (though small pieces of tissue can be passed down through it), there is no requirement for a wide vaginal passage, and there are fewer problems with increased urinary incontinence at a later date.

The surgical procedure lasts about 1 to 3 hours, and usually involves a hospital stay of 1 to 2 days. Recovery is usually a 2 to 4 week period of restricted activity. Because there is no requirement for a wide vaginal passage and because this procedure involves less blood loss, lowered risk of urinary incontinence, shorter hospital stay, and shorter recovery time for most patients, TLH can be an excellent choice if it is available. Because TLH is a relatively new procedure, not all surgeons are necessarily skilled in its practice. Be sure to inquire as to your surgeon's direct experience with TLH, or with any type of surgical procedure you are considering.

Bilateral Salpingo Oophorectomy (BSO)
This involves the removal of both ovaries and of both fallopian tubes (bilateral=both sides, salpingo=fallopian tubes, oophor=ovaries, ectomy=removal). For trans men, this procedure will usually be performed at the same time as your hysterectomy. Because the risk of ovarian cancer remains if the fallopian tubes are left behind, both the ovaries and fallopian tubes are usually removed during this procedure.

Risks & Cost
As with any surgical procedure, there are some risks that may occur. These include bleeding, infection, problems from anesthesia, blood clots, or death (rare). Some other problems that have been reported after hysterectomy include irritable bowel syndrome, incontinence, damage to the urethra or bowel, prolapse of the vagina, back pain, or loss of sexual feeling or function. Depending on the type of procedure you undergo, these risks may be more or less common-- speak directly with your surgeon about the risks of the specific procedures you are considering.

The cost of hysterectomy/oophorectomy will vary, but in general will run between $7,000 and $20,000 in the United States (including surgery fees and related hospital/staff fees). Because there is usually a hospital stay after the procedure, and since hospitals charge by the day, this will effect the overall price depending on the duration of the stay.

Hysterectomy is one of the few surgeries that trans men may be able to have covered by insurance, if the procedure is shown to be health-related. If you are experiencing pain or irregular bleeding, or if you have a history of abnormal Pap smears, fibroids, or polyps, you may wish speak with your doctor about the possibility of hysterectomy as a necessary procedure for insurance purposes.

Reasons For Transgender Men To Get a Hysterectomy

There are several different reasons that motivate a transgender man to get a hysterectomy, ranging from preventative health care and the treatment of persistent gynecological conditions, to obtaining correct identification and aligning anatomy with gender identity. Below are the common reasons for trans men to have hysterectomy surgery.

Source: Hysterectomy and Oophorectomy Experiences of Female--to--Male Transgender Individuals

1. If a trans man is at risk for cervical cancer and fails to get regular Pap tests, a hysterectomy is recommended.
2. While there's no conclusive evidence suggesting that Testosterone causes cervical or uterine cancer, the fear of atrophic cancerous cells developing, especially if there's a family history of pelvic cancer, is often cited as a reason for having a hysterectomy.
3. Hysterectomy is used to remove fibroid cysts (non-cancerous tumors), and as a treatment for endometriosis (the growth of the uterine lining outside of the uterus) and breakthrough bleeding, conditions that are commonly reported by trans men.
4. Abdominal pain is also commonly reported by trans men and can suggest hysterectomy. Testosterone causes atrophy of the uterus and vagina, which puts tension on surrounding muscles and ligaments which can cause painful cramping.
5. Another strong indication for hysterectomy is failure to practice safe sex, risking sexually transmitted disease and accidental pregnancy.
6. Many trans men seek out hysterectomy to eradicate the primary source of Estrogen production, to maximize masculinization from Testosterone.
7. Some trans men are required to have a hysterectomy in order to obtain a corrected birth certificate from the jurisdiction in which they were born.
8. Another strong indication for female-to-male hysterectomy is to provide a feeling of wholeness and completeness. While some trans men are not bothered by having a uterus, others find its presence to be an acute source of gender dusphoria, and hysterectomy can help align internal anatomy with external identity.

Hysterectomy Risks & Complications

As with any surgery, there are both short term and long term risks associated with having a hysterectomy. Although hysterectomy is a frequently performed procedure, it should not be underestimated in terms of the potential for complications.

A 2010 study queried participants about the complications they experienced after hysterectomy:

• 25% Experienced post-surgical onset bladder/urinary problems. The most common bladder/urinary problems included increased urinary frequency (14%) and frequent/chronic pain during urination (5%).
• Keloid scarring (10%)
• Infections (8%)
• Adhesions(6%)
• Post-surgical bleeding (3%)

The 2004 eVALuate study compared complication rates between TLH, LAVH and Abdominal Hysterectomy:

Laparoscopic hysterectomy was associated with a significantly higher rate of major complications than abdominal hysterectomy. It also took longer to perform but was associated with less pain, quicker recovery, and better short term quality of life. The trial comparing vaginal hysterectomy with laparoscopic hysterectomy was underpowered and is inconclusive on the rate of major complications; however, vaginal hysterectomy took less time. Source: The eVALuate study

Short Term Risks of Hysterectomy

Adverse reactions: Nausea and vomiting, breathing or heart problems due to anesthesia.

Pain from CO2 gas: At the beginning of surgery, your abdomen is filled with gas to give the surgeon adequate internal visibility of your organs. The CO2 gas can become trapped against the diaphragm causing organ, diaphragm and possibly shoulder pain.

Infection: Wound infection or infection of the bladder, chest, or abdomen may necessitate antibiotic treatment.

Urinary problems: Kidney, bladder and/or urinary tract infection; temporary urinary incontinence or retention, requiring continued use of a catheter.

Hemorrhage: Excessive blood loss during or after surgery which requires blood transfusion.

Blood clots: Can happen in the veins in the leg (Deep vein thrombosis aka DVT) or pelvis. The risk is increased by smoking, inactivity, excess weight and oral contraceptives.

Adjacent organ perforation: Rectal fistula, vesicovaginal fistula or urethral fistula are serious complications that involve an abnormal connection between two spaces and fecal and/or urinary incontinence.

Long Term Risks of Hysterectomy

Urinary Frequency or Incontinence: Can be caused by accidental damage to the pelvic nerves.

Menopausal symptoms: Hot flashes, sleep disturbance, headaches, etc. can occur in trans men, even if the ovaries are left in place (due to decreased blood flow to the ovaries after hysterectomy.)

Reduced sexual satisfaction: In a 2010 study, 6% said that sexual response was worse after hysterectomy.

Prolapse: After hysterectomy, the intestines, bladder and vagina are no longer supported by the endopelvic fascia and can drop, leading to constipation and/or urinary incontinence/inability to control bladder and pain during sex. The risk of prolapse is heightened in those who have given birth, as the pelvic floor muscles are weakened.

Autoimmune disorders: There's little research to rely on, but anecdotal reports about the onset or worsening of autoimmune disorders after hysterectomy are common. (On the flip side, there are also anecdotal reports of improvements in autoimmune disorders post-hysterectomy.)

Adhesions: Internal scar tissue can attach itself to organs and cause pain and other problems.

FTM Hysterectomy Frequently Asked Questions

Pre-Op

I'm a minor. Can I get a hysterectomy done?
Maybe. Because this surgery eliminates the ability to reproduce, many surgeons require patients be at least 21 years of age. However, if you are experiencing symptoms such as pain or heavy bleeding hysterectomy may be medically indicated.

Is hysterectomy a required surgery for trans men who are on Testosterone?
No, hysterectomy is not required. It is not yet known if there is a direct link between long-term Testosterone therapy and incidences of PCOS and ovarian cancer among trans men. In the absence of this definitive information, combined with the difficulties many trans men experience in accessing gynecological services, some experts advocate for complete hysterectomy as part of gender-confirming therapy.

Will I need to spend a night in the hospital after hysterectomy?
Maybe, it will depend on what type of hysterectomy procedure you have and your surgeon's general practices. Many trans men who have a laparoscopic hysterectomy can go home the same day, while those who have an abdominal hysterectomy will have a short hospital stay.

Will I need to do a bowel prep before hysterectomy?
Maybe, it will depend on your surgeon's preferences.

How much pain will I be in after hysterectomy?
The level of pain that you experience will depend on the type of hysterectomy that you have and what organs are removed. Those who have laparoscopic and vaginal hysterectomies can expect moderate pain for 2-3 weeks, while Abdominal Hysterctomy is associated with longer term pain lasting 3-5 weeks, and even longer in some cases. You will be prescribed pain killers for when you leave the surgery center and go home. Many patients are able to transition to regular Tylenol within a week of surgery.

What kind of scarring will I have after hysterectomy?
The scarring you will have after hysterectomy will depend on the type of hysterectomy that you have.

• Vaginal Hysterectomy: No visible scars.
• Minimally invasive laparoscopic procedures: 2-5 small incisions; scarring is very minimal.
• Abdominal Hysterectomy: Long scar on abdomen.

Over time, hysterectomy scars will usually fade but the skin will never look exactly the same. You can improve the appearance of hysterectomy scars by using a silicone scar gel.

Does removal of the cervix lead to prolapse of the bladder, vagina, or rectum?
No. Comparison trials have shown that removing the cervix does not increase the rate of prolapse of the bladder, rectum, or vagina. Further, the studies clearly showed no increase or decrease in complications, recovery time, or readmission to the hospital, whether or not the cervix was removed. There are no medical or sexual advantages to keeping the cervix in place.

Are there ways to reduce the risk of vaginal prolapse?
Before hysterectomy surgery the bladder, urethra, vagina and uterus are all attached to the pelvic walls by a system of connective tissue called the endopelvic fascia. When the uterus is removed an element of this supportive structure is also removed. Suturing the cardinal and uterosacral ligaments to the vaginal cuff as part of hysterectomy is effective in preventing post-hysterectomy vaginal vault prolapse. Patients can also help prevent vaginal prolapse through the pelvic floor exercises, also known as Kegel exercises.

Post-Op

Should I take vitamin D and calcium supplements after hysterectomy to reduce the risk of osteoporosis?
Probably not. While doctors have long prescribed calcium supplements to prevent and treat osteoporosis, a U.S. government advisory group says doses found in dietary supplements don't prevent broken bones. They also concluded that taking 400 IU of vitamin D or less and 1,000 milligrams of calcium seems to slightly increase the risk for kidney stones.

Will I need to continue getting PAP tests after hysterectomy?
No, provided that you had a complete hysterectomy (that included removing the cervix) AND you have no history of cancerous or precancerous cervical cells. If you have a history of cervical cancer, precancerous conditions, HPV infection or immune suppression, you may need to have vaginal vault or cuff smears until you have three documented normal tests in a row. For more information, see the Trans Cervical Health Primer.

Should I lower my Testosterone dose after having a hysterectomy?
It is commonly said that trans men require less Testosterone after hysterectomy and can lower their dosage. However, this is unique to each individual and a 2010 study reported that 56% of trans men surveyed did not change their Testosterone dosage after having a hysterectomy.

When can I resume sexual activities after hysterectomy?
This will depend somewhat on the type of hysterectomy that you have but in general one should wait 6 weeks to have sex after hysterectomy. Be sure to ask your surgeon about this at your consultation.

Will my sex drive be affected by Hysterectomy?
Maybe. Here's what a 2010 study of post-hysterectomy trans men revealed:

• About half of 118 individuals (56%) who answered the question of whether or not their orgasms had changed since surgery said that there was no change.
• About one-quarter (25%) said that sexual response was better.
• 6% said that sexual response was worse.
• The remaining 11% said that it was "different" and reported more complicated experiences.
• Some respondents ascribed the different experience in their orgasm to increased comfort with their body.

When can I have a bath after hysterectomy?
This will depend somewhat on the type of hysterectomy that you have but in general one should wait 6 weeks before having a bath after hysterectomy.

Will I experience surgical menopause after hysterectomy?
Maybe. Menopause occurs when the production of estrogen and progesterone from the ovaries is ceased, either naturally or via surgical removal of the ovaries. Some trans men will experience menopausal symptoms after hysterectomy, like hot flashes, night sweats and sleep disturbance, even though the are taking Testosterone. Menopausal symptoms are uncommon when the ovaries are left in but can still occur as a result of diminished blood supply to the ovaries from the hysterectomy.

Removal of the ovaries (oophorectomy) in F2M Surgery

Oophorectomy (or ovariectomy) is the surgical removal of an ovary or ovaries. In the case of animals, it is also called spaying and is a form of sterilization. The term "castration" is occasionally used in the medical literature instead of oophorectomy.

In the case of humans, oophorectomies are most often performed due to diseases such as ovarian cysts or cancer; prophylacticly to reduce the chances of developing ovarian cancer or breast cancer; or in conjunction with removal of the uterus.

They are also performed on trans men to eliminate the production of estrogen and to stop menstruation, most often in conjunction with a hysterectomy.

The removal of an ovary together with a Fallopian tube is called salpingo-oophorectomy or bilateral salpingo-oophorectomy if both ovaries and tubes are removed. Oophorectomy and salpingo-oophorectomy are not common forms of birth control in humans; more usual is tubal ligation, in which the Fallopian tubes are blocked but the ovaries remain intact. In many cases, surgical removal of the ovaries is performed concurrent with a hysterectomy. The surgery is then called "ovariohysterectomy" casually or "total abdominal hysterectomy with bilateral salpingo-oophorectomy" (sometimes abbreviated TAH-BSO), the more correct medical term. However, the term "hysterectomy" is often used colloquially yet incorrectly to refer to removal of any parts of the female reproductive system, including just the ovaries.

When performed alone (without hysterectomy), an oophorectomy is generally performed by abdominal laparotomy, where a small, telescope-like device, about the width of a pencil, with a light on one end and a magnifying lens on the other—is inserted through a small cut near the navel. An attached camera allows the surgeon to see the abdominal cavity and pelvic organs on a video monitor.

Other small (1/4 to 1/2 inch wide) cuts are made in the abdomen, through which the doctor inserts slender instruments with which to cut and tie off the blood vessels and fallopian tubes. The ovaries are detached and removed through a small incision at the top of the vagina. The ovaries can also be cut into smaller sections and removed through the tiny abdominal incisions. The cuts are all closed with stitches, which will likely leave small scars.

Benefits

Reduced breast cancer risk

Women with a risk of breast cancer, especially those women with mutated BRCA1 and/or BRCA2 genes, have been shown to have a significantly reduced risk of developing breast cancer after prophylactic oophorectomy. In addition, removal of the uterus in conjunction with prophylactic oophorectomy allows estrogen-based hormone replacement therapy to be prescribed to aid the woman through her transition into surgical menopause, instead of mixed hormone hormone replacement therapy, which has a significant contribution to breast cancer as well.

Reduced ovarian cancer risk

Women with a risk of ovarian cancer, especially those women with mutated BRCA1 and/or BRCA2 genes, have been shown to have a significantly reduced risk of developing ovarian cancer after prophylactic oophorectomy. Risk is not reduced to zero, however, because the possibility of developing primary peritoneal cancer, which is basically ovarian cancer that begins outside the ovaries, does persist.

Reduced problems of endometriosis

In rare cases, oophorectomy can be used to treat endometriosis. This is done to remove a source of hormones that fuel uterine lining growth, thus reducing the overgrowth responsible for endometriosis.

Oophorectomy for endometriosis is usually a last-resort surgery, since hormonal agonists such as  are usually prescribed first to alter the hormonal cycle. Oophorectomy for endometriosis is often done in conjunction with a hysterectomy as a final shot at removing all traces of endometriosis in cases where non-surgical treatments such as hormonal agonists have failed to stop the uterine overgrowth.

Risks

Hormonal

Choosing to have this procedure done as part of bottom surgery, will require use of testosterone for the majority of ones life. In the event of detransition, replacement estrogen or a non-hormonal biphosphonates  will be required to prevent osteoporosis.

Longevity Risk

Removal of ovaries causes hormonal changes and symptoms similar to, but generally more severe than, menopause. Women who have had an oophorectomy are usually encouraged to take hormone replacement drugs to prevent other conditions often associated with menopause. Women younger than 45 who have had their ovaries removed face a mortality risk 1.7 times greater than women who have retained their ovaries. Retaining the ovaries when a hysterectomy is performed is associated with greater longevity. However, hormone therapy is commonly believed by many doctors to mitigate the mortality risks of oophorectomy. Mortality risks for trans men who have undergone these procedures have not been adequately researched.

Cardiovascular Risk

When the ovaries are removed a woman is at a seven times greater risk of cardiovascular disease, but the mechanisms are not precisely known. The hormones produced by the ovaries cannot be truly replaced. The ovaries produce hormones a woman needs throughout her entire life, in the quantity they are needed, at the time they are needed, and released directly into the blood stream in a continuous fashion, in response to and as part of the complex endocrine system. This risk is enhanced by the testosterone given as part of HRT for trans men and should be carefully watched.

Bone Density Risk

Some studies have found that increased bone loss or fracture risk is associated with oophorectomy. Reduced levels of testosterone in women is predictive of height loss, which may occur as a result of reduced bone density. Since hormone replacement therapy for trans men adds testosterone the risk of bone density loss is mitigated.

Sexuality Risk

Oophorectomy generally greatly impacts sexuality in ciswomen, reducing or eliminating the ability to have an orgasm, and lowering sexual desire. This reduction is greater than that seen in women undergoing natural menopause. Some of these problems can be addressed by taking hormone replacement. Increased testosterone levels in women are associated with a greater sense of sexual desire, and oophorectomy greatly reduces testosterone levels. This issue is moot for trans men, however, since their hormone replacement therapy adds more testosterone than is lost. Reduction in sexual wellbeing was reported in women who had been given a hysterectomy with both ovaries removed. The oposite has been reported for trans men.

Statistics

According to the Center for Disease Control, 454,000 women in the United States underwent this type of operation in 2004. There are no available statistics as to how many of these procedures were done for trans men.

Removal of the vagina (vaginectomy) in F2M Surgery

Vaginectomy is a surgery procedure that removes the vagina and closes the vaginal opening. Despite having a a reputation as a risky procedure with high blood loss, Vaginectomy is often combined with Metoidioplasty or Hysterectomy. Many Metoidioplasty surgeons believe that Vaginectomy reduces complications and have made the procedure standard when performing urethral lengthening.

What is Vaginectomy?

In the context of Metoidioplasty, Vaginectomy is a Colpectomy plus a Colpocleisis, but the general term Vaginectomy is more commonly used.

• Colpectomy: Removal of the vaginal lining (epithelium)
• Colpocleisis: Fusion of the vaginal walls, which creates support for pelvic organs.

Some surgeons offer partial closure of the vaginal opening in combination with Simple Release and Ring Metoidioplasty but this is not to be confused with Vaginectomy; it is just a partial closure.

Why Do Trans Men Have a Vaginectomy?

• The desire to have the vagina removed and have a male-looking perineum.
• To eliminate the secretions produced by vaginal mucosa.
• To eliminate the need for speculum exams or Pap tests.
• To reduce complications with Urethroplasty.

How Vaginectomy Is Performed?

• Incisions are made inside the vagina and the vaginal mucosa is carefully removed, either with cautery or laser.
• The vaginal walls are sutured together and the vaginal opened is closed.
• Operative time is 2-3 hours.
• Laparoscopic and robot-assisted laparoscopic Vaginectomy are emerging methods.

Is Vaginectomy Safe?

There is very little published data regarding the safety of FTM Vaginectomy, but modern techniques Vaginectomy have made the procedure less risky than previously thought. For example, Doctor, one of the most experienced surgeons in the United States when it comes to FTM gynecological surgery, has perfected his Vaginectomy technique to minimize blood loss.

Vaginectomy Satisfaction Rates

Surgeons at the Institute of Urology London reported that complications with Vaginectomy are few and easy to manage, and that the amount of bleeding is directly related to vaginal length. They also reported a high satisfaction rate among FTM patients.

Can Vaginectomy Reduce Complications with Urethral Lengthening?

Dr. Webb has noted very low rates of complication with urethral lengthening in patients who had Vaginectomy. He believes that eliminating vaginal secretions and improving blood flow to the urethra by fusing the vaginal walls, the urethral junction heals better.

What is Recovery From Vaginectomy Like?

Length of hospital stay, recovery time and time off work all depend on if Vaginectomy was combined with Metoidioplasty or Hysterectomy or done on its own. Some pain is normal but this typically diminishes significantly within two weeks. Restrictions on prolonged sitting, cycling, swimming, hot tubbing, heavy lifting, and sexual activities will also vary based on the procedures done.

Construction of a phallus (phalloplasty) or (metoidioplasty)

A phalloplasty is the construction or reconstruction of a penis. The phalloplasty is a common surgical choice for transgender and nonbinary people interested in gender confirmation surgery. It’s also used to reconstruct the penis in cases of trauma, cancer, or congenital defect.

The goal of a phalloplasty is to build a cosmetically appealing penis of sufficient size that is capable of feeling sensations and releasing urine from a standing position. It’s a complex procedure that often involves more than one surgery.

Phalloplasty techniques continue to evolve with the fields of plastic surgery and urology. Currently, the gold standard phalloplasty procedure is known as a radial forearm free-flap (RFF) phalloplasty. During this procedure, surgeons use a flap of skin from your forearm to build the shaft of the penis.

What happens during a phalloplasty?

During a phalloplasty, doctors remove a flap of skin from a donor area of your body. They might remove this flap entirely or leave it partially attached. This tissue is used to make both the urethra and the shaft of the penis, in a tube-within-a-tube structure. The larger tube is basically rolled up around the inside tube. Skin grafts are then taken from inconspicuous areas of the body, where they will leave no visible scars, and grafted on to the donation site.

The female urethra is shorter than the male urethra. Surgeons can lengthen the urethra and attach it to the female urethra so that urine will flow from the tip of the penis. The clitoris is usually left in place near the base of the penis, where it can still be stimulated. People who can achieve orgasm before their surgery can usually still do so after their surgery.

A phalloplasty, specifically, is when surgeons turn a flap of donor skin into a phallus. But generally, it refers to a number of separate procedures that are often done in tandem. These procedures include:

• a hysterectomy, during which doctors remove the uterus
• an oophorectomy to remove the ovaries
• a vaginectomy or vaginal mucosal ablation to remove or partially remove the vagina
• a phalloplasty to turn a flap of donor skin into a phallus
• a scrotectomy to turn the labia majora into a scrotum, either with or without testicular implants
• a urethroplasty to lengthen and hook up the urethra inside the new phallus
• a glansplasty to sculpt the appearance of an uncircumcised tip
• a penile implant to allow for erection

There is no single order or timeline for these procedures. Many people do not do all of them. Some people do some of them together, while others spread them out over many years. These procedures require surgeons from three different specialties: gynecology, urology, and plastic surgery.

When looking for a surgeon, you may want to look for one with an established team. Before any of these medical interventions, talk to your doctor about fertility preservation and impact on sexual functioning.

Phalloplasty techniques

The difference between the prevailing phalloplasty techniques is the location from which the donor skin is taken and the way in which it is removed and reattached. Donor sites can include the lower abdomen, groin, torso, or thigh. However, the preferred site of most surgeons is the forearm.

Radial forearm free-flap phalloplasty

The radial forearm free-flap (RFF or RFFF) phalloplasty is the most recent evolution in genital reconstruction. In a free flap procedure, the tissue is completely removed from the forearm with its blood vessels and nerves intact. These blood vessels and nerves are reattached with microsurgical precision, allowing blood to flow naturally to the new phallus.

This procedure is preferred to other techniques because it provides excellent sensitivity along with good aesthetic results. The urethra can be constructed in a tube-within-a-tube fashion, allowing for standing urination. There is room for the later implantation of an erection rod or inflatable pump.

The chances of mobility damage to the donor-site are also low, however skin grafts to the forearm often leave moderate to severe scarring. This procedure is not ideal for someone worried about visible scars.

Anterior lateral thigh pedicled flap phalloplasty

The anterior lateral thigh (ALT) pedicled flap phalloplasty is not the leading choice of most surgeons because it results in a much lower level of physical sensitivity in the new penis. In a pedicled flap procedure, the tissue is separated from the blood vessels and nerves. The urethra can be restructured for standing urination, and there is ample room for a penile implant.

Those who have undergone this procedure are generally satisfied, but report low levels of erotic sensitivity. There is a higher rate of urinary and other complications with this procedure than with RFF. The skin grafts can leave significant scaring, but in a more discrete place.

Abdominal phalloplasty

The abdominal phalloplasty, also called the supra-pubic phalloplasty, is a good choice for trans men who don’t require a vaginectomy or a restructured urethra. The urethra will not go through the tip of the penis and urination will continue to require a seated position.

Like the ALT, this procedure does not require microsurgery, so it is less expensive. The new phallus will have tactile, but not erotic sensation. But the clitoris, which is preserved in its original location or buried, can still be stimulated, and a penile implant can allow for penetration.

The procedure leaves a horizontal scar stretching from hip to hip. This scar is easily hidden by clothing. Because it does not involve the urethra, it is associated with fewer complications.

Musculocutaneous latissimus dorsi flap phalloplasty

A musculocutaneous latissimus dorsi (MLD) flap phalloplasty takes donor tissue from the back muscles underneath the arm. This procedure provides a large flap of donor tissue, which allows surgeons to create a larger penis. It is well-suited for both a restructuring of the urethra and the addition of an erectile device.

The flap of skin includes blood vessels and nerve tissue, but the single motor nerve is less erotically sensitive than the nerves connected with RFF. The donor site heals well and is not nearly as noticeable as other procedures.

Risks and complications

Phalloplasty, like all surgeries, comes with the risk of infection, bleeding, tissue damage, and pain. Unlike some other surgeries, however, there is a fairly high risk of complications associated with phalloplasty. The most commonly occurring complications involve the urethra.

Possible phalloplasty complications include:

• urethral fistulas
• urethral stricture (a narrowing of the urethra that obstructs urinary flow)
• flap failure and loss (the death of the transferred tissue)
• wound breakdown (ruptures along the incision lines)
• pelvic bleeding or pain
• bladder or rectal injury
• lack of sensation
• prolonged need for drainage (discharge and fluid at wound site requiring dressings)

The donation site is also at risk for complications, these include:

• unsightly scarring or discoloration
• wound breakdown
• tissue granulation (red, bumpy skin at wound site)
• decreased mobility (rare)
• bruising
• decreased sensation
• pain

Recovery

You should be able to go back to work about four to six weeks after your phalloplasty, unless your job requires strenuous activity. Then you should wait six to eight weeks. Avoid exercise and lifting during the first few weeks, although taking a brisk walk is fine. You will have a catheter in place for the first few weeks. After two to three weeks you can start to urinate through the phallus.

Your phalloplasty may be broken into stages, or you may have the scrotoplasty, urethral reconstruction, and glansplasty simultaneously. If you separate them, you should wait at least three months between the first and second stages. For the final stage, which is the penile implant, you should wait for about one year. It is important that you have full feeling in your new penis before getting your implant.

Depending on which type of surgery you had, you may never have erotic sensation in your phallus (but you can still have clitoral orgasms). It takes a long time for nerve tissue to heal. You may have tactile sensation before erotic sensation. Full healing can take up to two years.

Aftercare

• Avoid putting pressure on the phallus.
• Try to elevate the phallus to decrease swelling and improve circulation (prop it up on a surgical dressing).
• Keep incisions clean and dry, reapply dressings, and wash with soap and water as directed by your surgeon.
• Do not apply ice to the area.
• Keep the area around drains clean with a sponge bath.
• Do not shower for the first two weeks, unless your doctor tells you otherwise.
• Do not pull at the catheter, as this could damage the bladder.
• Empty the urine bag at least three times per day.
• Do not try to urinate from your phallus before you are supposed to.
• Itching, swelling, bruising, blood in the urine, nausea, and constipation are all normal in the first few weeks.

Questions to ask your surgeon

• What is your preferred phalloplasty technique?
• How many have you done?
• Can you provide statistics about your success rate and the occurrence of complications?
• Do you have a portfolio of postoperative pictures?
• How many surgeries will I need?
• How much could the price increase if I have complications that require surgery?
• How long will I need to stay in the hospital?
• If I’m from out of town. How long after my surgery should I stay in the city?

Outlook

While phalloplasty techniques have improved over the years, there is still no optimal procedure. Do a ton of research and talk to people in the community before making a decision about which type of bottom surgery is right for you. There are alternatives to phalloplasty, including packing and a less risky procedure called a metoidioplasty.

REQUENTLY ASKED QUESTIONS

Female to Male FAQ | Phalloplasty

• Can I procreate (father a child) after having phalloplasty?

No, this surgery will not allow you to father a child. The main objective of this surgery is to obtain the most natural as possible male external genitals. To have children, your body needs internal male structures like testes, where sperm is created, and a prostate, which makes secretions of male seminal fluid possible.

• Which methods are used to have biological children?

Depending on your goals and expectations, your doctor will be able to provide you with information and resources. Discuss your options with your doctor before surgery.

• What preparations are involved in having phalloplasty surgery?
  • Hysterectomy including removal of the cervix (at least 6 months before the procedure);
  • Permanent hair removal on the donor arm by laser and/or electrolysis (must be completed before the procedure);
  • Smokers are not candidates for phalloplasty. If you smoke, you must stop using tobacco and products derived from tobacco at least 6 months before and after surgery.

These conditions are essential; without them, surgery will be postponed.

• Why do I have to remove the hair on my forearm?

The skin of the forearm will be used to construct the phallus. Removing the hair from the forearm is therefore necessary, otherwise:

• hairs may grow insidethe urethra and cause complications;
• hairs may grow on the penis. In this case, it is possible to continue hair removal treatments once your wounds have completely healed.

During your preoperative appointment, your surgeon will confirm which arm’s skin will be used for surgery and will provide you with more information about the area to remove hair from. Following this appointment, begin your permanent hair removal treatments as soon as possible.

*If you wish, you can begin now to consult with an aesthetician to find out which permanent hair removal treatments works best for you, as well the estimated time to complete the treatment. You will then have this information with you during your preoperative consultation with your surgeon.

• I currently have tattoos on one or both arms. Am I still eligible for phalloplasty?

Yes, the surgery can still be performed despite the presence of tattoos. However, these tattoos risk being found on the penis after surgery. The preoperative consultation is the appropriate time to discuss with your surgeon what options are available to you.

• How can I know which forearm (donor arm) will be used for the construction of my penis?

The skin is usually taken from the non-dominant arm unless you present a medical reason not to, or if you have tattoos that you do not want on your penis. During your preoperative appointment, your surgeon will perform a painless test to determine which arm will be the best donor and go over the alternatives with you.

• Before surgery, should I work out to strengthen the muscles in my forearm ?

No, exercising the forearm before surgery will have no beneficial effect on the surgery, or on you postoperative recovery. It is, of course, important to maintain good overall fitness.

After surgery, you will have to perform specific exercises on the operated forearm to promote rapid and maximum recovery. The care team will inform you about these exercises and their frequency of execution.

• Will I have less feeling in my arm after surgery?

Because the nerves will be affected, the donor arm will no longer have the same sensitivity after surgery at the site of the graft. It is therefore important after surgery to pay particular attention to that region as the sensation of pain after an injury and the perception of temperature variations will be altered.

• Why do I have to wear a compression sleeve on my arm after surgery?

The compression sleeve helps reduce the appearance of scars on the donor arm. Once the wounds on the arm are completely healed, you will have to wear the compression sleeve 24 hours a day except in the shower, for a period of about 1 year. A medical prescription for this will be given to you during your recovery at Asclépiade.

• Can I tattoo the donor arm after surgery?

Yes, it is possible to get a tattoo on the operated arm about 1 year after surgery.

• Can I choose the length and size of my penis?

The length and size of your penis are determined according to the thickness and length of the skin of the forearm. Your surgeon will give you more information about this subject during your preoperative consultation.

• Can I undergo a phalloplasty without proceeding with the closure of my vagina?

No, it is not possible to have a complete phalloplasty without a vaginectomy because the tissues of the vagina are necessary for the construction of the urethra.

*If a vaginectomy is not performed, only the phallus can be constructed. It will then be impossible to construct the urethra that would allow you to urinate standing up or to construct a scrotum with a masculine appearance.

• Do I have to stop taking my testosterone before or after surgery?

No, you can continue taking your testosterone according to your regular schedule.

• Do I have to remove the sutures after surgery?

Two types of sutures are used. The first will be removed by a nurse or doctor 3 weeks after your surgery. The other sutures are “dissolvable stiches” and take 30 to 90 days to dissolve completely.

• Will I be able to have an orgasm after phalloplasty?

Yes, because the nerves of the clitoris will be released and freed during surgery, creating the possibility that they grow into the phallus. The clitoris is preserved and buried at the base of the phallus. Therefore, you will retain your sensibility allowing for sexual pleasure in this area, and possibly also on the phallus.

Nerve regeneration is significantly influenced by your age and lifestyle habits, such as smoking. The younger and healthier you are, the better the chances for nerve regeneration are. In the case where the nerves do not develop, the clitoris can still be stimulated in its new location at the base of the phallus. Your ability to achieve orgasm after phalloplasty remains essentially the same as before surgery.

• Will I be able to ejaculate after my surgery?

No, because internal male structures, such as the prostate, seminal vesicles, and glands are absent. However, a clear fluid from the Skene’s glands (preserved during surgery) may flow from the urethra in an amount that varies from one person to another.

• Will I be able to ejaculate after my surgery?

No, because internal male structures, such as the prostate, seminal vesicles, and glands are absent. However, a clear fluid from the Skene’s glands (preserved during surgery) may flow from the urethra in an amount that varies from one person to another.

• Can I choose the length of my penile implant before having surgery to insert it?

The penile implant is available in different lengths, but will be chosen by your surgeon in the operating room according to the length of your phallus.

• After the insertion of my penile implant, will I be able to have sexual relations with penetration?

Yes, you can have sexual relations with penetration about 6 weeks after surgery as you will have satisfactory rigidity of the phallus. It is important to note that the penis will not grow in length and will not rise as much during an erection as in biological men.

• What is the lifespan of the testicular and penile implants?

The implants can be left in place as long as no complications arise. If you do have a problem, it will be important to contact your surgeon.

Facial Hair Transplant - Beard and Mustache

Masculinization – FTM Transgender Hair TransplantDr. Anderson understands that in your journey to FTM transition, you want to look exactly how you feel. At the Anderson Center for Hair, we have hair transplant specialists that understand the subtle aesthetic differences between masculine and feminine hair. For one thing, did you know that male and female hairs tend to grown in different directions? Our surgeons will keep the most intricate details in mind when crafting your new, masculine look through a hair transplant. When it comes to becoming the person you’ve always wanted to be, you deserve only the most natural-looking, artistic results.

FTM Transgender Hairline Revision

One aesthetic difference between men and women are their hairlines; men tend to have hairlines that form an M shape, meaning it has high corners with a slight dip in the middle.

Using follicular unit extraction, the linear method, or the  robotic system, our surgeons can help FTM transgender patients turn their hairline into a more masculine one. Because of our surgeons’ advanced technique and surgical artistry, you’ll be sure that your hairline revision will look as natural and possible—with none of that artificial “doll hair” look commonly associated with hair transplants of the past.

Facial Masculinization – Transgender Hair Transplant

Facial hair growth: is there a bigger symbol of masculinity and virility? Recent celebrities and cultural trends have made beards and mustaches the most popular accessories for men. If you’re a transgender man, then you know that hormone treatments can help immensely with growing facial hair. Unfortunately, your facial hair might seem sparse and underdeveloped.

Thankfully, a hair transplant can give our FTM patients fuller, thicker looking facial hair, including eyebrows, beards, goatees, mustaches, and sideburns. Our surgeons will plan the transplants in a precise pattern, so that your facial hair will look as full and strong as possible.

Chest Hair Transplant for FTM

Are you a transgender man looking forward to having a hairy chest? One of the wonders of a hair transplant is that it works with body hair, too. You can get a hair transplant for your chest and finally join the 1970s hair revival happening right now! It’s not just aesthetics, either, a hairy chest can also be useful for covering unsightly scarring from top surgery.

Mastectomy

Elective cosmetic mastectomy, or “top surgery”, is a procedure designed to remove unwanted breast tissue in order to create a more masculine chest appearance. Alongside hormone therapy, top surgery is typically one of the first steps for patients who are transitioning from female to male; this may also be the only surgical procedure undergone by many transmen.  Patients who opt for cosmetic mastectomy can expect to experience a number of benefits, including a greater congruence between their outside appearance and experienced gender, improved self-esteem and self-image, and an increased ability to blend-in society as a man.

There are a number of surgical techniques that may be utilized to accomplish the desired breast tissue removal. The most common technique is called a “bilateral mastectomy with free nipple grafts.”  This technique allows for the removal of essentially all of the breast tissue (including milk ducts) and excess skin, along with proper placement and downsizing of the nipples. This technique is utilized most frequently because the majority of patients present with a combination of excess skin and a naturally low nipple position.

Types of mastectomy FTM Top Surgery

Double Incision with Free Nipple Grafts

With Double Incision Top Surgery, horizontal incisions are made along the top and bottom of the chest muscles and breast tissue, as well as the nipple and areola, are removed. The top and bottom incisions are brought together and sutured, with the resulting scar line running under the pectoral muscles, following the natural contour. Smaller areolas and nipples, created from native areola tissue, are grafted on.

Double Incision Top Surgery is an outpatient procedure done under general anesthesia that takes approximately 1-3 hours.

Pros & Cons: Double Incision Top Surgery produces excellent male contour with areolas and nipples appropriately sized and positioned. However, patients should not expect sensation to return in the areola or nipple because the nerves are cut when the original areola and nipple are removed.

Who’s a Good Match: Trans men with medium to large chests and low skin elasticity, and without concern for areola/nipple sensitivity.

Inverted-T Top Surgery, aka. T-Anchor

With Inverted-T Top Surgery,  horizontal incisions are made along the top and bottom of the chest muscles as with Double Incision. Breast tissue is removed but the areola and nipple are not removed. Instead, an additional vertical incision is made on each side, from the areola down to the incision below the chest muscles. This extra incision allows the areola and nipple to be reduced and repositioned appropriately without severing nerves, thus largely preserving sensation.

Inverted-T Top Surgery is an outpatient procedure done under general anesthesia that takes approximately 1-3 hours.

Pros & Cons: Inverted-T Top Surgery produces excellent male contour with areolas and nipples appropriately sized, positioned and having sensation. However, patients need to be comfortable with having the two extra vertical incisions.

Who’s a Good Match: Trans men with medium to large chests and low skin elasticity, who would like to retain areola and nipple sensation.

Peri-areolar Top Surgery

With Peri-Areolar Top Surgery, two circular incisions are made around the areolas. Breast tissue and the “donut” ring of tissue between two two incisions is removed. The areolas and nipples may be resized. Next, the chest skin is pulled together toward the areolas and sutured around the edges (similar to a drawstring purse.) Like Inverted-T, the areola and nipple are not removed, but resized and repositioned, resulting in largely retained sensation.

Peri-areolar Top Surgery is an outpatient procedure done under general anesthesia that takes approximately 1-3 hours.

Pros & Cons: Peri-Areolar Top Surgery produces excellent male contour with areolas and nipples appropriately sized, positioned and having sensation. Additionally, scarring is minimal as incisions follow the natural outline of the areolas. However, revisions are often required, such as additional liposuction.

Who’s a Good Match: Trans men with medium to small chests and good skin elasticity, who would like to retain areola and nipple sensation.

Keyhole Top Surgery

With Keyhole Top Surgery, semi-circular incisions are made at the base of the areolas. Breast tissue is removed. The nipples may be resized. Because the areola and nipple are not removed, sensation is largely retained.

Keyhole Top Surgery is an outpatient procedure done under general anesthesia that takes approximately 1-3 hours.

Pros & Cons: Keyhole Top Surgery produces excellent male contour, with areola and nipple sensation. Additionally, scarring is minimal as incisions follow the natural outline of the areolas. However, revisions are often required, such as additional liposuction and areola/nipple reduction.

Who’s a Good Match: Trans men with small chests and good skin elasticity, who would like to retain areola and nipple sensation.

METOIDIOPLASTY

When it comes to lower surgery, transgender and nonbinary people who were assigned female at birth (AFAB) have a few different options. One of the most common lower surgeries that is routinely performed on AFAB trans and nonbinary people is called metoidioplasty.

Metoidioplasty, also known as meta, is a term used to describe surgical procedures that work with your existing genital tissue to form what is called a neophallus, or new penis. It can be performed on anyone with significant clitoral growth from the use of testosterone. Most doctors recommend being on testosterone therapy for one to two years before having metoidioplasty.

What are the different types of metoidioplasty?

There are four basic types of metoidioplasty procedures:

Simple release

Also known as simple meta, this procedure consists only of the clitoral release — that is, a procedure to free the clitoris from surrounding tissue — and doesn’t alter the urethra or vagina. Simple release increases the length and exposure of your penis.

Full metoidioplasty

Surgeons who perform full metoidioplasty release the clitoris and then use a tissue graft from the inside of your cheek to link the urethra with the neophallus. If desired, they may also perform vaginectomy (removal of the vagina) and insert scrotal implants.

Ring metoidioplasty

This procedure is very similar to full metoidioplasty. However, instead of taking a skin graft from the inside of the mouth, the surgeon uses a graft from the inside of the vaginal wall combined with the labia majora in order to connect the urethra and the neophallus.

The advantage to this procedure is that you’ll only have to heal at one site as opposed to two. You also won’t experience complications that may arise from surgery in the mouth such as pain while eating and decreased production of saliva.

Centurion metoidioplasty

The Centurion procedure releases the round ligaments that run up the labia from the labia majora, and then uses them to surround the new penis, creating extra girth. Unlike other procedures, Centurion doesn’t require that a skin graft be taken from the mouth or from the vaginal wall, meaning there is less pain, less scarring, and fewer complications.

What is the difference between metoidioplasty and phalloplasty?

Phalloplasty is the other most common form of lower surgery for AFAB trans and nonbinary people. While the metoidioplasty works with existing tissue, phalloplasty takes a large skin graft from your arm, leg, or torso and uses it to create a penis.

Metoidioplasty and phalloplasty each have their own unique benefits and disadvantages.

Pros and cons of metoidioplasty

Here are some of the pros and cons of metoidioplasty:

Pros

• fully functioning penis that can become erect on its own
• minimal visible scarring
• fewer surgical procedures than phalloplasty
• can also have a phalloplasty later if you choose
• Shorter recovery time
• significantly less expensive than phalloplasty, if not covered by insurance: ranges from $2,000 to $20,000 versus $50,000 to $150,000 for phalloplasty

Cons

• new penis relatively small in both length and girth, measuring anywhere from 3 to 8 cm in length
• may not be capable of penetration during sex
• requires use of hormone replacement therapy and substantial clitoral growth
• may not be able to urinate while standing

How does the procedure work?

The initial metoidioplasty surgery can take anywhere from 2.5 to 5 hours depending on the surgeon and on which procedures you choose to have as part of your metoidioplasty.

If you’re seeking out simple meta only, you’ll likely be placed under a conscious sedation, meaning that you’ll be awake but mostly unaware during the surgery. If you’re having a urethral lengthening, hysterectomy, or vaginectomy performed as well, you’ll be placed under general anesthesia.

If you choose to have scrotoplasty, the doctor may insert what are known as tissue expanders into the labia during the first procedure in order to prepare the tissue to accept the larger testicle implants during a follow-up procedure. Most surgeons wait three to six months to perform the second surgery.

Most doctors perform metoidioplasty as an outpatient surgery, meaning you’ll be able to leave the hospital on the same day that you have the procedure. Some doctors may request that you stay overnight following your surgery.

Results of and recovery from metoidioplasty

As with any surgery, the recovery process will vary from person to person and from procedure to procedure.

While recovery times vary somewhat, you’re likely to be out of work for at least the first two weeks. As well, it’s generally recommended that you don’t do any heavy lifting for the first two to four weeks following surgery.

In general, doctors typically advise against travel between 10 days to three weeks after the procedure.

Apart from the standard issues that may arise from having surgery, there are a few potential complications you may experience with metoidioplasty. One is called a urinary fistula, a hole in the urethra that can cause leakage of urine. This can be repaired surgically and in some instances may heal itself without intervention.

The other potential complication if you’ve chosen scrotoplasty is that your body may reject the silicone implants, which may result in needing to have another surgery.

Optional additional procedures

There are several procedures that can be performed as a part of metoidioplasty, all of which are completely optional. Metoidioplasty.net, a useful resource for those interested in pursuing metoidioplasty, describes these procedures as follows:

Clitoral release

The ligament, the tough connective tissue that holds the clitoris to the pubic bone, is cut and the neophallus is released from the clitoral hood. This frees it from the surrounding tissue, increasing the length and the exposure of the new penis.

Vaginectomy

The vaginal cavity is removed, and the opening to the vagina is closed.

Urethroplasty

This procedure reroutes the urethra up through the neophallus, allowing you to urinate from the neophallus, ideally while standing up.

Scrotoplasty/testicular implants

Small silicone implants are inserted into the labia to achieve the look and feel of testicles. Surgeons may or may not suture the skin from the two labia together to form a joined testicular sac.

Mons resection

A portion of the skin from the mons pubis, the mound just above the penis, and some of the fatty tissue from the mons are removed. The skin is then pulled upward to shift the penis and, if you choose to have scrotoplasty, the testicles further forward, increasing the visibility of and access to the penis.

It’s entirely up to you to decide which, if any, of these procedures you would like to have as a part of your metoidioplasty. For instance, you may wish to have all of the procedures performed, or you may wish to undergo the clitoral release and urethroplasty, but retain your vagina. It’s all about making your body align best with your sense of self.

How do I find the right surgeon for me?

It’s important to do your research and figure out which surgeon is the best fit for you. Here are some factors that you may want to consider when choosing a surgeon:

• Do they offer the specific procedures I want to have?
• Do they accept health insurance?
• Do they have good reviews for their results, instances of complications, and bedside manner?
• Will they operate on me? Many doctors follow the World Professional Association for Transgender Health (WPATH)standards of care, which requires that you have the following:
  • two letters from medical professionals recommending you for surgery
  • presence of persistent gender dysphoria
  • at least 12 months of hormone therapy and 12 months of living in the gender role congruent with your gender identity
  • age of majority (18+ in the United States)
  • ability to make informed consent
  • no conflicting mental or medical health issues (Some doctors won’t operate on persons with a BMI of over 28 under this clause.)

What is the outlook after surgery?

The outlook after metoidioplasty is generally very good. A 2016 survey of several metoidioplasty studies in the journal Plastic and Reconstructive Surgery found that 100 percent of people who undergo metoidioplasty retain erogenous sensation while 51 percent are able to achieve penetration during sex. The study also found that 89 percent were able to urinate while standing up. While the researchers argue that further studies will be necessary to improve the accuracy of these results, the initial findings are very promising.

If you wish to have lower surgery that is affordable, has minimal complications, and offers great results, metoidioplasty might be the right option for you to align your body with your gender identity. As always, take time to do your research to figure out which lower surgery option will help you to feel like your happiest, most authentic self.

TESTICULAR IMPLANTS

Testicle Implants

Scrotoplasty

Scrotoplasty is the construction of a testicle implant laden scrotal sac, also known as testicle implants. This procedure can be combined with a Simple Meta or done as a separate procedure. Scrotoplasty can also be performed in conjunction with the Ring Meta (RM) although not yet performed at the original procedure. Patients are asked to wait 3 months after RM to have the implants placed due to potential strain on the original incisions of the Ring Meta and urethral extension. The second procedure also allows Dr. Bowers to repair any potential leak or fistula when the testicles are placed.

Procedure

Scrotoplasty is performed while under general anesthetic normally. The original incisions of the Simple Meta allow the implants to be placed through a single incision hidden in the midline between the testicles (as it is in natal males!). If performed as separate procedure, two small nick incisions along each labia minora are continued in to the deep space beneath the labia majora. The space in the labia minora is mostly fatty and leaves ample space for manual expansion (not requiring tissue expanders). The implant is soaked in antibiotic solution and placed. The layers are sewn back over with dissolvable suture and the procedure completed.

The implants are made of solid, medical grade silicone and are imported from Brazil. Hence: Brazil nuts. They range in size from 1 to 4 (small-medium-large-extra large). Also called huevos. Dr. Bowers has examples of each and will show and discuss size options with patients prior to surgery so that a joint decision is made in choosing size-appropriate testicles. Most patients choose medium or large implants.

Postoperative course

Patients typically do well with scrotoplasty although can experience expulsion due to the body rejecting the implants as foreign bodies. This rejection, were it to occur, would happen within the first 3 weeks although Dr. Bowers has taken care of clients of Dr. Biber and others who have experienced rejection of the implants years after insertion. This is an unlikely scenario however, decidedly rare. While some surgeons advocate prior tissue expanders to allow the skin to stretch while the implant is adjusting to its new location, Dr. Bowers’ experience favors a one-stage procedure with ample stretching of the skin that eliminates the immediacy and cost of tissue expanders.

PENILE IMPLANT

Penile implants for erectile dysfunction have been been continually improved and refined over the last 40 years. More than 300,000 cis gender and trans gender men have had penile implant surgery, with approximately 20,000 penile implant surgeries a year. ¹

Penile implants provide an erection by serving as a replacement for the spongy tissue (corpora cavernosum) inside the penis that normally fills with blood during an erection. They come in a variety of diameters and lengths.

Penile implant surgery is typically performed at stage 2 or 3 of a multi-stage phalloplasty (a minimum of nine months following stage 1.) Recovery time is typically 6 to 8 weeks. Patients can resume sexual activity after physician consultation.

Note On Terminology: Penile implants are also known as penile prosthetics. However a penis “prosthetic” or “prosthesis” commonly refers to a non-surgical “packer” — a polymer or silicone penis that’s worn in a harness or affixed with medical adhesive. Similarly, “erectile device,” which is also sometimes used interchangeably with “penile implant,” can refer to external devices that assist with erections via vacuum pressure, vascular constriction, nerve stimulation, stretching, etc. This article will use the term “penile implant” exclusively to describe those penile prosthetic devices that are surgically implanted.

TYPES OF PENILE IMPLANTS

There are three basic kinds of penile implants used in FTM phalloplasty: the non inflatable or semi-rigid implant (malleable and non-malleable), the 2-piece inflatable implant, and the 3-piece inflatable implant.

Non Inflatable Penis Implants

(Includes semi-rigid malleable and non-malleable rods.)

One or two bendable and “positionable” rods are inserted into the penis. The rods have an outer coating of silicone and inner stainless steel core or interlocking plastic joints. Non inflatable (or semi-rigid) implants are always firm. They can be bent into different positions for erect and flaccid states. These implants are used the least of all types, in approximately 10% of cases.²

How it works: For an erection, simply bend the penis in the erect position. To end the erection, bend the penis down. Erections can be of various degrees depending on how the penis is bent.

Pros:

• Easy to use: bend it up for an erection and bend it down when not in use.
• Totally concealed in body
• Simplest penile implant procedure
• Least expensive
• With fewer mechanical parts, these implants can last more than 20 years.

Cons:

• Having a permanent semi-erection can feel and look awkward

2-Piece Inflatable Penile Implants

Inflatable penile implants have two cylinders in the shaft of the penis, a reservoir that holds salt water, and a hydraulic pump to move the salt water from the reservoir to the cylinders, providing an erection.

The release valve on the pump drains the salt water out of the cylinders and back into the reservoir.

A 2-piece inflatable implant has the reservoir at the beginning of the cylinders (at the base of the penis) and the pump and release valve in the scrotum. These are used in about 15% of cases.³

How it works: Gently squeeze the concealed pump in the scrotum several times. This moves the saline solution from the reservoir into the cylinders. As the cylinders fill, the penis becomes erect and firm. To end the erection, gently bend the penis down for 6-12 seconds. This transfers fluid back into the reservoir.

Pros:

• Easy to use: pump it up for an erection, bend to deflate.
• Totally concealed in body
• Simplest inflatable penile implant procedure, least expensive surgery and implant.
• More easily concealed under clothing than semi-rigid/non inflatable implant

Cons:

• Requires some manual dexterity to inflate
• Because only a small amount of fluid is transferred into the cylinders to obtain an erection, the penis is not as rigid as with a multi-component 3-piece inflatable penile implant.
• The pump can be felt more in the scrotum to sex partners compared to the softer pump of the 3-piece inflatable implant

3-Piece Inflatable Penile Implants

A 3-piece inflatable implant has the cylinders in the penis, the reservoir in the belly, and the pump and release valve in the scrotum. Compared to 2-piece inflatable implants, the reservoir in this type of implant is larger and separate from the cylinders. These are the most common of the penile implants, used in approximately 75% of cases.⁴

How it works: Gently squeeze the concealed pump in the scrotum several times. This moves the saline solution from the reservoir into the cylinders. As the cylinders fill, the penis becomes erect and firm. To end the erection, simply press a “deflation site” on the pump. Deflating the cylinders transfers the fluid back to the reservoir and the penis becomes flaccid.

Pros:

• Most closely resembles the process and “feel” of a non-assisted erection
• Easy to use: pump it up for an erection, press the release valve to deflate
• Easier to inflate than a 2-piece device due to larger, softer pump
• Provides better rigidity of the two inflatable devices
• Provides the best flaccidity of all implants when not in use
• Creates the least amount of pressure on penile flesh when not in use, lessening risk of deterioration and thinning
• Often more reliable than 2-piece penile implants
• Totally concealed in body
• More easily concealed under clothing than semi-rigid/non inflatable implant

Cons:

• Requires some manual dexterity to inflate
• Most involved implant surgery, most expensive surgery and implant.
• More mechanical parts translates into a higher chance of mechanical failure compared to other implants. Can last as little as 3 years before needing replacement, though research has indicated that they can last 10-15 years.
• Patients do not typically see any increase in length or girth due to the thickness of the flaps used to create the phallus
• Highest complication rate. Most centers in Europe have stopped using this implant because, in some series, 50% of implants needed to be removed.

FACTORS IN CHOOSING A PENILE IMPLANT

Choosing a type and brand of penile implant can be difficult as several factors need to be considered:

• Age
• Penis size: Overall size (including intra-operative measurement), ratio between the length to girth of penile shaft, ratio between penile length and size of scrotum, overall size of scrotum, size of glans penis.
• History of previous implant, abdominal surgery, kidney transplant or other major pelvic surgery
• Body type, incl. presence of a very prominent supra-pubic fat
• Overall patient health and life expectancy
• Costs

While the 3-piece inflatable penile implants are the most commonly used implants today, there are compelling reasons for trans men to consider the semi-rigid non-inflatable devices.

POTENTIAL COMPLICATIONS

While improvements over the years have made the penile implant more reliable, no mechanical device is 100% free of malfunction, and that includes penile implants.

As with any surgical procedure, there always is the chance of post-operative infection. If the infection is severe, the implant must be removed.

Chronic pain may occasionally require removal of the implant.

Leakage from the cylinders can also require removal or replacement of the implant.

Less common complications include tissue erosion (particularly in the glans), implant malfunction (such as pump or reservoir failure) or defectiveness, and incorrect positioning or migration or the implant.

MASCULINIZATION OF THE FACE AND BODY SURGERIES

If you are a female transitioning into a male, we would like to offer you a consultation for our facial masculinization surgery at Inspire Cosmetic Surgery & Med Spa in Delray Beach, FL. When you look in the mirror there are details of your face that are more gender specific, such as the angles of your jaw and chin, the absence of an Adam's apple, your short brow, and your softer, rounder features. Our board-certified plastic surgeons can surgically enhance your face to look more masculine in your transition.

While the male scull is much larger than a female scull (this cannot be changed), we can still enhance your facial attributes to appear as a male face would: more angular with wider, larger features. Many of our female-to-male patients in transition will also take part in hormone therapy to increase testosterone production, which leads to thicker facial hair growth and other masculine facial features. Our goal at Inspire is to help each patient understand the FMS procedures that will give them maximum impact and their best results. FMS can greatly improve your self-esteem and confidence, as well as your appearance during and after the transition.

SUITE OF PROCEDURES

ADAM'S APPLE ENHANCEMENT

To create a more masculine facial profile, our plastic surgeon can enhance the appearance of an Adam's apple at the base of the throat for a female transitioning to male. Known as a thyroid cartilage enhancement, this procedure augments the area with a synthetic implant or a cartilage transplant.

RHINOPLASTY

By changing the width and projection of the nose with rhinoplasty, a female can have a more masculine nose. It is also important to design the nose to keep the balance and proportions of the rest of the face in check.

CHEEK AND CHIN AUGMENTATION

Cheek augmentation in the female-to-male transition should make the cheeks more angled and less round. Our board-certified plastic surgeon will place cheek implants that are sized and shaped to give the patient a more masculine mid-face shape. The chin can be made to appear longer and square (instead of round or oval). This enhancement can be produced with a synthetic implant or a contouring surgery (genioplasty or mentoplasty) to make the chin more masculine

FOREHEAD LENGTHENING

A female's forehead can be lengthened and augmented to look more like some males: tall with a brow ridge. Our plastic surgeon can create a new hairline further back on the scalp, use an implant to visualize the brow ridge, and implement a surgical brow lift to lengthen the forehead.

JAW CONTOURING

To widen and sharpen the angles of the female jaw, we offer jaw contouring surgery. Our plastic surgeon may use an implant to recontour the jaw or reshape the jawbone with surgical techniques.

WHAT TO EXPECT

We can perform facial masculinization surgery under general anesthesia in our AAAASF-accredited surgical facility as an inpatient or outpatient surgery, depending on the procedure or procedures selected. For your health and safety, your plastic surgeon may recommend staging the surgeries in a series of operations instead of performing them all at once. Your cosmetic surgeries will require incision, and our talented surgeon will make these incision as inconspicuous as possible. During your treatment planning sessions, we will discuss with you in detail how your procedures will be performed, how long you will be in recovery, how to care for surgical incisions, and much more to ensure a smoother recovery.

OTHER CONSIDERATIONS

Your aesthetics team may also recommend nonsurgical treatments to further enhance your face.

Keep in mind that the facial skin will continue to age, and some of the cosmetic procedures performed on your face will mature as well.