With people around the world waking up to gender equality, the race for trans people to get in the league is going with much gusto too. There are people out there who do not identify themselves with the rest of the gender in which they are born. Due to these reasons, sex reassignment surgery has become a common practice. For most transwomen, this phase starts with hormonal therapy. Some men end up having natural female instincts and thus they opt for this surgery. The first step towards it is estrogen therapy followed by counseling. Some undergo a complete surgical procedure in order to get the body they desire.

Transwomen who undergo these procedures enjoy a number of benefits. They actually end up feeling like a part and parcel of society. In addition this their morale and confidence also get boosted and they end up living the lives of their dreams.

Facial Feminization Surgery

Facial feminization surgery (FFS) refers to a series of surgical processes that ensure that the overall facial look of a male gets converted into that of a female. This involves defining the female characteristics on the face. The face is the first thing that a person notices in another person. Thus, it is important to work on it.

FFS includes brow lift with bossing, scalp advancement, nose reshaping, blepharoplasty, tracheal shave, cheek implants, lip lift, lip and cheek implants, cheek softening, etc. Not all clients need all of these procedures. It is very much client-specific and is done according to the needs and desires of every client.

Breast Augmentation

Breasts are indeed a sign of feminity and transwomen go for it. The majority of them get breast implants. There are many who undergo hormone therapy. But this can take years. Thus, a breast implantation therapy is something they can always go to to get the perfect results. This surgery gives rise to round and firm breasts.

Body Feminization Surgery

Body feminization surgery (BFS) aims at giving transwomen the perfect body shape. Unlike men, women tend to have a more curvaceous body type. Most of them have an hourglass shape and BFS can help transwomen in getting this very body shape. This is a quick, easy and effective way of getting a feminine look. Fat around the waist is removed in this procedure. In addition to this breast augmentation is also carried out.

Genital Surgery in MTF transition

The genital surgeries include three distinct procedures. This involves removing male sex organs and the creation of both internal and external female organs. All three stages can be performed as one operation. But one can also get them done at different stages. It depends on the personal choice of the client and the doctor.

Removing the testicles, or orchiectomy

An orchiectomy is defined as the surgical removal of the testicles. This can be done before the penis is removed. Removing this part of the male sex organ means that they would need less estrogen for the transforming given the primary male part gets removed.

Testes sits in the scrotum. During an orchiectomy some of the scrotum skin is left behind so as to be used in creating the labia or to line part of the vagina in transwomen. Thus orchiectomy and vaginoplasty are both done together.

Removing the penis or penectomy

Penectomy is the surgical removal of the penis. One can actually stop here. This means that there are clients who do not go for the creation of female sex parts or vaginoplasty. A penectomy when done without vaginoplasty is sometimes called nullification. For those who want the female organs have some portion of their penis left out for its creation. Penectomy involves creating a shallow vaginal dimple and a new urethral opening. This allows peeing in the sitting position. Thus one must decide beforehand what they want. A discussion with the doctor is a must before proceeding further.

Creating the female genitals

Creating female genitals involves a whole world of procedures and it’s a complex procedure. It can involve vaginoplasty, labiaplasty, and clitoroplasty. In vaginoplasty, the female vagina is created. While doing so the doctor must keep in mind that the vagina retains its shape. In addition to this, it must also be ensured that it is erogenous in touch and has those sensations.

Penile inversion is the most common technique used in vaginoplasty. In this procedure, the scrotal sac is used to form the vagina in transwomen. The clitoris is then created using a small section of the penis head. The erectile tissue, from the penis, is also removed. During vaginoplasty, the urethra is shortened and also repositioned.

The prostate gland is not removed during vaginoplasty.

The labia minora is created from the leftover penis skin and labia majora, the outer labia from the skin of the testicles.

This procedure is done under local anesthesia and gets completed within an hour. It is a simple procedure now unlike in the past. The success rate of the procedure is also very high. Most of the time vaginoplasty is done prior to labioplasty or other procedures. A lot depends on the doctor.

Hormone therapy

Sex change surgery usually follows hormone therapy. One has to get a mental health certificate before proceeding into this very surgery. This requires a lot of care and the candidate must also be 18.

A minimum of three months of psychotherapy is required in order to analyze the mental well-being of the person. Before going for this therapy it is made sure that the person is in a sound mental state and knows the pros and cons of the therapy. Then the social effects of this surgery must also be kept in mind before going for it.

Hormone therapy is necessary during all stages of the transition. In male to female transition is important because it helps change the physical appearance of the person seeking the surgery. As soon as the hormone therapy starts, the person starts experiencing bodily changes. The body of the male slowly transitions into that of a female.

There are many people who go just for hormone therapy meaning they ditch the surgical procedures involved in this very transformation. In hormone therapy, the female hormones oestrogen and progesterone as well as blocking agents for the male hormone testosterone are administered into the client. They can be taken orally, by injection or in the form of a patch.

Real-life experience

A person wishing to have male to female sex reassignment surgery must live as a female from beforehand itself. They need to bring about these minute changes in their lives slowly. Thus, getting used to a different type of life and body must be practiced early on itself.

In addition to this, these people undergo extensive psychological and psychiatric assessments.They do this to ascertain suitability, get referrals from at least two psychiatrists, and attend counseling sessions.

There are several steps one can take in order to prepare for any surgery and the same applies to male to female sex change surgery.

Preparing for surgery

Typically you’ll be admitted to the hospital the day before your surgery. All the necessary formalities are carried out. A whole-body check-up is done in order to ensure that one’s body is ready for surgery. Tests, blood sample tests and X-Rays are a part of this very process. Then the bowel clean up of the body is done. Then the pubic region of the body of a person is shaved. After this, the entire procedure is carried out for sex reassignment surgery.

After surgery

There are a number of things you can do after any surgery to ensure a speedy recovery. Hospital staff will closely monitor one’s bodily functions. This procedure is carried out under the influence of local anesthesia. It is necessary to stay in hospital till one feels good. Recovery takes around one week to get cured. Vaginoplasty is something that is considered as a severe surgery. It takes very long to recover from this surgery. So, one would be needed to stay for a longer duration of time for its speedy recovery. During the initial days one is required to follow strict bed rest.

Following vaginoplasty, a rod-shaped prosthesis is placed on the vagina of the person. This makes sure that the vagina is in place of a person and is set well.  A catheter will be placed in the new urethra to drain urine You will be given detailed instructions on how to take care of your vagina once you go home. Typically, one has to stay for one to three days in the hospital. By the second week you will start to feel more. Pain and soreness is a part of this surgery during the recovery period.

Vaginoplasty requires a lot of care and precision. This is a complicated procedure and thus requires a lot of care. Bleeding and infection is a part of this procedure. Thus one must not shy away from discussing any discomfort that one feels after the surgery. Only then one will be able to take care of the situation.

Most people feel well enough to get back to their usual routines within a period of six weeks or so. Thus, this depends from person to person. The doctor will determine the period when one can actually start doing physical activities.

Testes removal puts an end to most of your testosterone production. But once one starts feeling that their male characteristics are resuming, then one will start getting hormone therapy ones again.

Possible risks and complications

As with any surgical procedure, there are risks involved in a male to female sex change procedure. You should be fully aware of potential risks and complications involved in any surgical procedure before you elect to have the surgery. It is always better to be on the side of caution.

Specific complications that are likely to occur after vaginoplasty procedure includes the following:

• An opening, tear, or fistula may occur between the rectum and new vagina given it is a very sensitive part. This should be brought to immediate attention. One may experience faeces and gas leaking out of the vagina if at all this happens.
• A drop in sexual sensation and a decrease in the ability to have an orgasm is likely to occur too. Many women have ended up complaining about this. Orgasm is considered of real importance when it comes to sexual intercourse. Many transwomen have complained that they never experienced an orgasm after the surgery.
• Total or partial death in the tissue that was used to make the new vagina, clitoris or the labia. This is a rare condition.
• Rupture of multiple stitches. This can turn severe as it opens up the wound.
• Narrowing or closure of the new vagina.
• Narrowing or closure of the restructured.
• Prolapse, meaning the vagina falls off the body.
• Hair-bearing tissue used in lining the vagina causing hair growth.
• Dissatisfaction with the shape or size of the vagina.

Other complications, such as bleeding, swelling, minor infections or rupture of stitches can be cured in no time.

You must contact your surgeon in cases of serious infections or bleeding or scarring occurs. After discharge from the hospital, you need to extra careful. One must take care of one’s body. Take extra care and stay hydrated. Make sure that you are not needed to get revision surgery. Visit the doctor at regular intervals so as to ensure a speedy recovery. It is important to stay vigilant during the recovery period. Any unusual sign after the recovery of the person must immediately be brought to the attention of the concerned doctor. Do not ignore your condition. The transformation from a male to a female is a more complex process. These minute changes not only affect one physically but also psychologically. So, do not lose your strength and go on with a strong heart. This transformation may seem a bit too much but the end results are indeed life-changing in nature.

Not all Trans people have SRS. There can be various reasons why people opt SRS. Some people have it to reduce physical discomfort as there may feel certain mismatch between their identity and their body.

Many people may feel like they can adjust with their bodies, but may dislike how other people see or judge them (social dysphoria), and want to change their physical appearance to be able to blend in a way that better matches their identity.

For MTFs the objectives of SRS are to reduce masculine characteristics and make the body look more feminine.

Different Aspects of MTF Sex Reassignment Surgery

 

Medical term                                      Explanation

Breast Surgery       Face/Neck Surgery	Augmentation Mammaplasty       Facial Feminization Surgery (FFS)     Thyroid Cartilage reduction or Chondrolaryngoplasty	Inserting implants to make the breasts larger (breast augmentation)   Making changes to the nose, forehead, jaws, cheeks, lips, ears and eyes through surgery.   Shaving down the Adam’s apple (tracheal shave)
Genital  surgery	Orchiectomy   Penectomy   Vaginoplasty   Labiaplasty     Clitoroplasty	Removing the testicles   Removing the penis   Creating a vagina   Creation of labia (the “lips” around the vagina   Creation of a clitoris
Other possible surgeries	Abdominoplasty or abdominal lipoplasty   Implants         Scalp surgery       Voice surgery	Removing fat (and possibly excess skin)   Implants are inserted into the hips or buttocks to make these areas look more rounded and in shape.   Various surgical methods to treat baldness in hair like hair transplants   Surgery on the vocal cord, larynx or pharynx to raise voice pitch

 

 

Breast Implants (Breast Augmentation)

For Trans people who want larger breasts or a different breast shape, implants can be put in through incisions under the breast region, in the armpit, or around the nipple.

What are breast implants made from?

Most breast implants consist of saline or silicone.

It is essential for people to be realistic and understand that all types of breast implants commonly leak or rupture and will be needed to replace or remove in regular intervals. Breast implants should not be seen as lifetime devices; you will likely need additional surgeries and visits to your surgeon over time.

It is also common knowledge that implants stretch the skin. If you have implants removed and choose not to replace them, your skin will likely be wrinkled, dimpled, or puckered.

How will my chest change after implants?

After surgery, breasts tend to be firmer and rounder than naturally developed breasts. Transitioned women often have larger chest muscles and a wider chest than non-trans women.

One should interact in a detailed manner with a surgeon who understands how  trans women skin, muscle shape, and breast development is different than in non-trans women can be helpful in deciding on an implant shape and techniques that will satisfy her as far as looks and what it feels like is concerned.

When is the best time to do breast augmentation?

Breast surgery can be done as a first step in surgery, or after you’ve already done other types of SRS (e.g., genital surgery). MTF breast augmentation is usually done as a single surgery, but in SRS programs where there are various types of surgeons working together, it can be done at the same time as genital surgery to reduce the number of times you have to go through general anaesthetic.

Estrogens can significantly change breast size and shape in some MTFs. While changes in breasts start soon after taking estrogens, it is slow and gradual, and it typically takes two or more years for breasts to reach their maximum size. If you take hormones, it’s recommended that you wait at least 18 months, to give your breasts time to develop with hormones.

Hormonal development will help your nipples increase in size, and will also stretch out the skin of your chest so you can have a more natural looking implant.

Possible complications specific to breast implants include:

• Thickening and contraction of the scar tissue that is formed around the implant (less amount scar tissue is normal; an excess can be a problem)
• Uneven breast size in both the sides, difference in shape position
• Lopsided placement of the nipple (one side looks higher than the other)
• spotting or withering of the skin over the implant: more likely if breasts haven’t developed and matured well after hormones
• Complications involving the implant: leakage, rupture, infection or wearing out
• Change in nature or intensity of feeling in nipples/breast skin: less sensation or more extreme sensation

 

MTF Face and Neck Surgery

MTFs have varying perspectives about face and neck surgery. Some feel it is essential in helping reduce their gender dysphoria and helping in blending in. Others are concerned that MTFs may feel pressure to get face and neck surgery to reach to the conventional standards of attractiveness for women.

Tracheal Surgery

The thyroid cartilage can be surgically altered (or chondrolaryngoplasty) to reduce the size and noticeability of the Adams apple which a prominent feature of men. This can be done at the same time as voice surgery or separately.

Given below is a list of facial parts and which aspects of them are or can be changed in MTF face and neck surgery:

Forehead

• Brow shave: grinding down the upper edge of eye sockets to remove unusual enlargement of forehead or heavier than normal brow ridge.
• Forehead transition: using synthetic bone-filler to shape flat forehead to a desirable shape
• Brow lift: reduce the wrinkle lines that develop horizontally across the forehead by tightening the skin around it as well as those that occur on the bridge of the nose, between the eyes.

Chin and jaws

• removing a little part of the bone from the back corner of the jaw to make it less pronounced
• removing a little part of the bone from chin and reshaping it so it looks less square
• Liposuction under the chin to make the lower part of the face looks less heavy

Nose

• reducing the size of the nose to make it more slim
• making the nose look smaller by removing some of the cartilage present at the tip of the nose
• narrowing the nostrils

Lips

• removing a part of skin from between the nose and top lip to raise the upper lip a little bit for better look
• spacing the portion of skin between the nose and upper lip and making a slight dip
• using implants to make the lips seem bigger

Ears

Some MTFs have the position of their ears changed, or have the size of their earlobes reduced.

Cheeks

Cheek augmentation can be done to make the cheek bones look more pronounced, making the cheeks more prominent and also making the chin/jaw look smaller.

When is the best time to do face/neck surgery?

Forehead and nose surgery is recommended to be done together, as changes to the forehead can affect the shape of the nose. Generally it is not recommended that you have multiple surgeries close together, as it contains a lot of risks and stresses out your body.

You can have FFS safely with a gap of minimum 3 months of vaginoplasty as long as there are no complications from whichever surgery is done first. If you are planning to have tracheal shave as part of voice surgery, you should do it last. Voice surgery is done last because some types of voice surgery narrow the windpipe, making it more complicated to put in the tube that keeps your trachea open during general anaesthesia.

Possible complications specific to face/neck surgery include:

• Numbness, pain, or difficulty while controlling the muscles of the area where the surgery took place: may be temporary (from swelling) or permanent (from nerve damage)
• Complications with implants, wires, or screws: infection, reabsorption, or wearing out of th implants
• Tracheal shave: possible damage to the voice
• Dissatisfaction with the appearance of results: eyebrows uneven, nose looks unnaturally big, etc.
• scarring

Genital Surgery

MTF genital surgery can include:

• Removal of the testicles (orchiectomy)
• Removal of the penis (penectomy)
• Creation of a vagina through vaginoplasty, labia through labiaplasty, and clitoris through clitoroplasty

Orchiectomy

In MTF orchiectomy, the testicles are removed carefully and the scrotal skin is typically left behind to create labia and to form the lining of vagina. With orchiectomy, even if the scrotal skin is not removed it may shrink or get damaged. Because of this risk, surgeons do not recommend having orchiectomy as a separate procedure if you may want to pursue vaginoplasty at a later date.

Penectomy

It refers to the removal of the penis and is not recommended as a separate procedure if you are considering vaginoplasty at a later time, as skin and tissue from the penis is used in vaginoplasty.

Vaginoplasty

In vaginoplasty, the surgeon’s goals are:

• To preserve the ability to have orgasms.
• To create a clitoris, labia, and opening to the vagina that look realistic and ca give a good touch sensation.
• To create a vagina that is sensitive to touch, is spacious enough for sexual penetration, and has moist, elastic, and hairless boundaries or flaps.
• To change the position of the urinary tract and its structure so you can urinate downwards and in a steady stream.

Possible complications specific to vaginoplasty include:

• Lesser sexual sensation or arousal, and possible decreased intensity of orgasm
• Partial or total death of the tissue or its wearing out with time which are used to create the new vagina, labia, or clitori
• Prolapse: vagina falling out of the body
• Excess hair growth in the vagina (from hair-bearing tissue used as vaginal lining)
• Unsatisfactory size or shape or type of the new vagina, clitoris, or labia you may be uncomfortable with.

Cost of m2f surgery in India :

7300$ for full Sigma-Lead Vaginoplasty GCS/SRS and  all other cost depends upon the evaluation.

The two main surgeries involved in Male to Female Transition are Breast Augmentation Surgery with Breast Implant, and Vaginoplasty. Combining both surgery the average cost would not go above 9500$.