Female to Male Surgery (FTM)
| Definition: | Chest Reconstruction- It is to create a “male” looking chest. This can include removing breast tissue, excess skin, resizing & repositioning the nipple & the dark area around areola. This also include preserving the as much sensation as possible and trying to minimize scarring. Metoidioplasty- A surgical change toward the male. An ongoing testosterone treatment in a Trans man typically causes his clitoris to grow longer. The amount of clitoral growth varies with each individual. Phalloplasty- Big Penis |
| Procedure: | Chest Reconstruction- Trans Men with moderate to large breasts usually require a formal bilateral mastectomy w/ grafting & reconstruction of the nipple-areola. This will result in 2 horizontal scars on the lower edge of the pectoralis muscle, but allows for easier resizing of the nipple & placement in a typically male position. For Trans Men with smaller breasts, a peri-areolar or keyhole procedure may be done where the mastectomy is performed through an incision made around the areola. This avoids the larger scars of a traditional mastectomy. Metoidioplasty- Testosterone makes your clitoris grow (usually 1-3cm). This procedure involves cutting the ligament that hold your clitoris in place under the pubic bone, as well as some of the surrounding tissue. Your clitoris is then freed up so more of it is showing. Phalloplasty Each step requires 4 months after the next surgery: Stage 1: Prepare Urethra for abdominal tube (can be performed w/ Hysterectomy & Ovary Removal). Stage 2: Penile reconstruction from abdominal skin (not recommended reconstruction from back hand, will create a lot of scars) Stage 3: Connect urethra and retouch penis. Stage 4: Insert Ball Implants (Testicles) |
| Duration of Surgery: | 1-2 Hours |
| Type of Anesthesia: | General Anesthesia |
| Pre-Operative Care: | • Chest Reconstruction- Assessed medical history
Checked health insurance policy
Checked laboratory result
No Aspirin 2 weeks prior to surgery
Avoid smoking and drinking alcoholic beverage 1 month prior to procedure
Checked patient’s readiness and knowledge about the procedure
Cosmetics should not be worn • Metoidioplasty- Assessed medical history Checked health insurance policy Checked laboratory result No Aspirin 2 weeks prior to surgery Avoid smoking and drinking alcoholic beverage 1 month prior to procedure Checked patient’s readiness and knowledge about the procedure Cosmetics should not be worn Stop hormone if taken 2 weeks before surgery Advised patient that removal of vagina is optional • Phalloplasty- Advised patient that in this procedure, vagina will be closed and the result of the surgery will be an adult penis. |
| Post-Operative Care: | • Chest Reconstruction- There is soreness & discomfort which easily removed by the medicine
Swelling & discoloration within incision will subside
There might be a temporary loss of sensation in the nipples & breast skin. This condition will improve in time.
Sutures will be removed within 5 days after surgery.
Scars remain highly visible for 8 months up to a year following surgery.
No heavy exercise within 4 weeks after surgery.
• Metoidioplasty- Advised patient that the result of penis size might be 1-3 cm Advised that sexual function would be good since the clitoris is not impacted much. The new penis will get erect on its own when the patient is sexually aroused, but won’t be large enough to penetrate a partner with. May urinate in standing position There would be minimal visible scaring but will fade in a couple of months • Phalloplasty: Advised patient that pulling on the penis will stimulate the clitoris that is buried at its base. Advised that 1 year after Phalloplasty, a stiffening device can be inserted to create an erection firm enough to penetrate sex. Patient will urinate in standing position Advised that there will be large scar on the waist where the tissue was removed and on the graft sites that maybe lessen in time. Take medication and antibiotics as prescribed to prevent blood clots for the first 5 days. The skin grafted will be wrapped under special bandages for 5 days. There can be pain and soreness for a long time which is normal. |
“Lower Surgery” or Hysterectomy/ Salpingo-oopherectomy Colpectomy or Vaginectomy Scrotoplasty
| Definition: | • “Lower Surgery” Hysterectomy/ Salpingo-oopherectomy- Removing of uterus / removing of fallopian tube and ovaries • Colpectomy or Vaginectomy- Removing the vagina or closing the vagina • Scrotoplasty- Creating a scrotum (Testicle Balls) |
| Procedure: | An expander of the proper size and shape is placed under the skin in the desired location. The expanders are slowly expanded over a three month or greater period. The procedure may be performed under either local I.V. sedation or under general sedation, on an outpatient or inpatient basis. Following placement, the expander is gradually filled with saline injected into a "fill port" which will be located either internally or externally. When enough expanded or new skin is present, the expanders will be removed and permanent prostheses will be placed. |
| Pre-Operative Care: | Assessed medical history Checked health insurance policy Checked laboratory result No Aspirin 2 weeks prior to surgery Avoid smoking and drinking alcoholic beverage 1 month prior to procedure Checked patient’s readiness and knowledge about the procedure Cosmetics should not be worn |
Male to Female (MTF) Sex Re-assignment Surgery (SRS) / Genital Reconstruction Surgery
| Methods: | 1. Long Penis (> 6 inches when erect) = Penile Skin Inversion (PSI) 2. Medium Penis (2-6 inches when erect)= Penile Skin Inversion (PSI) with Scrotal Skin Graft (SSG) 3. Short Penis (<2 inches when erect)= Penile Skin Inversion (PSI,SSG) with Sigmoid Colon Graft (SCG) |
| Definition: | This is to reassign the patient’s sex from male to female involves the use of skin, tissues and sexual sensory nerves of the patient to transform the male sexual organ into a female sexual organ. Also, this is done to create an erotic sensate area including clitoris, labia minora, labia majora & vaginal opening; to achieve satisfactory vaginal depth, to preserve orgasm during sexual intercourse. |
| Procedure: | 1. This procedure is a combination of a penile skin inversion and an immediate full thickness skin graft. The vaginal canal and opening is created beneath the urethral opening and prostate gland. Vaginal depth is of concern to most patients. The most important factor in creating this depth is the amount of penile shaft skin. The technique that lengthens the depth of the vagina is using the full thickness skin graft from the scrotal. Hair on the scrotum must be removed so that the skin graft is placed at the distal end of the penile skin flap. This technique can lengthen the depth at least 2 more inches.
2. A portion of the glans (head of the penis), with its nerves and vessels, is converted into a clitoris. In so doing, the clitoris will be functional in sensation as well as in appearance. 3. The excess erectile tissue around the urethra should be removed in order to avoid symptoms that stem from engorged erectile tissue during sexual arousal, that may result in the narrowing of the vaginal opening. 4. Colon transposition is used for patients who need more depth (exceeding 8 inches). |
| Duration of Surgery: | 4- 8 Hours |
| Type of Anesthesia: | General Anesthesia |
| Pre-Operative Care: | Assessed medical history Checked health insurance policy Checked laboratory result No Aspirin 2 weeks prior to surgery Avoid smoking and drinking alcoholic beverage 1 month prior to procedure Checked patient’s readiness and knowledge about the procedure Cosmetics should not be worn Advised patient not to take hormonal pills 4-6 weeks before procedure Advised patient to do fasting midnight prior to procedure |
| Post-Operative Care: | Patient should be in bed rest for 24 hours Advised that Surgeon will perform post-op care & dilation at least 2 weeks Patient must dilate to achieve desired depth and width of the newly made vagina. (if patient will not dilate properly, result will be narrowing of the width and depth of the newly made vagina due to scar contractures.) After each dilation session with the doctor, wound dressing will be performed to speed up healing process Advised patient that depth usually reaches 6 inches but will continue to extend after 6-12 mos. Advised patient to do daily & proper wound care. Difficulties in voiding usually occur but will get back to normal so catheter should still be in place. If bleeding persist due to stump of the urethral opening, repacking or suturing is required. After 6 weeks, patient can already engage in neovaginal intercourse. |
Labia Augmentation
| Definition: | A procedure for genital alteration that improve appearance and possibly sexual fulfillment. This procedure is less expensive than other genital surgeries and can be combined with other procedures. |
| Procedure: | Cosmetic surgeons can inject the labia w/ extracted body fat. This technique can also be used to increase the size of one side of the labia if the other side is smaller. |
| Duration of Surgery: | 30- 50 Minutes |
| Type of Anesthesia: | Local Anesthesia |
| Pre-Operative Care: | Assessed medical history Checked health insurance policy Checked laboratory result No Aspirin 2 weeks prior to surgery Avoid smoking and drinking alcoholic beverage 1 month prior to procedure Checked patient’s readiness and knowledge about the procedure Cosmetics should not be worn |
| Post-Operative Care: | Numbness & temporary discomfort may occur for few days but maybe controlled by medicine Bruising & swelling usually subside in the first week Apply ice pack on the affected area for the first 2 days. No heavy exercise 2 weeks after the procedure Scars will fade 1-2 week |
Labia Repair (Labia Reduction, Labiaplasty)
| Definition: | A procedure that reduces skin excess so that labia minora are even or within labia majora. |
| Procedure: | It is typically done when labial reduction & able to combined with other procedures. The redundant skin of labia minora to be excise preserving only enough Labia minor to ensure that the vaginal opening is closed when the person is standing. |
| Duration of Surgery: | 40 Minutes |
| Type of Anesthesia: | Local Anesthesia |
| Pre-Operative Care: | Assessed medical history Checked health insurance policy Checked laboratory result No Aspirin 2 weeks prior to surgery Avoid smoking and drinking alcoholic beverage 1 month prior to procedure Checked patient’s readiness and knowledge about the procedure Cosmetics should not be worn |
| Post-Operative Care: | The result is immediate Some numbness & temporary discomfort may persist around incision for few days but will subside in the first week. Minor swelling & bruising can usually subside in the 1st week Avoid heavy activity. Can take shower once the bandage was took off |