Gender Affirmation Surgery

Gender affirmation surgery, also known as gender confirmation surgery or gender reassignment surgery, refers to a range of surgical procedures that can be performed to help people who identify as transgender or nonbinary align their physical bodies with their gender identity. There are different types of surgical options to achieve this outcome, including procedures that alter the face, chest, or genitalia, such as:

• Facial reconstructive surgery to create more feminine or masculine facial features.
• Chest surgery (also known as "top" surgery), such as breast reconstruction, to alter breast tissue to appear more masculine or feminine.
• Genital surgery (known as "bottom surgery") to reconstruct and transform genitalia.

Possible procedures may include:

• Reduction of an Adam's apple
• Breast implants, breast reduction, or mastectomy
• Penectomy and orchiectomy (removal of penis and scrotum)
  Oophorectomy and hysterectomy (removal of ovaries and uterus)
• Metoidioplasty, phalloplasty, and scrotoplasty (construction of penis and scrotum)
• Feminizing genitoplasty (construction of labia and vagina)

Gender affirmation surgery is often the last step in a gender affirmation treatment process that includes one year of continuous hormone therapy and living in the desired gender role. Working with a trusted healthcare provider who can help you understand the benefits and risks of treatment is important.

Many insurance companies will require health records of documented gender dysphoria and a letter of support from a mental health provider before they will cover the procedure. Gender dysphoria is the medical term for when a person experiences a "marked incongruence between their experienced or expressed gender and the one they were assigned at birth."

During your initial consultation, your plastic surgeon will present a customized treatment plan to help you reach your goals. Your surgical team will let you know if there are any steps you need to take before your gender affirmation surgery. You may also be asked to quit smoking or lose weight to reduce the likelihood of complications.

Your surgical team will let you know what's involved with your specific treatment plan and will give you details on the specific procedures they will perform during your gender affirmation surgery. Expect a general anesthesia procedure(s) and a hospital stay after, particularly if your treatment plan includes genital surgery.

Recovery from a gender affirmation surgery will vary based on the specific procedures performed. Some procedures, such as breast implant surgery, are outpatient procedures, meaning you will be discharged on the same day as treatment. Other procedures may require a hospital stay.

All gender affirmation surgeries are conducted under general anesthesia, so you will need a ride home from the hospital. Depending on your specific treatment, you may also need a family member or friend to help as a caregiver for up to a week once you return home. Your medical team will help you understand what to expect immediately after your surgery and in the weeks following.

All surgical procedures carry the possibility of risks and side effects, including gender affirmation surgery. The chances of significant complications are rare, especially when performed by an experienced team of gender affirmation surgeons. Potential side effects will depend on the surgical procedures performed and may include:

• Anesthesia risks: All surgeries involve the use of anesthesia, which carries its own set of risks. These may include allergic reactions, breathing problems, or other complications.
• Infection: Any surgery carries a risk of infection, which can be treated with antibiotics if caught early.
• Bleeding: Excessive bleeding during or after surgery can lead to complications.
• Blood clots: Blood clots can form in the legs or lungs and can be dangerous if they travel to other parts of the body.
• Scarring: All surgery leaves scars, which may be more or less noticeable depending on the procedure and the individual's healing process.
• Changes in sensation: Some gender affirmation surgeries, such as those involving the genitalia, may result in changes in sensation or sexual function.
• Complications with wound healing: In some cases, wounds may take longer to heal or may not heal properly, which can lead to complications.
• Emotional side effects: It is common for people to experience a range of emotions after gender affirmation surgery, including relief, excitement, and sadness. It is important for individuals to have access to supportive resources and to be prepared for these potential emotional reactions.

Your surgical team will help you determine if gender affirmation surgery is a safe option. In general, a good candidate will be in good physical and mental health. Pre-operative requirements for gender affirmation surgeries set by the World Professional Association for Transgender Health (WPATH) include:

• 1 letter in support of the surgery from a mental health provider with a Phd or MD
• 1 letter from a mental health provider with a master's degree
• Patient must reach the age of maturity before sterilization
• Significant mental health or medical concerns must be well-controlled
• 12 continuous months of hormone therapy
• 12 continuous months of living in the gender identity role
• Pre- and post-surgery visits with a mental health or medical professional
• Non-smoker
• BMI requirements (healthy weight)

Gender affirmation surgery is the final step in a gender affirmation treatment plan, but that doesn’t mean you need to wait to set up your consultation. Schedule an appointment with our team of gender affirmation surgeons today to explore your options and start the qualification process.