Trans Women - Surgery & Followup Care

alanabehrens
Feb 6, 2020
3 min read

Updated: Feb 10, 2020

NONGENITAL / NONBREAST

Facial Feminization Surgery2

Forehead contouring

Bone reduction, hairline correction

Brow Lift

Raises eyebrows to more feminine position
Postoperative massage of eyebrow can address pulling

Scalp Advancement

Addresses male pattern hairline recession
May require hair transplant months after procedure

Rhinoplasty

Reduces nose dorsal hump and nasal bridge

Cheek Implants

High-density polyethylene implants inserted through mouth

Lip Lift and Dermis Graft

Feminizing lip by shortening area between lip and nose

Mandible Angle Shave & Taper

Makes jawline less square
Pain and swelling for 2-3 weeks, up to 6 months

Genioplasty

Reduces chin width by removing part of mandible and Complications are pain, swelling, and sensory disturbance of lip and chin

Thyroid Shave

Reduces thyroid cartilage "Adam's apple"

BREAST / CHEST "TOP" SURGERY

Mammoplasty

Surgical Technique:

Implant Position

Subpectoral is the typical approach due to inadequate breast development3
Subglandular placement preferred over subpectoral due to better appearance and less implant dislocation4

Postsurgical Care3

After Surgery:Reduction of mechanical stress and tension reduces scar width
No Earlier than 2 weeks After Surgery:
Gentle scar massage, taping, or silicone gels and sheets may reduce hypertrophic scarring6

Results5

A study with 773 respondents showed that 80% of transgender women were satisfied with the result
One third experienced health complaints

GENITAL "BOTTOM" SURGERY

VAGINOPLASTY

Penile Inversion Vaginoplasty

Preparation:

Permanent hair removal (electrolysis or laser) are recommended or required7

Procedure7

Vagina lining created from penile skin, testes removed, prostate left in place
Labia majora created from scrotal skin

Outcomes: Study of 232 transgender women11

Overall satisfaction with the surgery as 8.7 out of 10
Happiness with sexual function as an average of 7.8 on a 10-point scale 6% percent had some degree of regret

Intestinal Vaginoplasty

Procedure7

Less common and indicated when there are revisions to prior penile inversion surgery

Advantage:

Diminished need for dilation

Disadvantage:

Digestive secretions are frequent and may have malodor
Panty liners or pads may be necessary long-term
Requires more invasive abdominal surgery

Outcomes: Study of 86 patients with vaginoplasty, 28 transwomen12

78% total reported satisfactory sexual function
89% transwomen reported "good aesthetic appearance"
11% reported "fair" appearance

Postoperative Care7

Avoid strenuous activity for 6 weeks, swimming / cycling for 3 months
Donut ring suggested to relieve pain with sitting
Usually may resume sexual intercourse 3 months after surgery
Bathing & Hygiene:
No baths or submerging for 8 weeks
Wash hands before and after genital contact
Wipe from front-to-back
Labial swelling typically resolves 6-8 weeks postoperatively, apply ice for 20 min every hour to perineum first week
Avoid smoking for 1 month
Start with liquid diet, stool softener prevents constipation
Dilation 3 times daily for 3 months after vaginal packing is removed
Stop dilation if a lot of resistance or severe pain

References:

World Professional Association for Transgender Health. Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People. 7th version. World Professional Association for Transgender Health; 2012. https://www.wpath.org/media/cms/Documents/SOC%20v7/Standards%20of%20Care_V7%20Full%20Book_English.pdf
Morrison SD, Vyas KS, Motakef S, et al. Facial feminization: Systematic review of the literature. Plast Reconstr Surg. 2016;137(6):1759-1770. doi: 10.1097/PRS.0000000000002171 [doi].
Wang, Eric D, Kim, Esther A. “Perioperative and postoperative care for feminizing augmentation mammaplasty.” Perioperative and postoperative care for feminizing augmentation mammaplasty | Transgender Care, University of California, San Francisco, 17 June 2016, transcare.ucsf.edu/guidelines/bone-health-and-osteoporosis.
Kanhai RC, Hage JJ, Asscheman H, Mulder JW. Augmentation mammaplasty in male-to-female transsexuals. Plast Reconstr Surg. 1999;104(2):542-9; discussion 550-1. doi: 10.1097/00006534-199908000-00039 [doi].
de Blok CJM, Staphorsius AS, Wiepjes CM, Smit JM, Nanayakkara PWB, den Heijer M. Frequency, determinants, and satisfaction of breast augmentation in trans women receiving hormone treatment. J Sex Med. 2019. doi: S1743-6095(19)31517-6 [pii].
Broughton G, Rohrich R. Wounds and scars. Sel Read Plast Surg. 2005;10(7).
Crane Center for Transgender Surgery. “Vaginoplasty.” Crane Center for Transgender Surgery, Crane Center for Transgender Surgery, https://cranects.com/vaginoplasty
Meltzer, Toby. “Vaginoplasty procedures complications and aftercare.” Vaginoplasty procedures complications and aftercare| Transgender Care, University of California, San Francisco, 17 June 2016, https://transcare.ucsf.edu/guidelines/vaginoplasty
Horbach SE, Bouman MB, Smit JM, Ozer M, Buncamper ME, Mullender MG. Outcome of vaginoplasty in male-to-female transgenders: A systematic review of surgical techniques. J Sex Med. 2015;12(6):1499-1512. doi: 10.1111/jsm.12868 [doi].
Bouman M. Intestinal vaginoplasty revisited: A review of surgical techniques, complications, and sexual function. Journal of sexual medicine. 07;11(7):1835-1847.
Lawrence AA. Patient-reported complications and functional outcomes of male-to-female sex reassignment surgery. Arch Sex Behav. 2006;35(6):717-727. doi: 10.1007/s10508-006-9104-9 [doi].
Djordjevic ML, Stanojevic DS, Bizic MR. Rectosigmoid vaginoplasty: Clinical experience and outcomes in 86 cases. J Sex Med. 2011;8(12):3487-3494. doi: 10.1111/j.1743-6109.2011.02494.x [doi].
Ferrando, C, Thomas, TN. Transgender surgery: Male to female. In:UpToDate, Brubaker, L (Ed), UpToDate, Waltham, MA.