A Short Guide to Surgical Interventions for Feminising Trans and AMAB Non-Binary Individuals
[Trigger Warning: Mentions genitalia and surgical procedures]
This post will provide a brief overview of the most common forms of surgery available to help feminise transgender and AMAB non-binary people.
Breast Augmentation
Breast augmentation is used to increase in the size of the breasts. Male to female transgender and AMAB non-binary individuals may develop some breast tissue after hormonal therapy, but the size may remain small so they may seek to have breast augmentation.
Transwomen and AMAB non-binary people are recommended to wait at least twelve months from their first estrogen prescription to allow for breasts to develop before deciding to have augmentation.
The most common method of breast augmentation is using implants. There are a variety of surgical options to choose from each with their advantages and disadvantages, some of which may be appropriate for you. You should research the differences in:
Surgical approach: Inframammary, periareolar, transaxillary, or umbilical incision
Implant position: Submuscular or subglandular
Implant composition: Saline or silicone gel
Implant shells: Smooth or textured surface
Implant shape: Round or anatomical (teardrop)
Implants are placed either beneath glandular breast tissue or beneath the pectorals. Most surgeons use the crease underneath where the breast sits as the incision site which hides scarring.
After surgery it is common to experience pain for several days and tenderness coupled with swelling for several weeks. It is also important to be aware that some surgeons may recommend replacing the implants every 10-15 years.
Moderate pain is to expected for 3 – 5 days after surgery.
Patients should avoid strenuous exercise and activity for 6 weeks.
You will have to wear a support bra for the first 3 weeks, day and night and the second 3 weeks during the day.
Most of the swelling should resolve in 2 – 3 weeks but it will take up to 3 months for the breast to feel normal.
Potential Complications:
Capsular contraction (the body forming a tough shell around the implant which shrinks, often causing pain or change in shape of the breast).
Infections.
Loss of sensitivity in the nipple area.
Bleeding inside the breast.
Displacement.
Asymmetry.
Vocal Surgery
The most widely known vocal surgery for trans feminine people is called Cricotyroid Approximation where the surgeon increases the tension of the vocal cords.
Types of surgery include:
Cricothyroid Approximation
Anterior Commissure Advancement
Anterior Glottal Web Formation
Laser Assisted Voice Adjustment
Thyrohyoid Approximation
Please be aware that while research suggests that the surgery can provide benefits for some patients but pitch elevation alone may not result in a voice that is widely regarded as ‘feminine’. Voice surgery also requires additional speech therapy after the surgery
Possible Complications:
Reduced loudness.
Decreased vocal range.
Decreased clarity of voice.
Lack of decrease in pitch.
Depending on the surgical technique, you may have permanent scarring after the operation.
Facial Feminisation
Facial feminisation is the term for a range of different surgical procedures involving the face and neck that aims to create an appearance that results in the patient being socially regarded as female/feminine more easily.
Surgical options include:
Reshaping the forehead.
Brow lift.
Lip lift.
Hairline advance.
Rhinoplasty.
Cheek implants.
Genioplasty.
Jaw shaving.
Tracheal shaving.
Genital Surgery: Orchidectomy
Orchidectomy is removal of the testes. Many trans feminine people will have an orchidectomy at the same time as a vaginoplasty, but it is important to remember that some people may desire testicular removal while leaving the penis intact.
In this surgery, the scrotum is cut open and the testes and the spermatic chords leading to the testes are removed through the incision, which is then sutured closed.
Orchidectomy may not be suitable for people who are interested in later obtaining a vaginoplasty as it can make the vaginoplasty more difficult - check with your surgeon if you are unsure. Warnings:
Orchidectomy results in the permanent destruction of the testes and is irreversible. After orchidectomy you will be infertile and unable to have children unless you have previously carried out gamete storage.
Orchidectomy may cause erectile dysfunction in people with penises.
Surgical removal of the testes causes a permanent reduction in testosterone levels. After orchidectomy, you will need to take at least one sex hormone in order to prevent medical problems like osteoporosis.
Genital Surgery: Vaginoplasty
Vaginoplasty is the construction of a vagina uses inverted penile skin. An alternative version of this surgery uses a segment of the bowel (total laparoscopic sigmoid vaginoplasty) which can be necessary if there is a lack of tissue to use to create the vagina. This may be used if a patient has been circumcised and/or has a small penis.
Vaginoplasty only creates the vaginal canal (the internal tube). The vulva is created by labiaplasty and clitoroplasty. These operations are usually carried out together with vaginoplasty, but some people opt to avoid vaginoplasty because they do not want a vagina or to reduce the risk of complications, reduce recovery time, or avoid the need to dilate. Those who do not wish to have a vagina created can opt to just have clitoroplasty and labiaplasty.
Vaginoplasty is a complex surgery, involving delicate tissue, vasculature, and nerve fibers. Here is what to expect:
The testicles are removed and discarded.
The new vaginal cavity is carved out in the space between the urethra and the rectum.
A penile prosthesis (surgical dildo) is inserted into the cavity to hold the shape.
The skin is removed from the penis. This skin forms a pouch which is sutured and inverted.
A triangular piece of glans penis (the bulbous tip) is removed to become the clitoris.
The urethra is removed, shortened, and prepared for repositioning before the remaining parts of the penis are amputated and discarded.
Possible Complications:
Deep vein thrombosis.
Prolapse of the neovagina.
Weakness of the rectal wall.
Urethral stenosis (blockage of the urethra resulting in inability to pass urine).
Granulation tissue forming inside the neovagina.
Warnings:
Vaginoplasty results in the permanent destruction of the penis and testes and is irreversible. After a vaginoplasty you will be infertile and unable to have children unless you have previously carried out gamete storage.
You will be required to dilate by inserting cylinders called dilators into the vagina for the rest of your life. The recommendations for how often to dilate vary between surgeons. An example schedule would be to start at 2-3 times a day and gradually reduce in frequency to twice a week. Dilation can be time consuming and painful, but is essential to maintain the length and shape of the vagina. Failure to regularly dilate can result in prolapse, serious health complications and/or permanent loss of the vagina.
Please be aware that vaginoplasty does not give the ability to menstruate (have periods) or to become pregnant or give birth.
