Before undertaking a sex reassignment surgery, important medical and psychological evaluations, medical therapies and behavioural trials should be undertaken to confirm that surgery is the most appropriate treatment choice for the individual.
Medically necessary core surgical procedures for female-to male persons include: mastectomy, hysterectomy, vaginectomy, salpingo-oophorectomy, metoidioplasty, phalloplasty, urethroplasty, scrotoplasty and placement of testicular prostheses and erectile prostheses.
Gender-specific services may be medically necessary for transgender persons appropriate to their anatomy. Examples include:
- Breast cancer screening may be medically necessary for female-to-male transgender persons who have not undergone a mastectomy
Limitations of hormone therapy
- There may be no change in voice or hair growth.
- There may be change in the quality of body hair and redistribution of body fat.
Expected outcomes of surgery
- Cosmetic / aesthetic effect
- Psychological outcome-happiness and satisfaction to be able to live with the gender inclined by the person
- Social outcome - ability to work, maintain relationships and contribute to society
Hysterectomy / oophorectomy
This is a routine gynaecologic procedure where the uterus and the ovaries are removed. Complications / risks are no different in the female-to-male patient than the non-transgender female patient.
The aim of chest surgery in the FTM is not just to remove the breast tissue, but also to recontour the chest to create a masculine appearance.
Patients with larger breasts or poor skin quality have a higher chance of requiring revision surgery. Typical revisions include, but are not limited to:
- Liposuction to improve contour abnormalities
- Scar revisions
- Excision of skin excess, wrinkling or puckering
- Adjustment of nipple-areola complex position or size
Management of complications following FTM chest surgery
- Post operative bleeding
- Haematoma infection
- Wound healing problems
- Mastectomy flap necrosis nipple necrosis (loss of nipple)
- Contour abnormalities
- Nipple asymmetry
Management of complications following FTM genital reconstruction
After phalloplasty, revision surgery may be necessary to correct urinary dysfunction, a common complication of urethral lengthening.
- Post operative bleeding / haematoma (all sites)
- Infection (all sites)
- Seroma (recipient site)
- Wound healing problems (all sites)
- Partial or complete flap necrosis (loss of phallus)
- Compromised sensation / function of hand and wrist (donor arm)
- Urethral fistula