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Male to Female Procedures

There is no single story when it comes to the transitioning process. As a result, there are various procedures for bottom surgery- Male to Female Procedures.

Every transgender patient needs care that is unique to them. We know that there is no single story when it comes to the transitioning process of male to female procedures. As a result, there are various procedures for bottom surgery.

Along with the expertise of Dr. Sidhbh Gallagher and her team, patients can decide which procedure will work best for them. They can choose surgeries based on their goals and their health in general and social circumstances. For example, more mature transgender women may want to have everything done except for creating a vagina (zero depth procedure) since the recovery is much quicker and easier. On the other hand, some patients are not at a point where they can commit to the dilation schedule that accompanies vaginoplasty and may then decide just to do an orchiectomy.

Here are some of the procedures that Gallagher Plastic Surgery offers. They are listed from the most straightforward to the most complex.

Orchiectomy

What is it?

An orchiectomy is the removal of both testicles. This procedure is performed via a small two-inch incision in the middle of the scrotum. The surgery takes twenty minutes, and patients can go home that same day. 

Is this the right procedure for me?

Some patients may only choose an orchiectomy and not require any more bottom surgeries. Other patients decide to do this procedure because of financial reasons. In contrast, others have not undergone hair removal or are not ready to take care of a new vagina (dilation and douching). 

Other patients may choose to undergo this procedure because they are having challenges regulating their hormone levels or are not responding well to some of their medications (for example, testosterone blockers, spironolactone).

Having the testicles removed will not impact a person’s ability to have bottom surgery down the line. 

What does the recovery look like?

Patients will generally leave the hospital once they have recovered from anesthesia. They will experience very little pain and mostly just experience some groin discomfort. Most people go back to work the following day.

Orchiectomy with Scrotoplasty

What is it?

Some patients want to have the extra scrotal skin removed during testicle removal. The reason patients choose this option is that they prefer a “tidier” appearance. This procedure features a longer incision (approximately five inches) down the middle where the scrotum was, and it gets rid of the extra tissue.

Is this the right procedure for me?

This procedure is suitable for those who have no plans to have a vagina made in the future. When people undergo this procedure, it gets rid of some of the skin used to line the vagina.

What does the recovery look like?

Patients will generally leave the hospital once they have recovered from the anesthesia. Similar to the orchiectomy, there is minimal pain and just some groin discomfort. Most people will go back to work the following day.

Zero-depth or Dimple Vaginoplasty

What is it?

More and more patients are requesting this procedure. It involves feminizing the genitalia, which includes removing the penis, creating a clitoris, taking out the testicles and scrotum, and creating labia. However, this procedure is different from full vaginoplasty in that Dr. Gallagher does not make a vaginal canal but rather creates the appearance of one. It is also known as a “dimple”. 

In essence, everything looks the same on the outside, but there is no vaginal opening, which makes it not possible to have intercourse with a penis.

Is this the right procedure for me?

This procedure is suitable for patients who have no interest in penetrative intercourse. By not having to create a vaginal canal, patients do not have to dilate, and it can minimize both the recovery time and surgical risks. 

Older patients or patients with medical issues may be the perfect candidates for this procedure since it takes less time and is not as dangerous.  

However, it is necessary to be sure that this is the right procedure for you. There is the possibility of being able to create a vagina down the line if the patient should choose to do so, although it would be more challenging. 

What does the recovery look like?

Patients who undergo this procedure will need to stay in the hospital for about one to three nights. Depending on what the patient does for work, they can usually return in two to four weeks. 

Penile Inversion Vaginoplasty

What is it?

This procedure is the most requested bottom surgery by transgender women. It features changing the male genitalia to look, feel, and function like female genitalia, and a “penile inversion” technique is used. During this type of surgery, we remove the testicles, followed by removing the scrotal skin. It is then put to one side and prepared to make the deepest part of the vagina. 

After that, the skin of the penis is removed, and the head of the penis is used to make the clitoris. As a result, the patient will be able to orgasm. The erectile tissue is then taken away, the urethra is shortened, and the vaginal canal is created by lining both the penis and scrotal skin.

Is this the right procedure for me?

Looking after a new vagina is a significant undertaking, and the patient needs to be prepared to look after it (dilation) for the remainder of their lives. Therefore, it is essential to be at a place where you can cope if complications arise and be able to look after a new vagina.

What does the recovery look like?

The patient will generally remain in the hospital to recover for approximately three days. Four to six weeks off of work is usually required.  

Male to Female Procedures- Labiaplasty

What is it?

During the original bottom surgery, we do everything to give an aesthetically pleasing and natural appearance. However, some things may come up and need to be addressed during a future surgery. 

The term labiaplasty is a modification a patient may need for improving the appearance. The most well-known procedure is to make the labia majora meet in the midline at the front. Unfortunately, this modification cannot be performed at the first surgery because of the blood supply to the vagina.

Is this the right procedure for me?

Patients will be encouraged to wait nine to twelve months after their first bottom surgery before having a labiaplasty. This timeframe is needed for everything to heal and is a much safer way to do so. Not every patient will want or require this surgery, but it can enhance the appearance and remove unwanted scars or lumps.

What does the recovery look like?

Recovery from this surgery depends on what is required. In many cases, the patient will not even need to go to sleep. For the most part, it is an outpatient procedure where a few days off work is needed.

Revisions

What is it?

Dr. Gallagher and her team always welcome patients who have had their surgery initially done somewhere else. They have been known to help with complications or with an appearance that is not pleasing. 

Is this the right procedure for me?

  • Typical patients who undergo this procedure typically experience the following:
  • Loss or lack of depth in the vagina,
  • Scar tissue buildup
  • Lumps and bumps,
  • A clitoris that is too large

What does the recovery look like?

Recovery from this procedure depends on what specifically needs to be done. Most patients may not have to go to sleep. It will likely be an outpatient procedure where only a few days off of work is required. 

MTF Top Surgery

Dr. Gallagher always ensures that each patient receives the most affirming results. 

There are usually subtleties involved in breast augmentation for transfeminine patients that need attention and adaption of the technique to obtain the best results. 

Looking into what growth is already there from the hormones

First, will consider what changes hormones have already created. It is essential to wait a minimum of two years to have the maximum benefit on the hormones and so that the breasts have stopped changing shape. Dr. Gallagher and her team will never want to perform a procedure on a moving target. Also, they will consider the size and shape of the breasts.

Tuberous breasts

Often, many transgender women will notice that they have tuberous-type breasts. These types of breasts are the fold is high, and the lower part doesn’t have a rounded contour. Also, it’s not unusual to have asymmetrical breasts.

The team will keep every factor in mind when choosing the size and positioning of the implants. Usually, will select two implants of different sizes to balance out any size differences. 

Size preference is personal to the individual, and Dr. Gallagher will outline the pros and cons in great detail. There is generally a “sweet spot” range that someone’s chest can accommodate. If we go past this point, it could cause distortions, making results look unnatural or more prone to drooping. As a result, Dr. Gallagher and the patient will agree on a range before performing the procedure. 

What Are Some of the Other Differences for a Transgender Woman’s Chest?

  • Many transgender women may benefit from having their implants put on top of the muscle. That way, it will prevent the implants from being pushed out to the sides and ensure the lower part of the implant’s rounded contour will shape to the lower part of the chest.
  • Many times the nipples on a transwoman’s chest are spaced a bit further apart. Even though we want to create cleavage, it can create difficulties as it is necessary to center the implant on the nipple. Usually, once swelling reduces, the implants settle, and nice cleavage in a bra is possible.
Male to Female Procedures
Three months after MTF top surgery (left) & Three months after MTF breast augmentation (right)
Male to Female Procedures
Six months after MTF top surgery (left) & Six months after MTF breast augmentation (right)

Six months after MTF breast augmentation, most trans-feminine patients will see breast growth after being on hormones. We always encourage patients to wait for the full effects of hormones to occur before deciding if they want or need another procedure to feminize the breasts. This process can take two years.

Mastoplasty includes two basic approaches as a way to feminize the breasts.

Breast Augmentation

Many patients may need a bigger volume cup size. This procedure can be done using the patient’s own fat from other parts of their body, like the abdomen. This process is known as fat grafting. 

This procedure can also be performed by using an implant. There are various options and approaches that are suitable. Dr. Gallagher will help the patient determine and comprehend which option will work best for enhancing and feminizing the breast.

The significant decisions you will make with Dr. Gallagher are as follows:

  • The type of implant (Silicone vs Saline)
  • The placement of the incision (above or below the muscle) 
  • What size implant you want to use

Most patients choose a silicone implant to be placed through an incision in the fold underneath the breast and under the muscle.

Mastopexy or shaping

Sometimes the breast will require additional shaping or lifting for feminizing the appearance. For instance, in many transgender women, the fold under the breast may sit too high. However, this placement can be adjusted. 

Patients will generally have this procedure done at the same time as a breast augmentation.

Nipple Enlargement

Even though hormones can increase breast tissue, many transgender patients may find themselves disappointed at the feminization of the nipples themselves. However, various surgical techniques can be implemented to increase nipple size.

Body Feminization/ Contouring

Dr. Gallagher uses a wide range of skills and techniques to provide a more feminine and curvier appearance to the patient’s chest, abdomen, buttocks, or hips.

Depending on the patient’s preferences, they could undergo a combination of liposuction, fat grafting, and lifts to assist in giving a more affirming appearance.

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