American Society of Plastic Surgeons
For Medical Professionals
 

Plastic surgery an important step in gender dysphoria treatment of transgender individuals


Individuals with gender dysphoria often describe being born in the wrong body, and plastic surgery is an important step in aligning their bodies with whom they know themselves to be.

To guide transition, the World Professional Association for Transgender Health (WPATH) developed the The Standards of Care to help provide "the highest standards" of care for individuals with gender dysphoria. Accordingly, the overarching treatment goal is "…lasting personal comfort with the gendered self, in order to maximize overall health, psychological well-being and self-fulfillment."

Several surgical procedures are available for transgender females (individuals transitioning from male to female.) Successful genital reconstruction involves the creation of a natural-appearing vagina and mons pubis that is both sensate and functional. This includes a feminine-appearing labia majora and minora, removal of the stigmatizing scrotum, a sensate neoclitoris, and adequate vaginal depth and introital width for intercourse. Additional desirable qualities include a moist appearance to the labia minora, clitoral hooding and lubrication for intercourse.

Aside from female genital reconstruction, other procedures designed to feminize one's appearance include breast augmentation, thyroid chondrolaryngoplasty ("tracheal shave") and facial feminization.

Genital reconstruction can also be performed in transgender males (individuals transitioning from female to male). Phalloplasty represents the most complete genito-perineal transformation and requires use of tissue from a distant donor site. Phalloplasty can be performed with urethral reconstruction to allow for urination while standing, and implantable prostheses (testicular and penile) can be placed in subsequent procedures.

An alternative to phalloplasty, metoidioplasty involves lengthening of the virilized clitoris to create a micropenis. Metoidioplasty can also be performed with urethral lengthening so as to allow an individual to urinate while standing.

Additional procedures, such as "chest surgery," include bilateral subcutaneous mastectomies, chest contouring and repositioning and re-sizing of the nipple-areola complex. Several different techniques are employed; the choice of technique depends upon the volume of breast parenchyma, degree of breast ptosis and position of the nipple-areola complex, and degree of skin elasticity.

Care of individuals with gender dysphoria requires a multidisciplinary approach that may include mental health professionals, primary care physicians, endocrinologists and plastic surgeons. Working together, health care teams can help meet WPATH's high standards to enhance health, happiness and contentment.


The views expressed in this blog are those of the author and do not necessarily reflect the opinions of the American Society of Plastic Surgeons.

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