Female to Male Gender Reassignment Surgery

Gender reassignment surgery for female to male transsexuals may cover multiple surgeries. The "top surgery" which involves removing breast tissue is frequently the first (and sometimes the only) surgery that trans men may choose to have. The others include hysterectomy, bilateral salpingo-oophorectomy, and the "bottom surgery" on the genitals. Many trans men don't opt for the genital surgery, finding the potential outcomes dissatisfying.

"Top Surgery"/Mastectomy

This is the surgery which removes breast tissue and sculpts the chest to male contours. Because full breasts can be difficult and uncomfortable to hide, this surgery can greatly enhance comfort and quality of life for trans men. Binders will no longer be required to "pass" in public and swimming without a shirt will be a blessedly uneventful affair.

Men with moderate to large breasts typically require a formal bilateral mastectomy. This involves grafting and reconstruction of the nipple and results in horizontal scars along the bottom of the pectoralis muscle. Nipples can be placed in a typically male position, enhancing the appearance of the chest.

Female to male patients with less breast tissue may opt for the "keyhole" surgery, also called a peri-areolar procedure. A peri-areolar surgery only requires a small incision around the areola, through which excess tissue can be removed. Scarring is greatly reduced, but the nipples will not be resized or repositioned. There is also less nerve damage in this procedure and chest sensation will return sooner.

Hysterectomy and Bilateral Salpingo-Oophorectomy

A hysterectomy removes the uterus and, sometimes, the cervix. Typically, an abdominal incision is made, through which the uterus can be removed. During this same procedure, both ovaries and fallopian tubes can also be removed. This is termed a bilateral salpingo-oophorectomy. The removal of these organs in someone receiving hormone replacement therapy (HRT) is seen not only as a way to reduce gender dysphoria and physical discomfort, but a possible reduction in health risks. The risk of developing cervical, endometrial, or ovarian cancer due to raised testosterone levels is unknown, however. Once the ovaries are removed, the post-operative trans man is permanently sterile and will require HRT for life.

"Bottom Surgery"/Genital Realignment

There are currently two major forms of the "bottom" surgery for trans men, each with their own strengths and drawbacks. Because the drawbacks for both are significant, many trans men will never have either surgery. The two procedures are metoidioplasty and phalloplasty.

Metoidioplasty

This procedure uses existing genital structures to create a neopenis. Testosterone treatment will cause the clitoris to enlarge and this is what the neopenis is made from. The enlarged clitoral tissue is released from its position and moved forward on the body so that it is closer to the positioning of a penis. A vaginectomy, hysterectomy, and/or oophorectomy may be performed at the same time. Because the female urethra is shorter than the male, if the trans man desires to urinate through his new penis the urethra will need to be extended. The labia minora will be moved to form the new exterior skin for the neopenis, giving it added protection and girth. The labia majora may be used to form a scrotum.

Men who have had a metoidioplasty retain the ability to achieve an erection or experience genital orgasm. However, their penis may be too small for satisfactory sexual intercourse.

Phalloplasty

A phalloplasty relies on tissue grafts and erectile implants, rather than existing genital structures. Extensive grafts may be taken from the arm, chest, leg, or pubic area. The neopenis is created from grafted tissue which is attached to blood and nerve supplies in the groin. Clitoral nerves may be incorporated into the neopenis. A vaginectomy, hysterectomy, and/or oophorectomy may be performed at the same time, as well as a urethral extension.

Aesthetic satisfaction is high with the phalloplasty method, but erotic sensation is only retained in 9 percent of cases. Satisfactory penetration without difficulty or pain only occurs in 49 percent of patients. Erectile implants are required for intercourse, due to the lack of erectile tissue. Complication rates are high.

Post Op Care

Recovery time will depend heavily on which procedures have been done. Metoidioplasty has the quickest recovery time as well as the fewest complications.

Phalloplasty patients are required to keep the neopenis parallel to the abdomen during initial recovery.

In either case, if a urethral extension was opted for a catheter will be used during initial recovery to give the mucosa time to heal.

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