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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.
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.
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