Transgender Surgery – How Does Male To Female Surgery Work

Sex reassignment surgery, also known as gender confirmation surgery or GCS, is a broad term used to describe a variety of procedures meant to confirm someone’s gender and treat gender dysphoria. When it comes to MTF gender confirming surgery, these procedures can include genital surgeries, facial feminization surgeries, breast implants, and more. When combined with hormone therapy, these procedures can help make a person feel more comfortable in their own skin and in their gender.

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Another thing to keep in mind, while it’s fast and quick to Google “FTM or MTF transition,” the term “male to female” is as, Dr. Loren S. Schechter, M.D, Medical Director for the Center for Gender Confirmation Surgery at Weiss Memorial Hospital, puts it, “a bit outdated.” Schechter explains that referring to surgeries as “male to female” and vice versa doesn’t fully reflect the spectrum of identities. “Some identify either as male or female, either identify along the spectrum, some identify as both male and female. Others as neither male or female,”

Because GCS is such a broad term, we’ll help further explain what to expect during gender confirming surgeries here, with a focus on top surgery and genital surgery.

1. What is transgender surgery?

The term “transgender surgery” is really a larger umbrella term to describe any of the gender confirming surgeries a person might undergo to treat gender dysphoria.

There’s top surgery, which uses breast implants to create breasts. This surgery, Dr. Javad Sajan, a top plastic surgeon specializing in MTF top surgery in Seattle, explains, “is performed similarly to a routine breast augmentation, with the creation of a pocket for the breast implant to sit in.”

Then there’s genital surgery, or “bottom surgery” which often refers to vaginoplasty. This surgery really depends on the patient’s individual goals, Dr. Schechter says. “For many women who are transgender, it involves constructing a vaginal canal and the external genitalia [ed note: which can include labia and vulva].”

For a vaginoplasty, Dr. Schechter says, “a surgeon will create a vaginal cavity between the rectum and urethra, with the goal of creating a vagina out of penile tissue.”

Here’s a video from the European Society of Urology that shows a detailed example of how male-to-female gender reassignment surgery works:

Gender-Reassignment – Male to Female Surgery 2009 from Azraels-Art on Vimeo.

2. What should a patient expect?

Be prepared for an emotional rollercoaster, as Dr. Sajan says. “Patients have been living a pretense all their life and will finally have the body that feels right to them. This is an extremely emotional experience that requires the best care,” Sajan adds.

3. How much does it cost?

The cost will vary depending on surgery being performed, your location, the surgeon, and any material chosen (in the case of implants). For top surgery in his specific practice, Dr. Sajan says the cost varies from $4,995 to $8,495, on average.

Dr. Schechter says that the out of pocket cost for a vaginoplasty can usually cost anywhere from $35,000 to $40,000. Keep in mind, that’s out of pocket, meaning with no insurance coverage. “When I first started practicing, many years ago, insurance truly didn’t cover these surgeries, but now in 2020, many insurances do pay for the majority of the procedures,” Dr. Schechter adds.

Another thing to keep in mind: “It is illegal discrimination for your health insurance to refuse to cover medically necessary transition-related care,” per the National Center for Transgender Equality. Check with your insurance to make sure you don’t need to pay for everything out of pocket.

5. How do you find a legit doctor who specializes in it?

“The best way to find a legit doctor who specializes in MTF gender confirming surgery is to get referrals from the [trans] community,” says Dr. Sajan. While it’s great that GCS is becoming more commonplace, it’s led to gender confirming surgeries becoming a growth field of some doctors not doing as good of a job as possible and leaving patients with horror stories and bad experiences.

Besides consulting the community, Dr. Sajan also recommends checking out before and after photos to help decide on a surgeon.

Dr. Schechter also recommends checking out WPATH, the World Professional Association for Transgender Health, for more resources and possible surgeons. If you meet with a surgeon for a consultation, you can ask them questions like:

  • What specific training do they have in this field?
  • How many procedures have they done?
  • What facility is the surgery being done in?
  • Who is providing the anesthesia?

    It’s also a good idea to ask to speak to any former clients to hear about their experiences, or see if the surgeon has client testimonials already available.

    One last pro tip from Dr. Samir Pancholi, a trans-friendly cosmetic surgeon in Las Vegas: it’s more important to look for patients who most closely match your appearance in their before images, than it is to focus on the “after” images that you favor most. Yes, it’s tempting to look at just the results and focus on that, but by assessing based on the before images, it gives you a much more realistic idea of what the surgeon can actually accomplish when starting with facial and body features like yours.


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