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Feminizing Mammoplasty, or “Breast Augmentation/Breast Implants”
This procedure places saline or silicone sacs in the breast area to create larger female appearing breasts.
Mastectomy with Chest Reconstruction
Also called “Top Surgery,” this procedure includes the removal of most breast tissue and the surrounding skin, the alteration of the size and placement of nipples and the areola (the darker skin around the nipples) to create a male-appearing contoured chest.
A hysterectomy is the removal of the uterus or womb. A total hysterectomy is the removal of the uterus and the cervix. There are a few different procedures that surgeons can use to perform a hysterectomy. Both procedures are permanent and irreversible and make it impossible to become pregnant. The procedure also stops menstruation (periods).
Fertility may still be possible through harvesting eggs if the patient has not had their ovaries removed. Removing eggs is typically very expensive and not covered by most insurance plans. Patients interested in possible future fertility should be sure to talk to their doctor prior to any surgical intervention.
This procedure is the complete removal the fallopian tubes and ovaries and can be performed at the same time as a hysterectomy. The ovaries produce estrogen and this procedure may change the recommended dosage of testosterone. This procedure eliminates any possibility of fertility unless banking of ovarian tissue or embryos is done prior to surgery. Banking is usually costly and not typically covered by insurance
This procedure is the removal of the vagina. This procedure may also be accompanied by the removal of the uterus and cervix (a hysterectomy). This procedure is not required for a phalloplasty or metoidioplasty, although some individuals do have this procedure with a phalloplasty or metoidioplasty. Some surgeons perform partial vaginectomies to reduce complication rates. The type of procedure offered by each surgeon should be discussed in detail as well as the patient goals for end results. The need for future pelvic exams should also be discussed with the surgeon.
This is the term for the closing of the vagina and can be performed with a vaginectomy. Individuals may choose to have this procedure as a part of phalloplasty or metoidioplasty. Some surgeons do not recommend full closure of the vagina and the particular procedures each surgeon performs must be discussed with the selected surgeon.
This procedure is sometimes called “meta” and involves the creation of a phallus from existing genital tissue. While not possible or desired by everyone, surgeons generally suggest that individuals be taking testosterone consistently for about two years prior to surgery to add additional length to the phallus. Individual outcomes for functioning including capacity for urination and expected length vary depending on body size and anatomy. Expected phallus size is smaller than the penis of an average cis-gender man. The goal of a metoidioplasty is to retain sensation and erectile capability. There are two main types of procedures: metoidioplasty with urethral lengthening or metoidioplasty without urethral lengthening. Urethral lengthening routes the urethral tube carrying urine through the penis.
This procedure can be performed with metoidioplasty or phalloplasty and consists of the lengthening the tube that carries urine through the bladder, to exit through the penis.
This procedure is the surgical construction of a scrotum (“balls”). The scrotum is usually created from existing tissue in the genital area along with a testicular implant.
This is a procedure that involves the construction of a penis from the skin of a patient’s abdomen, forearm, or inner thigh. The goal of phalloplasty is to construct a penis with length similar to an average cis-gender man. The functions and expected outcome of the procedure should be discussed with a surgeon. A common component of surgery is urethral reconstruction with the goal of urination through the penis. Erections are only possible through either a rod that is implanted permanently or inserted temporarily or with an implanted pump. This is a highly complicated surgery and is usually completed in a series of surgeries over a 1 year time period.
An orchiectomy is a procedure to remove the testicles. This procedure lowers the levels of testosterone in the body. For those individuals who are on hormone therapy, an orchiectomy can result in a decreased need for spironolactone and possibly estrogen. Sexual functioning often changes after an orchiectomy and expected post-surgical results should be discussed with the surgeon. An orchiectomy alsoeliminates the possibility of fertility. If future fertility might be desired, patients are advised to pursue sperm banking. Banking is not usually covered by insurance and can be expensive.
Penectomy refers to removal of the penis. A shallow vaginal dimple is created and a new urethral opening is created to allow for urination in a sitting position. Removal of the penis as a separate procedure is not recommended if a person is considering vaginoplasty at a later time because skin and tissue from the penis are typically used in vaginoplasty.
The creation of a vagina (inner canal) and the vulva (outer genital area) involves a few different procedures. People may choose to have one of these procedures or all of these procedures when they decide to have genital surgery. The construction of a vagina is called vaginoplasty and the outer genital area procedures are called labiaplasty (creation of outer lips) and clitoroplasty (creation of a clitoris). Typically an orchiectomy (removal of the scrotum) is done at the same time, unless that procedure has already been done previously.
While many people think of genital SRS as a vaginoplasty, the word actually means the procedure that creates the vaginal canal. The goals of the procedure is to create a vagina that will hold its shape, is sensitive to touch, is wide and long enough for sexual penetration (by fingers, a dildo, or a penis), and has a moist, elastic, and hairless lining. Individuals will be advised to follow a course of dilation after surgery to retain elasticity and functioning of the vaginal canal. Best results occur when a course of laser surgery or electrolysis is undertaken by a patient to reduce hair growth. This process results in infertility and of a patient is interested in preserving fertility options, this should be discussed with surgeon and doctor. Preserving sperm cells for future fertility is often expensive and typically not covered by insurance.
The procedure that creates the labia (lips around the vagina). Labia minora and majora are created out of penile and scrotal skin.
The procedure refers to the creation of a clitoris. Individual experience of orgasm and sexual functioning varies. While orgasms are possible post-surgery, the experience of sexual arousal and pleasure will most likely be different.
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Transgender Health Services
San Francisco Department of Public Health