Introduction:
Gender dysphoria means psychological distress occurs due to a mismatch between sex assigned by birth that does not match the patient's gender identity. Many patients do sex reassignment surgery to regain their self-identified gender. This surgical procedure is also called gender confirmation surgery or gender affirmation surgery.
Gender affirmation surgery is a fast-growing plastic surgery, gynecologic surgery, and urologic surgery. People opt for this procedure so that their physical appearance matches their identical sex. Gender affirmation surgery provides relief for gender dysphoria and improves their mental status. The field of gender affirmation surgeries is a super-specialization region under the developmental stage.
What Is Gender Affirmation Surgery?
Gender affirmation surgery is done on people with a mismatch in gender assigned at birth with their gender identity. It combines various surgical procedures done in patients with gender dysphoria. These surgeries aim to align the patient's appearance with their mental gender identity and thus improve their mental status and well-being. This procedure involves a multidisciplinary team like a psychologist, psychiatrist, endocrinologist, urologist, surgeon, physical therapist, etc.
What Are the Types of Gender Affirmation Surgery?
Different types of surgeries are involved in gender affirmation surgery, including facial reconstructive surgery, chest or top surgery, and genital or bottom surgery.
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Facial Reconstructive Surgery - There are facial masculinization surgery and facial feminization surgery. In facial feminization surgery, it is done to change masculine features of the face to feminine or non-binary features (non-binary means people with a gender identity that does not fit with either traditional male or female gender). In facial masculinization, surgery changes from feminine facial features to masculine features is done. A few types of facial reconstruction surgeries are: In transgender women, injections are given to the cheekbone to enhance it.
Treatments are done on the chin to soften it or make it angle prominent. Jaw surgery is done either to shave down or use filler to enhance the jaw bone. In the nose a surgical procedure called rhinoplasty reshapes the nose. Surgery on Adam's apple (adam's apple reduction), lip augmentation, hairline restoration, and earlobe reduction was done to improve feminine features. Procedures like forehead lengthening and augmentation, cheek and jaw augmentation, and thyroid cartilage enhancement to construct Adam's apple.
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Chest or Top Surgery - It includes transfeminine top surgery, which involves feminizing chest surgery. This procedure is performed to enhance the breast's size and shape to improve the chest's feminine appearance. Even after hormonal therapy to increase the size of the chest, few may opt for top surgery to increase the size of breasts, known as breast augmentation.
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Breast Augmentation - An incision made along the areola, where the chest and tissues of the breast meet or are under the armpit. This is followed by inserting custom-made silicone or saline implants and suturing the incision. Silicon implants are soft and realistic, but saline is less expensive.
-Transmasculine surgery removes tissues from both breasts to provide a male or non-binary appearance of the chest.
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Mastectomy - A double incision is made on the top and bottom of the pectoral muscle, and chest tissue is removed. Skin is reconnected with the lower incision. Nipples are removed and are used to create a graft that mimics the nipple. This reduces the sensation of the nipple. Thus with the inverted T and the buttonhole methods, an incision around the nipple allows them to remain intact and retain sensation. These procedures are done in medium to large-sized chests,
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Periareolar and Keyhole Procedure: An incision is made around the areola and a large incision around that. The breast tissue is removed as the ring of skin between incisions. The skin is pulled around the nipple like a drawstring and reattached, thus making the nipple intact. In the keyhole procedure, only one incision is made underneath the nipple, and chest tissues are removed. These procedures are done for small chests.
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Genital or Bottom Surgery- It includes transfeminine bottom surgery, which involves the reconstruction of male genitalia into female genitalia.
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Vaginoplasty - A functional vagina is created from the tissues present mainly through the invasion of the penis. In this procedure, the penis is inverted to create a vagina, the tip of the penis to the functioning clitoris, and the scrotal skin to the labia. A graft is taken from the intestine to create a vaginal wall, or a scrotum is inverted to create a vaginal wall.
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Orchiectomy and Scrotectomy - One or both testicles or scrotums are removed in these procedures. In orchiectomy, testes are removed, allowing the body to produce fewer testosterone hormones. This helps in hormone replacement therapy. In scrotectomy, this also provides a similar result but is not applied in patients who need to have vaginoplasty because scrotal skin is required for that procedure.
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Transmasculine Bottom Surgery - This surgery involves the reconstruction of female genitalia into male genitalia. Testosterone is used to increase the size of the clitoris, and testicular implants are added. Vagina and other reproductive organs are removed. Urethra into the new phallus.
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Metoidioplasty - The clitoris is released from its hood to create a new phallus. The addition of the testicular implant is also done. Done for patients who opt for a less invasive procedure than phalloplasty.
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Phalloplasty - a graft taken from the thigh and back used to create a penis. Depending on surgery urethra is linked through a new penis, and an implant is placed, which helps to erect the penis. It is useful for an average-sized penis.
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Other Procedures - include hysterectomy(removal of the uterus), oophorectomy(removal of one or both ovaries), and vagina vaginectomy.
What Are the Complications of Gender Affirmation Surgery?
Gender affirmation surgery involves different types of surgeries; each carries different complications. In bottom surgeries patients, the sexual sensation is changed. Or they may have trouble with bladder emptying. Other complications include bleeding, infection, and side effects of anesthesia.
Conclusion:
Gender affirmation surgeries are done in patients with gender dysphoria. Various transfeminine and transmasculine surgeries are available. It improves the patient's mental status and well-being. Most patients choose this surgery to improve their well-being. 94 % of patients have a positive effect after surgery. Few patients took consultation with mental health providers, and with their support, this patient achieved more positive results after surgery.
