FTM Surgery

Transgender men are people whose gender identity is that of a man however they are assigned female at birth. If you are a transgender male who wants to go through with gender-affirmation surgery- that could include both top and bottom surgery. If you are also feeling gender dysphoria because of your facial hair and such, you can also go ahead with facial procedures.

Note: This article is just to inform you of the procedures and should not be treated as a final opinion. You should consult a Trans-friendly doctor before taking up your gender-confirmation surgery.

FIRST STEP 

  • Before you can go through with the surgery, you need to get a GD (Gender Dysphoria) certificate from a psychiatrist. The fees may vary and the psychiatrist might ask you to take a psychological evaluation or meet an endocrinologist beforehand. As there is no standard procedure here, it is extremely easy to meet a transphobic psychiatrist who tries conversion therapy on you. So keep yourself safe. 
  • The next step would be to go to an endocrinologist so you can get a head start on your HRT (Hormone Replacement Therapy) pills. There might be general check-ups, especially some blood tests just so they can ensure that your body is ready. This would range anywhere between 1.5k- 5k.
  • Lastly, a psychiatrist will give you a surgery letter to deem you mentally and physically fit for going through the surgery. 

If you are deemed ready after all this-

First things first, you would need to consult a Trans-friendly surgeon, and a plastic surgeon if you need the facial procedures as well.

TOP SURGERY

Top surgery is also known as mastectomy and is typically the first—and sometimes the only—surgical procedure performed for the transman patient who is transitioning. To get a flat chest, doctors would have to remove the breast tissue from your body. Depending on how your chest is, there are different procedures that doctors would choose.

  1. Bilateral mastectomy with free nipple grafts: This removes essentially all of the breast tissue, including milk ducts, and excess skin, along with proper placement and downsizing of the nipples. It is utilized most frequently because the majority of patients present with a combination of excess skin and a naturally low nipple position. It could take from about 60k to 1.7 lakhs. 
  2. Keyhole technique: The peri-areolar, or “keyhole” technique consists of breast tissue removal through a small incision around the nipple. This technique has significantly reduced scarring. However, a suitable candidate for this type of mastectomy is typically the young, slim patient with a small amount of breast tissue, no excess skin, and a nipple position that does not require modification.
  3. There could also be a need to move and shrink the areolas. This would need incisions and would be pretty invasive. Larger chests would require a “double incision” to save the pectoralis major muscle, which is a defining characteristic of the male chest.
  4. Patients who have a very large amount of breast tissue or chest wall fat tissue may benefit from combining lateral chest wall liposuction with their mastectomy.
  5. If on the other hand, you have smaller breasts, it is possible to just do liposuction. This would mean that there would be no incisions.

BOTTOM SURGERY

  1. Phalloplasty: A multi-staged procedure including:
  • Creating a penis: There are three primary types of skin flaps the surgeon is able to use to create the penis. 

 (i) Radial forearm free flap (arm)- Takes the skin, fat, nerves, arteries, and veins from your wrist to about halfway up your forearm to create the penis.

 (ii) Anterolateral thigh flap (leg)-  Involves the skin, fat, nerves, arteries, and veins from your leg to create a penis.

 (iii) Musculocutaneous latissimus dorsi flap (side) – Involves the skin, fat, nerves, arteries, and veins from the side of your back to create a penis.

  • Lengthening the urethra if you want to stand while urinating. It involves connecting the native urethra to the new urethra created in the shaft of the penis.
  • Creating the tip (glans) of the penis
  •  Creation of the scrotum
  • Removal of the vagina
  • Placing erectile and testicular implants.
  1. Metoidioplasty takes your existing genital tissue and makes it longer, turning it into a defined phallus. It is a less-extensive procedure than phalloplasty and is performed after the clitoris has been enlarged through the use of testosterone therapy.
  2. You may or may not want to also have an operation to remove your internal reproductive organs. 

 (i) A hysterectomy takes out your uterus, fallopian tubes, and ovaries.

 (ii) Oophorectomy is a broad term for a medical procedure that removes one or both ovaries. There are various ways to go through with it and it will depend on what you want to do finally.

FACIAL MASCULINISATION

Through a combination of procedures, your chin, jaw, and cheeks can be sculpted to make it appear more masculine.  Your nose can be reshaped and make your Adam’s apple look bigger.

COST

In India, in private clinics, FTM Surgery would cost onwards of Rs. 4 to 8 lakhs. Even though the cost of SRS is free in both central and state-run hospitals, most Trans people have felt like the environment is extremely Transphobic. Also, it is almost impossible to get a session when you desire. 

Added with this would be the first year of therapy which would include two to four sessions a month which can cost Rs 1,000 to Rs 1,500 per session, bringing the total cost to Rs 48,000 to Rs 72,000.

Problems

Female to male surgery usually achieve lesser success rates due to the difficulty of creating a functioning penis from the much smaller clitoral tissue available in the female genitals.  

Top Surgery is a very safe procedure. Possible complications are just regular surgery complications that include bruising, swelling, nausea and vomiting, blood clots, infection, seroma (i.e., fluid build-up), and poor reaction to the anaesthesia.

People wonder if their breasts will “grow back” if they gain weight.  Because this procedure removes the actual breast tissue (rather than just fat tissue), patients would have to gain a substantial amount of weight for the chest to recover a feminine appearance. Keep in mind that the results of top surgery are considered permanent and are not reversible.

If you are still unsure about surgery, you can take hormone pills and also lean on psychiatric help to figure out if you want to go through with gender confirmation surgery. But if you do go through with surgery, we hope this article serves as a helpful guide. 

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