The Psychological and Emotional Journey of Gender Affirmation Surgery

Gender affirming surgery is not only a physical transformation, but also an emotional one. This blog explains how to prepare for gender affirming surgery, provides an overview of some of the procedures, and offers resources for more information.

Gender affirmation surgery (GAS) is on the rise, with one study reporting that the number of patients undergoing GAS almost tripled between 2016 and 2020. The reason for the jump in numbers is unknown, though it may partly be attributed to laws requiring insurance coverage for patients seeking gender-affirming medical procedures.

Restore Medical Center is proud to offer transgender patients a safe and supportive environment staffed with skilled, board-certified surgeons who specialize in gender affirmation surgery. Below, we explore some of the surgical options offered at Restore and resources for patients navigating their journey to their true selves.

Preparing For Gender Affirming Surgery

The process of moving towards gender affirming surgery has several steps, all of which are designed to help you transition physically and emotionally and ensure that you have the community and support around you that you need.

Ideally, the first step in your journey should be working with a therapist specializing in gender identity. Support groups, whether online or in-person, are also helpful. As far as the first medical step towards gender affirming surgery, you’ll typically begin hormone replacement therapy under the supervision of a medical doctor.

Once you’ve decided that you’re ready for gender affirming surgery at Restore Medical Center, you’ll need to have the following items:

• A meeting with a gender therapist, who must write a letter in support of your surgery. In general, top surgery requires one evaluation, while bottom surgery requires two. Our staff at Restore can help you find a therapist well versed in gender identity.
• Insurance authorization, which the staff at Restore will handle for you.

Recovery from gender affirming surgery, whether chest or genital, requires an intensive period of rest and refraining from doing everyday activities. You will need to be ready to handle potential complications and have social or familial support in place to help with transportation to follow-up office visits, filling prescriptions, and other tasks as you recover. Finally, it is vital that you are emotionally prepared for the results of your surgery and have realistic expectations of the outcome.

Transmasculine and Transfeminine Top Surgery

Breast and chest procedures made up more than half of the 48,000 gender affirming surgeries performed between 2016 and 2020. Some of the options you will discuss with your surgeon include:

Transmasculine Top Surgery

Transmasculine top surgery is designed to give the patient a more masculine chest contour. Known as a subcutaneous mastectomy, transmasculine top surgery removes breast tissue, sculpting and refining the shape of the chest. Dr. Whitehead also reshapes and repositions the areola and nipple. In some cases, you may elect to have the nipples removed altogether for a more non-binary appearance. There are a number of different approaches that Dr. Whitehead may take to help you achieve your desired aesthetic. Though patients may read about these different approaches (double incision, periareolar, etc), not all options are available to all, if the best aesthetic possible is desired. Your body will tell Dr. Whitehead what approach is best. Dr. Whitehead will discuss this with you in consultation. If what you had in mind is different from what he recommends, he is open to discussing all options with you, and honoring your wishes as best as possible, while always keeping in mind that safety comes first! Come to your consultation open-minded.

Transfeminine Top Surgery

Transfeminine top surgery is designed to transform a masculine chest contour into a more feminine silhouette. The surgery uses breast implants to achieve this, and you will work with your surgeon to choose implants and decide on the best positioning. Every patient has unique requirements, and your surgical plan will be tailored to your needs and desires.

Transmasculine and Transfeminine Bottom Surgery

Gender-affirming genital procedures also increased between 2016 and 2020. One of the reasons could be the changes in insurance coverage, with Medicare and more private insurance companies covering gender affirming procedures. It may also be because more surgeons are trained to perform these procedures, given the increasing demand. Patients should be very aware of this—bottom surgeries (both trans masculine and trans feminine) are very difficult procedures, with many potential complications. Patients should ensure that whoever is operating on them is trained well and can achieve the desired outcome safely. Patients should seek surgeons who have done enough cases to understand all of the possible complications. Having surgery performed by an inexperienced surgeon is dangerous.

Transmasculine Bottom Surgery

Transmasculine bottom surgery (phalloplasty, metoidioplasty) usually requires a hysterectomy as the first step. Typically, the surgeons performing the hysterectomy and phalloplasty are different people, as these are different skill sets. While we do not perform phalloplasty, we can perform the first step en route to this procedure, which is a hysterectomy.

Transfeminine Bottom Surgery

Transfeminine bottom surgery refers to the variety of surgical methods used for the feminization of the perineum. During this surgery, male anatomy is transitioned to female anatomy. The penis, testicles, and scrotum are all removed. The urethra is shortened so that the patient may urinate in a more feminine nature. A vaginal canal may be created with depth so as to allow penetrative intercourse, or with minimal depth. With regard to vaginoplasty, there are two main things to consider:

• Full Vaginoplasty: allows for vaginal penetrative intercourse
• Minimal Depth Vaginoplasty: externally all will appear the same as full vaginoplasty. However, you will not be able to have vaginal penetrative sex. This is an option for those who do not desire vaginal penetration, or who can not tolerate the creation of a full vaginal canal for medical reasons.

Learn More About Gender Affirming Surgery in Miami

At Restore Medical Center, not only are you in the skilled and experienced hands of our surgeons, but you’re also in a place where you are cared for and safe to express on the outside who you are on the inside. All of our procedures are performed onsite in our accredited surgical center, ensuring your privacy and comfort from start to finish.

To schedule a consultation at Restore, call us today at 305.865.2000 or fill out our online contact form.

Resources For Patients Seeking Gender Reassignment Surgery

World Professional Association for Transgender Health

The World Professional Association for Transgender Health (WPATH) is an organization committed to furthering the “understanding and treatment of gender dysphoria by professionals” in a variety of fields, including medicine, psychotherapy, and a variety of other sociological fields. Their mission is to promote evidence-based care, education, research, public policy, and respect for transgender health.

To help transgender patients advocate for themselves and for professionals to navigate the changing parameters around care for transgender individuals, WPATH also publishes the Standards of Care and Ethical Guidelines.

Johns Hopkins Center for Transgender and Gender Expansive Health

The Johns Hopkins Center for Transgender and Gender Expansive Health, following the guidelines set forth by the WPATH standards of care, offers “comprehensive, evidence-based and affirming care for transgender youth and adults.”

To find resources to support the health and well-being of transgender and non-binary individuals, visit the Johns Hopkins Transgender Resources page. Resources include their Mental Health Evaluation for Surgical Readiness Criteria, giving patients an idea of the requirements for moving forward with gender-affirming surgery.

The Trevor Project

The primary mission of The Trevor Project is to “end suicide among lesbian, gay, bisexual, transgender, queer & questioning young people.” They offer 24/7 crisis services, and an online community. The Trevor Project also works to further advocacy, research, education, and public awareness. They seek to ensure that LGBTQ+ youth know they have options available to help them feel safe being who they are.