Surgical Options for Folks Assigned Female at Birth. Liam Gallagher

Transcription

1 Surgical Options for Folks Assigned Female at Birth Liam Gallagher

2 Agenda Making an informed decision Choosing your surgeon What is currently available? Understanding surgical options Preparing for surgery Post-op Recovery and aftercare Questions?

3 First things first Who is in the room? Providers, community members? Everybody is on their own journey. Every body heals differently. This is a judgement free space. Respect pronouns. Ask questions!

4 Have you had The Surgery? Not everyone wants to pursue surgical options. Dysphoria is not a uniform experience for all trans people. May only choose to have top or bottom. Financial concerns. Risks and complications. Reproductive capacity. Fear of rejection in dating or sexual experiences. Still trans even if you have not had any affirming surgeries. May not desire to change body at all. Fear of surgery or negative results. Pre-existing medical conditions.

5 What is Gender Affirming Surgery for AFAB Folks and why pursue it? Top surgery: Chest reconstruction Bottom surgery: Hysterectomy: Metoidioplasty Phalloplasty Facial Masculinization Ability to urinate standing up See yourself reflected in the mirror Physical relief from binding Require a lower dose of hormones Alleviate dysphoria Physical safety Ability to be read as true gender

6 Things to consider when choosing a surgeon: Cost $$$ Insurance coverage? Will limit surgeon choices Distance Hotel and travel costs Recovery time and postsurgical care Timeline Is there a waitlist? Testosterone Is it a requirement? Aesthetic and functional results Ask to see examples of similar body types or skin tones TransBucket Tumblr Facebook Surgeon reputation Bedside manner Therapist letter vs Informed consent

7 What are your priorities? Cost or Aesthetics? Insurance coverage? Is it worth the wait or distance for ideal surgeon? What about functionality? Bedside Manner Is it important that your surgeon is trans affirming and friendly? Complication rates Higher for specific procedures. What procedures are you eligible for? Are revisions free? How long do you have to stay local?!!

8 Surgery is HOW much?? Cost is often the number one barrier for accessing surgery Priority to housing, healthcare/hormones, name change Insurance Policy by policy for coverage, not just based on company *Some surgeons do not work with insurance* - may limit options Pay out of pocket Ask surgeon about financing plans Fundraising/crowdfunding CareCredit Some grant/scholarship/partnership programs Jim Collins Foundation

9 Top Surgery Removal of breast tissue -- usually includes male contouring Can include liposuction hips, flank and midsection Breast cancer history May be able to get insurance coverage, but can lead to tricky situations May not cover nipple grafts Not all tissue is removed, so will need to be aware May have drains Usually only have them for about a week taken out at post-op appt Usually will not be able to shower

10 Top Surgery Locating a Surgeon Ohio Dr. Daniel Medalie Dr. Steven Robinson Dr. Preston Ftmsurgery.net Things to consider: Scarring, sensation, nipple grafts Cost: $5,000 10,000 Recovery: 0-2 days overnight 1-7 days local 4-6 weeks

11 Top Surgery Common Procedures First -- consultation with surgeon Chest size Skin elasticity Body type Double incision With or without nipple grafts Lower chances of nipple sensation Peri/keyhole Typically B-cup or smaller May depend on skin elasticity

12 The Myth of the T-Rex Light stretching is recommended Allows your body to heal within your full range of motion Loosens tight muscles shoulders and neck NO HEAVY LIFTING Tension on incisions may cause stretching Know your limits and when to ask help Refrain from intense workouts for 6-8 weeks Or longer if your body tells you to wait!

13 What will my chest look like? Everyone heals differently You can expect your scars to heal similar to any past scars Can take actions to reduce scarring, but ultimately up to genetics Revisions Potential Complications May be desired for a variety of reasons Ask surgeon if they do them for free! many do Dog ears, keloid/hypertrophic scarring, excess tissue, nipple placement, tissue death 3 month guideline give yourself time to heal 6 weeks! 3 months 3 months! 6 months

14 Bottom Surgery Many people do not pursue Hysterectomy Salpingo-oopherectomy Metoidioplasty Vaginectomy Clitoral release Urethroplasty (lengthening) Scrotoplasty Phalloplasty Most expensive Priority to top surgery or hormones visibility Pleasure don t want to compromise function or satisfaction Risk of complications too high Other medical reasons Reproductive reasons

15 Hysterectomy/Salpingo-Oopherectomy Hysterectomy: Removal of the uterus May include the cervix Eliminate the need for pap smears Total HSO Includes uterus, fallopian tubes, and ovaries Cost: $6,000 8,000 Much easier to get insurance to cover May be done in combination with bottom surgery

16 Hysto Common Procedures Laparoscopic -- preferred method Several small incisions = minimal scarring Short recovery time Vaginal approach Little to no scarring Higher risk of complication Open abdominal One large incision Usually performed if uterus or ovaries are too large Longer recovery time

17 Hysterectomy/Salpingo-Oopherectomy Things to consider: Risk of gynecologic cancers Testosterone usage and recommendations Reproductive considerations Recovery time varies 2-3 days in the hospital Usually require a catheter 2-6 weeks of limiting activity 6-8 weeks of no sexual penetration

18 Metoidioplasty Clitoris/phallus length is increased without grafting tissue from other parts of the body Phallus is freed from labia minora and suspensory ligament Average size: 1 3 inches Recommended to be on testosterone 1-2 years Must have a significant amount of growth from hormones Will not have huge gains max 50% increase Slightly lengthens and straightens the phallus Labia minora can be used to add girth to underside of phallus

19 Metoidioplasty options Simple Meta Clitoral release Ring or Full Meta Depends on desired results Centurion Gives a more natural appearance Limits surgeon option Vaginectomy: Removal of all or part of the vagina Urethroplasty: Extension of urethra to STP Scrotoplasty: Creation of testicular sac; implants Mons resection: Reduce pubic fat and frontate genitals All are optional

20 Metoidioplasty Different surgeons may be required to do specific parts Often requires multiple stages may be able to group together to reduce costs Cost: $5,000 15,000 Without urethral lengthening, much less expensive Simple meta Scrotoplasty -- $6,000 Recovery: 1-7 days overnight or local 2-3 weeks off work 6 weeks no heavy lifting

21 Phalloplasty Creation of a phallus using grafted skin Donor sites vary sensation and aesthetics Forearm, thigh, back, leg, abdomen, hip/groin Usually done in 2 3 stages Stage 1: creation of phallus Stage 2: implants added Erectile and testicular Improving technology for erectile devices Stage 3: glansplasty for aesthetics

22 Phalloplasty Radial Forearm Flap (RFF) Most common Most sensation Large forearm scar Anterolateral Thigh Flap (ALT) Less visible scarring Can be done in combination with RFF to maximize sensation Musculocutaneous Latissimus Dorsi Flap (MLD) Least visible scarring Usually less sensitive than ALT and RFF Largest results! Abdominal Microsurgeon.org No urethroplasty or vaginectomy required Tactile sensation, no erotic sensation No microsurgery = least expensive!

23 Phalloplasty Different surgeons may be required to do specific parts May be able to group together to reduce costs Cost: $30, ,000 Depending on procedure Recovery: 5 7 days overnight in hospital 3 4 weeks local 6-8 weeks before returning to work

24 Meta vs Phallo? Meta: Small size Option to STP Minimal scarring Full sensation Vaginectomy optional Phallo: Average to large size STP Large scarring Forearm, thigh Sensation at base where clitoris was buried May have full sensation if nerve is able to be connected Vaginectomy required

25 Risks and complications Less than anticipated length Loss of sensation Tissue necrosis Localized infection Persistent tenderness or hypersensitivity Urethral obstruction Urethral fistula (leakage of urine anywhere along the pathway of urethral extension) Always talk with your surgeon about possible risks and be prepared for complications.

26 Preparing for surgery Change in diet/exercise May help surgeon contour body Smoking Tobacco! at least 4-6 weeks before surgery Pre-op Appointment Discuss goals and ask questions! Lab work or physical may be required May need a therapist or primary care letter Practice limiting your range of motion for daily tasks Adjust sleeping patterns Removal of hair on graft sites

27 Surgery Day Full anesthesia If sensitive, tell anesthesiologist and they can help prevent/reduce nausea Outpatient or Inpatient How long do you need to stay local? Recommended things to bring: A buddy/friend/partner/family member! Post-op compression garments, comfort foods/snacks, water, comfy clothes, pillow and blanket, baby wipes, straws

28 Post-op Recovery Will need a caretaker Recovery periods vary Few days to weeks No driving May need extended time off of work Will have instructions from surgeon for aftercare Dressings over nipples, steri-strips along incision lines Bottom surgery recovery is extensive May need a local doctor if you had to travel and experience complications Bruising, swelling, and tenderness is common Watch for signs of infection

29 Long-term Aftercare Time is the best remedy Scars will go through lots of changes Massage, massage, massage More important than using expensive scar treatments* Breaks down scar tissue Scar care Lotion, cocoa butter, vitamin E oil, homemade remedies Scarguard, Bio-Oil Silicone sheets Sunscreen

30 Questions? Thanks for coming! Liam Gallagher Resources Used: ftmguide.org topsurgery.net genderconfirmation.com openmindedhealth.com/transgender-101-trans-people rainbowhealthontario.ca Trans Care Gender Transition Surgery: A Guide for FtMs