XVII Harry Benjamin International Gender Dysphoria Association Symposium
31 October - 4 November 2001, Galveston, Texas, U.S.A.

Procedures and Issues Related to Female or Male Gender Reassignment Surgery

MELTZER, TOBY U.S.A.

Surgeons performing female to male gender reassignment surgery must be able to present all options, risks and alternatives to the proposed patient. Equally important is careful preoperative screening and optimal postoperative care. Though the majority of female to male patients come very well prepared and have done their homework carefully, they still need a surgeon that will listen attentively to their wants and needs and explain the pros and cons of each procedure. Working with female to male patients is very rewarding yet frustrating, as we have yet to come up with the ideal lower surgery procedure. Techniques for female to male upper (chest surgery) are relatively straightforward and routine. The type of procedure performed is dictated primarily by breast size, integrity of skin and the amount of droop to the breast. One challenge to chest surgery on a patient with large, droopy breasts is providing an adequate explanation and understanding that it is unlikely for the procedure to be performed without scars. Procedures to be discussed are liposuction alone; liposuction and excision; liposuction with excision and skin reduction; and excision with free nipple grafts. Lower surgery (phalloplasty, metaidoioplasty) has immediate disadvantages due to deficiency of tissue. It is further complicated by a lack of an ideal procedure. Procedures available that will be discussed are the metaidoioplasty, the tube and other insensate phalloplasty flaps, the radial forearm free flap phalloplasty and urethral lengthening. Each available procedure has its own limitations and risk. It is critical that the prospective patients be made aware of these and makes an informed decision. Equally critical is the need for the surgeon to dissuade a prospective patient of procedures that may not be appropriate. In addition, lower surgery requires coordination by a team of surgeons involving a plastic surgeon, urologist and gynecological surgeon. Surgeons must be aware of their limitations and refer to other surgeons as necessary to meet the unique needs and wants of each prospective patient.