Gender Reassignment Surgery – Female to male

A Hysterectomy is a surgery performed by a Gynecologist to remove the uterus of a woman. The uterus is the core of the reproductive system in a woman. It is the womb in which a baby grows and is nurtured by the body for nine months before birth.

However, when a patient wishes to transition from Female to Male gender, the uterus needs to be removed. This is done through a Laparoscopic Hysterectomy, wherein the doctor makes keyhole incisions on your tummy and removes the uterus while simultaneously performing a Salpingo-Oophorectomy (removal of ovaries and fallopian tubes). Once both these procedures are completed, the incision will be closed.

The procedure takes about 1-2 hours and is considered safe. It is performed under general anesthesia. It is a day care procedure, and the patient can leave the hospital after a few hours of the surgery. After the surgery, the patient will stop getting periods and will be unable to bear children.

The Female to Male transition encompasses all aspects of the body and the physique of the patient. A female has large breasts, whereas males have flatter, more muscular chests. Therefore, when a patient is changing from Female to Male gender, the Plastic surgeon performs a “Top Surgery” for Chest Masculinization. This surgery is also called Chest Reconstruction Surgery or Subcutaneous Mastectomy.

The primary purpose of this surgery is to remove the excess breast tissue, fat, and skin from the chest and reshape it to make it look flat and masculine. This surgery helps patients in feeling more aligned with the male gender.

The surgery includes aspects of liposuction, mastectomy, and chest contouring. This procedure should be performed only by skilled Plastic Surgeons. In this surgery, the doctor will reshape the chest and reposition the nipple and areola to best fit the new shape and size of the chest.

The Chest Masculinization surgery significantly affects the looks of the patient who is transitioning from F to M. The Chest surgery makes them feel more confident and in tune with their new gender identity.

The female genitalia and male genitalia are completely different from one another. When a patient is moving from one gender to another, it is essential that, along with cosmetic changes, this part of his body is also in sync with the new gender.

This is where Phalloplasty comes into the picture. Phalloplasty is one of the most important surgeries that happen during the transition from Female to Male in SRS. It is a surgery done to construct a functioning penis for the transitioning patient.

In this surgical procedure, the cosmetic surgeon builds a penis for the patient by using tissue from a donor area of the body. The purpose is to construct a penis that is both aesthetic and functional. The doctor typically uses a skin flap from areas such as the forearms, thighs, abdomen, or upper back for this surgery. Then this tissue is used to create an elongated urethra and the shaft of the penis, allowing urine to flow from the tip of the penis. The penis created by Phalloplasty is also capable of sexual stimulation.

This is a complex surgery performed under general anesthesia. The most preferred technique is called Radial Forearm Free Flap Phalloplasty, where the skin and tissue from the forearm are used for the construction of the penis.

Metoidioplasty is considered an alternative to the popular Phalloplasty in SRS. The main aim of Metoidioplasty is elongating the clitoris into a penis. This surgery can be performed after the patient undergoes hormone therapy for 1-2 years, ensuring that the clitoris begins growing longer naturally.

During Metoidioplasty, the Cosmetic Surgeon uses the tissue from the vagina to create a penis. No other skin grafts are used in Metoidioplasty. However, the penis built using this surgery is smaller in length and girth compared to Phalloplasty. The sexual virility of the penis is also not as effective as Phalloplasty. Hence, most patients opt for Phalloplasty over Metoidioplasty.

Scrotoplasty is a part of the “bottom” surgeries in FTM SRS. It is a procedure in which the Cosmetic Surgeon uses the skin and tissue of the labia majora (woman’s genital area) to create a scrotum. A scrotum is a male reproductive organ that provides protection to the testicles. While a transitioning patient cannot produce sperm, after Scrotoplasty, the doctor can insert testicular (silicone) implants to make the scrotum appear natural and fuller.

Scrotoplasty is a relatively small and safe procedure performed on an outpatient basis under anesthesia.

Buttock Masculinization Surgery is a crucial component of Gender Reassignment Surgery for patients transitioning from Female to Male. The difference in buttock shape between males and females necessitates this procedure. Females typically have curvier, more angular buttocks, while males have flatter buttocks.

During this surgery, the Plastic Surgeon utilizes Liposuction to eliminate excess fat, skin, and tissue from the patient’s buttocks. The surgeon then skillfully reshapes the buttocks to create a more masculine appearance, achieving a proportionate transformation. Patients who have undergone this surgery report increased confidence in embracing their new lives as males.

This is considered an outpatient procedure and is conducted under general anesthesia.

The face is one of the most prominent features of an individual’s identity. When a patient is undergoing Gender Reassignment Surgery to transition from Female to Male, it’s essential to perform specific procedures to ensure their appearance aligns with the male gender.

There are several surgeries categorized as Facial Masculinization Procedures:

1. Forehead Lengthening:
   • In males, the forehead is larger, and the hairline starts higher than in females. Therefore, patients transitioning to the male gender require forehead lengthening surgery.
2. Rhinoplasty:
   • Rhinoplasty is performed to alter the appearance of the nose from feminine to masculine.
   • The surgery widens the patient’s nose and reduces its angularity to achieve a natural, masculine look.
   • Incisions are made inside the nose to reshape it aesthetically.
3. Cheek Shaping Surgery:
   • Male cheeks are typically lower and have a more rugged appearance, while female cheeks are softer and curvier.
   • Cheek shaping surgery involves incisions inside the mouth to insert cheek implants (either silicone or fat transfer) beneath the outer tissue layer.
   • The surgeon contours the cheeks to appear chiseled and angular, in line with male characteristics.
4. Chin Augmentation:
   • Genioplasty/Mentoplasty is a surgical procedure that alters the shape and size of the patient’s chin.
   • Males usually have wider, more protruding chins with square angles, while females have smaller, more curved chins.
   • Genioplasty widens the existing chin structure to achieve a more aesthetically pleasing appearance for the patient’s male body.
   • In some cases, chin implants may be used to enhance chin size, especially if the jawline is too narrow.
5. Jaw Shaping Surgery:
   • Similar to forehead lengthening, jaw shaping surgery transforms the lower part of the patient’s face.
   • It quickly changes feminine features into masculine ones, completing the overall facial masculinization.