Comparing Sex Before & After Surgery
The Transgender Dating Dilemma
3 Oct Maddy McKenna is a trans woman who got a sex change operation when she was Before my surgery, on average, I had to spend 20 minutes every morning cutting out strips of duct tape, wrapping my penis in toilet paper, taking that tape, sticking it from . Images: Giphy (5); courtesy of the author (7). 26 Jul After consultation with my Generals and military experts, please be advised that the United States Government will not accept or allow. Sources: American Psychological Association; The Associated Press; The Philadelphia Center for Transgender Surgery (AP Photo/U.S. Army, File) Associated Press. 7 Oct We're the dirty little secrets who get calls only after hours. No matter how beautiful , intelligent, or successful, we are the ones who have to settle for being nothing more than receptacles for men's desires and insecurities. I imagined the worst, but I said it anyway. “I'm a transgender woman.” I emphasized the.
In female-to-male transsexuals, the operative procedures are usually performed in different stages: The next operative procedure consists of the genital transformation and includes a vaginectomy, a reconstruction of the horizontal part of the urethra, a scrotoplasty and a penile reconstruction usually with a radial forearm flap or an alternative.
After about one year, penile erection prosthesis and testicular prostheses can be implanted when sensation has returned to the tip of the penis. The authors provide a state-of-the-art overview of the different gender reassignment surgery procedures that can be performed in a female-to-male transsexual. Transsexual patients have the absolute conviction of being born in the wrong visit web page and this severe identity problem results in a lot of suffering from early childhood on.
Although the exact etiology of transsexualism is still not fully understood, it is most probably a result of a combination of various biological and psychological factors. Gender reassignment usually consists of a diagnostic phase mostly supported by a mental health professionalfollowed by hormonal therapy through an endocrinologista real-life experience, and at the end the gender reassignment surgery itself.
Incredible Before And After Pictures Of Transgender People
It is usually advised to stop all hormonal therapy 2 to 3 weeks preoperatively. Because hormonal treatment has little influence on breast size, the first and, arguably, most important surgery performed in the female-to-male FTM transsexual is the creation of a male chest by means of a SCM. The goal of the SCM in a FTM transsexual patient is to create an aesthetically pleasing male chest, which includes removal of breast tissue and excess skin, reduction and proper positioning of the nipple and areola, obliteration of the inframammary fold, and minimization of chest-wall scars.
In the largest series to date, Monstrey et al 6 described an algorithm of five different techniques to perform an aesthetically satisfactory SCM Fig.
What is the difference between transgender and transsexual?
Preoperative parameters to be evaluated include breast volume, degree of excess skin, nipple-areola complex NAC size and position, and skin elasticity. Regardless of the technique, it is extremely important to preserve all subcutaneous fat when dissecting the glandular tissue from the flaps. This ensures thick flaps that produce a pleasing contour.
Liposuction is only occasionally indicated laterally, or to attain complete symmetry at the end of the procedure.
Postoperatively, a circumferential elastic bandage is placed around the chest wall and maintained for a total of 4 to 6 weeks. The semicircular technique Fig. It is useful for individuals with smaller breasts and elastic skin. A sufficient amount of glandular tissue should be left in situ beneath the NAC to avoid a depression.
The particular advantage of this technique is the small and well-concealed scar which is confined to the lower half of the nipple-areola complex. The major drawback is the small window through which to work, making excision of breast tissue and hemostasis more challenging. In cases of smaller breasts with large prominent nipples, the transareolar technique Fig. This is similar to the procedure described by Pitanguy in 8 and allows for subtotal resection and immediate reduction of the nipple.
The resulting scar traverses the areola horizontally and passes around the upper aspect of the nipple. Alternative Dating Transsexual Surgery Before And After Photos concentric circular technique Fig. The resulting scar will be confined to the circumference of the areola. The concentric incision can be drawn as a circle or ellipse, enabling deepithelialization of a calculated amount of skin in the vertical or horizontal direction.
A purse-string suture is placed and set to the desired areolar click at this page usually 25—30 mm.
The extended concentric circular technique Fig. This technique is useful for correcting skin excess and wrinkling produced by large differences between the inner and outer circles. The resulting scars will be around the areola, with horizontal extensions onto the breast skin, depending on the degree of excess skin. The free nipple Alternative Dating Transsexual Surgery Before And After Photos technique Fig.
Our preference is to place the incision horizontally 1 to 2 cm above the inframammary fold, and then to move upwards laterally below the lateral border of the pectoralis major muscle.
The placement of the NAC usually corresponds to the 4th or 5th intercostal space. Clinical judgment is most important, however, and we always sit the patient up intraoperatively to check final nipple position.
The advantages of the free nipple graft technique are easy chest contouring, excellent exposure and more rapid resection of tissue, as well as nipple reduction, areola resizing, and repositioning. The disadvantages are the long residual scars, NAC pigmentary and sensory changes, and the possibility of incomplete graft take.
Postoperative complications include hematoma most frequent, despite drains and compression bandagespartial nipple necrosis, and abscess formation.
This underscores the importance of achieving good hemostasis intraoperatively. Smaller hematomas and seromas can be evacuated through puncture, but for larger collections surgical evacuation is required.
Another not infrequent complication consists of skin slough of the NAC, which can be left to heal by conservative means. The exceptional cases of partial or total nipple necrosis may require a secondary nipple reconstruction.
The likelihood of an additional aesthetic correction should be discussed with the patient in advance. The recommendations of the authors are summarized in their algorithm Fig.
The FTM transsexual patients are rightfully becoming a patient population that is better informed and more demanding as to the aesthetic outcomes. Finally, it is important to note that there have been reports of breast cancer after bilateral SCM in this population 14Alternative Dating Transsexual Surgery Before And After Photos16 because in most patients the preserved NAC and the always incomplete glandular resection leave behind tissue at risk of malignant transformation.
In performing a phalloplasty for a FTM transsexual, the surgeon should reconstruct an aesthetically appealing neophallus, with erogenous and tactile sensation, which enables the patient to void while standing and have sexual intercourse like a natural male, in a one-stage procedure. Despite the multitude of flaps that have been employed and described often as Case Reportsthe radial forearm is universally considered the gold standard in penile reconstruction.
In the largest series to date almost patientsMonstrey et al 29 recently described the technical aspects of radial forearm phalloplasty and the extent to which this technique, in their hands approximates the criteria for ideal penile reconstruction. For the genitoperineal transformation vaginectomy, urethral reconstruction, scrotoplasty, phalloplastytwo surgical teams operate at the same time with the patient first placed in a gynecological lithotomy position. In the perineal area, a urologist may perform a vaginectomy, and lengthen the urethra with mucosa between the minor labiae.
The vaginectomy is a mucosal colpectomy in which the mucosal lining of the vaginal cavity is removed. After excision, a pelvic floor reconstruction is always performed to prevent possible diseases such as Alternative Dating Transsexual Surgery Before And After Photos and rectocele. This reconstruction of the fixed part of the urethra is link with a scrotal reconstruction by means of two transposition flaps of the greater labia resulting in a very natural looking bifid scrotum.
Simultaneously, the plastic surgeon dissects the free vascularized flap of the forearm. The creation of a phallus with a tube-in-a-tube technique is performed with the flap still attached to the forearm by its vascular pedicle Fig.
This is commonly performed on the ulnar aspect of the skin island. A small skin flap and a skin graft are used to create a corona and simulate the glans of the penis Fig. Once the urethra is lengthened and the acceptor recipient vessels are dissected in the groin area, the patient is put into a supine position. The free flap can be transferred to the pubic area after the urethral anastomosis: One forearm nerve is connected to the ilioinguinal nerve for protective sensation and the other nerve of the arm is anastomosed to one of the dorsal clitoral read article for erogenous sensation.
The clitoris is usually denuded and buried underneath the penis, thus keeping the possibility to be stimulated during sexual intercourse with the neophallus. In the first 50 patients of this series, the defect on the forearm was covered with full-thickness skin grafts taken from the groin area. In subsequent patients, the defect was covered with split-thickness skin grafts harvested from the medial and anterior thigh Fig.
Procedures After nasal surgery, here modification and tracheal shave. Two-stage versus one-stage sex reassignment surgery in female-to-male transsexual individuals. This is evident in the many YouTube videos in which teen-agers chronicle their transitions. The World Professional Association for Transgender Health, in its latest guidelines, still recommends that Americans wait until eighteen for genital surgery, but says that chest surgery may be done earlier. This underscores the importance of achieving good hemostasis intraoperatively.
The patients remain in bed during a one-week postoperative period, after which the transurethral catheter is removed. At that time, the suprapubic catheter was clamped, and voiding was begun.
TRANSGENDER Q&A (Surgery, Dating, & More)
Effective voiding might not be observed for several days. Before removal of the suprapubic catheter, a cystography with voiding urethrography was performed. Tattooing of the glans should be performed after a 2- to 3-month period, before sensation returns to the penis. Implantation Alternative Dating Transsexual Surgery Before And After Photos the testicular prostheses should be performed after 6 months, but it is typically done in combination with the implantation of a penile erection prosthesis.
Before these procedures are undertaken, sensation must be returned to the tip of the penis. This usually does not occur for at least a year. What can be achieved with this radial forearm flap technique as to the ideal requisites for penile reconstruction?
InHage 20 stated that a click here penile reconstruction with erection prosthesis never can be performed in one single operation. Monstrey et al, 29 early in their series and to reduce the number of surgeries, performed a sort of all-in-one procedure that included a SCM and a complete genitoperineal transformation.
However, later in their series they performed the SCM first most often in combination with a total hysterectomy and ovariectomy.
When I asked him about difficult moments as a kid, he thought for a minute and then mentioned a school assembly at which a magician asked for male volunteers. Now, what do you want to be when you grow up? In the nineteen-tens, German and Austrian scientists interested in the new field of endocrinology began attempting to change the sex of animals. The trans community is eclectic so maybe I could encourage you to be a better advocate than Caitlyn? Men in relationships with pre op or never having the op transgirls do the same or may find that girls with a little extra are more fun to be around for a variety of reasons.
Phallic construction has become predictable enough to refine its aesthetic goals, which includes the use of a technique that can be replicated with minimal complications. In this respect, the radial forearm flap has several advantages: The final cosmetic outcome of a radial forearm phalloplasty is a subjective determination, but the ability of most patients to shower with other men or to go to the sauna is the usual cosmetic barometer Fig. The potential aesthetic drawbacks of the radial forearm flap are the need for a rigidity prosthesis and possibly some volume loss over time.
Of the various flaps used for penile reconstruction, the radial forearm flap has the greatest sensitivity. The denuded clitoris was always placed directly below the phallic shaft. Later manipulation of the neophallus allows for stimulation of the still-innervated clitoris.
After one year, all patients had regained tactile sensitivity in their penis, which is an absolute requirement for safe insertion of an erection prosthesis. For biological males as well as for FTM transsexuals undergoing a phalloplasty, the ability to void while standing is a high priority. Complications following phalloplasty include the general complications attendant to any surgical intervention such as minor wound healing problems in the groin area or a few patients with a minor pulmonary embolism despite adequate Alternative Dating Transsexual Surgery Before And After Photos interrupting hormonal therapy, fractioned heparin subcutaneously, elastic stockings.
A vaginectomy is usually considered a particularly difficult operation with a high risk of postoperative bleeding, but in their series no major bleedings were seen. This was more often the case in smokers, in those who insisted on a large-sized penis requiring a larger flap, and also in patients having undergone anastomotic revision.
With smoking being a significant risk factor, under our current policy, we no longer operate on patients who fail to quit smoking one year prior to their surgery. The major drawback of the radial forearm flap has always been the unattractive donor site scar on the forearm Fig. Selvaggi et al conducted a long-term follow-up study 38 of radial forearm phalloplasties to assess the degree of functional loss and aesthetic impairment after harvesting such a large forearm flap.
An increased donor site morbidity was expected, but the early and late complications did not differ from the rates reported in the literature for the smaller flaps as used in head and neck reconstruction. Finally, with regard to the aesthetic outcome of the donor site, they found that the patients were very accepting of the donor site scar, viewing it as a worthwhile trade-off for the creation of a phallus Fig.
For the FTM patient, the goal of creating natural-appearing genitals also applies to the scrotum. As the labia majora are the embryological counterpart of the scrotum, many previous scrotoplasty techniques left the hair-bearing labia majora in situ, with midline closure and prosthetic implant filling, or brought the scrotum in front of the legs using a V-Y plasty.
These techniques were aesthetically unappealing and reminiscent of the female genitalia. Selvaggi in reported on a novel scrotoplasty technique, please click for source combines a V-Y plasty with a degree turning of the labial flaps resulting in an anterior transposition of labial skin Fig. The excellent aesthetic outcome of this male-looking anteriorly located scrotum, the functional advantage of fewer urological complications and the easier implantation of testicular prostheses make this the technique of choice.
In a radial forearm phalloplasty, the insertion of erection prosthesis is required to engage in sexual intercourse.