Cosmetic Plastic Surgery

Genital surgery

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The array of medically indicated surgeries differs between trans women (male to female) and trans men (female to male). For trans women, genital reconstruction usually involves the surgical construction of a vagina, by means of penile inversion or the sigmoid colon neovagina technique; or, more recently, non-penile inversion techniques that make use of scrotal tissue to construct the vaginal canal. For trans men, genital reconstruction may involve construction of a penis through either phalloplasty or metoidioplasty. For both trans women and trans men, genital surgery may also involve other medically necessary ancillary procedures, such as orchiectomy, penectomy, mastectomy or vaginectomy. Complications of penile inversion vaginoplasty are mostly minor; however, rectoneovaginal fistulas (abnormal connections between the neovagina and the rectum) can occur in about 1–3% of patients. These require additional surgery to correct and are often fixed by colorectal surgeons.

As underscored by WPATH, a medically assisted transition from one sex to another may entail any of a variety of non-genital surgical procedures, any of which are considered "sex reassignment surgery" when performed as part of treatment for gender dysphoria. For trans men, these may include mastectomy (removal of the breasts) and chest reconstruction (the shaping of a male-contoured chest), or hysterectomy and bilateral salpingo-oophorectomy (removal of ovaries and Fallopian tubes). For some trans women, facial feminization surgery, hair implants, and breast augmentation are also aesthetic components of their surgical treatment.

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Male-to-female sex reassignment surgery

At the Safe Urology, participants of the Comprehensive Gender Services Program who are ready for a male-to-female sex reassignment surgery will be offered a penile inversion vaginoplasty with a neurovascular neoclitoris.

During this procedure, a surgeon makes “like become like,” using parts of the original penis to create a sensate neo-vagina. The testicles are removed, a procedure called orchiectomy. The skin from the scrotum is used to make the labia. The erectile tissue of the penis is used to make the neoclitoris. The urethra is preserved and functional.

This procedure provides for aesthetic and functional female genitalia in one 4-5 hour operation.  The details of the procedure, the course of recovery, the expected outcomes, and the possible complications will be covered in detail during your surgical consultation. 

Female-to-male sex reassignment
At the Safe Urology, participants of the Comprehensive Gender Services Program who are ready for a female-to-male sex reassignment surgery will be offered a phalloplasty, generally using the radial forearm flap method. 

This procedure, which can be done at the same time as a hysterectomy/vaginectomy, creates an aesthetically appropriate phallus and creates a urethera for standing urination.  Construction of a scrotum with testicular implants is done as a second stage.  The details of the procedure, the course of recovery, the expected outcomes, and the possible complications will be covered in detail during your surgical consultation.

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What’s an orchiectomy?

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An orchiectomy is surgery done to remove one or both of your testicles. It’s commonly performed to treat or prevent prostate cancer from spreading.

An orchiectomy can treat or prevent testicular cancer and breast cancer in men, too. It’s also often done before sexual reassignment surgery (SRS) if you’re a transgender woman making the transition from male to female.

Read on to learn more about the different types of the orchiectomy procedure, how the procedure works, and how to take care of yourself after you’ve had the procedure done.

 

What are the types of orchiectomy?

There are several types of orchiectomy procedures depending on your condition or the goal that you’re trying to reach by having this procedure done.

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Simple orchiectomy

One or both testicles is removed through a small cut in your scrotum. This may be done to treat breast cancer or prostate cancer if your doctor wants to limit the amount of testosterone that your body makes.

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Radical inguinal orchiectomy

One or both testicles is removed through a small cut in the lower part of your abdominal area instead of your scrotum. This may be done if you’ve found a lump in your testicle and your doctor wants to test your testicular tissue for cancer. Doctors may prefer to test for cancer using this surgery because a regular tissue sample, or biopsy, can make cancer cells more likely to spread.

This type of surgery may also be a good option for a transition from male to female.

Subcapsular orchiectomy

The tissues around the testicles are removed from the scrotum. This allows you to keep your scrotum intact so that there’s no outward sign that anything has been removed.

Bilateral orchiectomy

Both testicles are removed. This may be done if you have prostate cancer, breast cancer, or are transitioning from male to female.

 

Who’s a good candidate for this procedure?

Your doctor may do this surgery to treat breast cancer or prostate cancer. Without the testicles, your body can’t make as much testosterone. Testosterone is a hormone that can cause prostate or breast cancer to spread more quickly. Without testosterone, the cancer may grow at a slower rate, and some symptoms, such as bone pain, may be more bearable.

Your doctor may recommend orchiectomy if you’re in generally good health, and if the cancer cells have not spread beyond your testicles or far beyond your prostate gland.

You may want to do an orchiectomy if you’re transitioning from male to female and want to reduce how much testosterone your body makes.

 

How effective is this procedure?

This surgery effectively treats prostate and breast cancer. You can try hormone therapies with antiandrogens before considering an orchiectomy, but these can have side effects, including:

• damage to your thyroid gland, liver, or kidneys

• blood clots

• allergic reactions

 

How do I prepare for this procedure?

Before an orchiectomy, your doctor may take blood samples to make sure you’re healthy enough for surgery and to test for any indicators of cancer.

This is an outpatient procedure that takes 30-60 minutes. Your doctor may use either local anesthesia to numb the area or general anesthesia. General anesthesia has more risks but lets you remain unconscious during the surgery.

Before the appointment, be sure that you have a ride home. Take a few days off work and be ready to limit your amount of physical activity after the surgery. Tell your doctor about any medications or dietary supplements that you’re taking.

 

How is this procedure done?

First, your surgeon will lift your penis and tape it to your abdomen. Then, they’ll make an incision either on your scrotum or the area right above your pubic bone on your lower abdomen. One or both testicles are then cut out from the surrounding tissues and vessels, and removed through the incision.

Your surgeon will use clamps to prevent your spermatic cords from gushing blood. They may put in a prosthetic testicle to replace the one that’s removed. Then, they’ll wash the area with a saline solution and sew the incision shut.

 

What’s recovery like for this procedure?

You should be able to go home a couple hours after an orchiectomy. You’ll need to return the next day for a checkup.

For the first week after an orchiectomy:

• Wear a scrotal support for the first 48 hours after the surgery if instructed to by your doctor or nurse.

• Use ice to reduce swelling in your scrotum or around the incision.

• Wash the area gently with a mild soap when you bathe.

• Keep your incision area dry and covered in gauze for the first few days.

• Use any creams or ointments following your doctor’s instructions.

• Take nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) for your pain.

• Avoid straining during bowel movements. Drink lots of water and eat high-fiber foods to keep bowel movements regular. You can also take a stool softener.

It can take two weeks to two months to fully recover from an orchiectomy. Don’t lift anything over 10 pounds for the first two weeks or have sex until the incision has fully healed. Avoid exercise, sports, and running for four weeks after surgery.

 

Are there any side effects or complications?

See your doctor right away if you notice any of the following side effects:

• pain or redness around the incision

• pus or bleeding from the incision

• fever over 100°F (37.8°C)

• inability to urinate

• hematoma, which is blood in the scrotum and usually looks like a large purple spot

• loss of feeling around your scrotum

Talk to your doctor about possible long-term side effects due to having less testosterone in your body, including:

• osteoporosis

• loss of fertility

• hot flashes

• feelings of depression

• erectile dysfunction

 

Outlook

An orchiectomy is an outpatient surgery that doesn’t take long to fully recover from. It’s much less risky than hormone therapy for the treatment of prostate or testicular cancer.

Be open with your doctor if you’re getting this surgery as part of your transition from male to female. Your doctor may be able to work with you to reduce scar tissue in the area so that future SRS may be more successful.