Gender Affirmation Surgery - Male to Female

• Patients looking to undergo gender affirmation surgery must first complete The World Professional Association for Transgender Health (WPATH) Recommendations, Version 7 Assessment (Coleman, et al., 2011). 
• The side effects that cause the most anxiety among patients undergoing gender affirmation surgery are the esthetic and sensation results from the newly formed organ. These results are dependent on several factors. Fortunately, experienced surgeons can provide advice and recommendations regarding suitable techniques that will ensure surgery outcomes closely match a patient’s desires while minimizing side effects. 

There are now a range of gender identities and sexual orientations, as well as a range of popular gender affirmation surgical techniques available for those wishing to make a physical change. Additionally, new surgical techniques are being developed by surgeons around the world all the time to ensure the best results can be achieved with minimal side effects. 

Gender affirmation surgery (male to female) is undertaken with the aim of altering the male genitalia to externally appear like female genitalia, with function and sensation similar to that of a vagina. This is achieved by surgical alteration of the testicles to create a vaginal cavity through which intercourse can take place. 

There are a number of surgical techniques available to achieve this, including orchidectomy, vaginoplasty, and labiaplasty. In addition, new techniques are continuously being developed, such as sensate clitoroplasty, labia minora reconstruction using the testicular sac, intestinal vaginoplasty, and endoscopic peritoneal flap vaginoplasty. All of these procedures can provide results that closely match the desires of the patient wishing to affirm their gender through surgery. 

In addition to genital reconstruction techniques, there are a range of other surgeries used to affirm a person’s gender, such as facial feminization surgery, tracheal shave surgery, voice feminization surgery, breast augmentation, buttock augmentation, and hair transplants.

• Transgender women (TGW) who have completed The World Professional Association for Transgender Health (WPATH) Recommendations Version 7 Assessment (Coleman, et al., 2011) 
• Patients within normal weight ranges (those looking to lose weight should do so before undergoing surgery) 
• Patients with no underlying health conditions that would prohibit surgery, such as hemophilia and Ehlers-Danlos syndrome 
• Patients looking for realistic results 
• Patients of sound mental health 
• Patients over 20 years of age (those under 20 must first seek permission from a parent or legal guardian) 

All forms of surgery carry with them an inherent risk that can affect anyone going under the knife. Nevertheless, the consulting doctor will carry out a risk assessment, and offer patients the chance to seek answers for any concerns they may have before deciding whether or not to undergo surgery. 

The side effects that cause the most anxiety among patients undergoing gender affirmation surgery are the esthetic and sensation results from the newly formed organ. These results are dependent on several factors. Fortunately, experienced surgeons can provide advice and recommendations regarding suitable techniques that will ensure surgery outcomes closely match a patient’s desires while minimizing side effects. 

Patients with no history of keloid type scarring are usually able to achieve a smooth looking finish to the skin, with incision scars hidden in suitable places. 

Other potential risks include wound complications, numbness, and skin necrosis, however these are most common among smokers or patients with underlying health conditions associated with the vascular system, such as diabetes, high blood pressure, and hyperlipidemia. Nevertheless, if these conditions are managed effectively, they should not prohibit surgery. 

Samitivej Srinakarin Hospital uses the latest techniques that help surgeons before, during, and after surgery. Our surgeons have been performing gender affirmation procedures for more than 20 years, and patients can feel confident knowing that their desired outcomes are achievable due to the modern techniques utilized by our expert medical team. 

6 months prior to surgery 

• Stop taking all forms of acne medication containing vitamin A (isotretinoin) because it can have a detrimental effect on the healing of scars 

3 months prior to surgery 

• Prepare the body for surgery with a light exercise regime and plenty of rest 
•  Undergo an annual health screening and, should you have any underlying health conditions, be sure to consult your doctor in order to ensure they are under control 

4 weeks prior to face lift surgery 

• Avoid smoking for at least 4 weeks preceding surgery, and again for at least 4 weeks following surgery 
• Avoid getting any new piercings/tattoos and avoid all forms of sunbathing; should you already have a piercing, make sure it is removed and cleaned regularly to avoid inflammation 

10 days prior to surgery 

• Avoid taking drugs that interfere with blood clotting, such as: 
  •  Anticoagulants, including aspirin, coumadin, Ticlid, Plavix and Aggrenox (consult your physician regarding the safe halting of any medication) 
  • NSAID drugs, including Ibuprofen, Advil, Motrin, Nuprin, Aleve, Relafen, Naprosyn, Diclofenac, Naproxen, Voltaren, Daypro, Feldene, Clinoril, Lodine, Indocin, and Orudis 
  • Sedatives, including Zoloft, Lexapro, Prozac, and Pristiq 
  • Consult your physician regarding the safe halting of any medication 
• Avoid all vitamin supplements that can interfere with blood clotting, such as fish oil, omega-3, co-enzyme Q10, evening primrose oil, glucosamine, arnica, ginseng, gingko, and herbs. 

In addition to following the prior list of recommendations, patients should attend a medical consultation regarding gender reassignment surgery to better understand its potential risks and benefits, as well as to address any misconceptions and ensure all parties share a full understanding of the desired results. 

For more information, please visit the following websites: 

• https://www.isaps.org/member-directory
• https://www.thprs.org/find-doctor
• https://checkmd.tmc.or.th

1. Medical staff will provide the patient with adequate time to consult and ask any questions before surgery 
2. The surgery usually takes 4-5 hours to complete 
3. A trained anesthesiologist will administer a general anesthetic 
4. Patients will be required to stay in the hospital for 5 days following the surgery 
5. Follow-up consultations to monitor the patient will be held on days 7 and 14 following the procedure 

Recovery times differ depending on a range of factors, such as the patient’s general health prior to surgery, the type of surgery performed, and post-surgery care. 

• There may be some moderate pain or aching at the incision site 
• Patients should be able to get up and walk around 2 days after surgery 
• Patients can take a bath 5 days after surgery, although they should pay special attention to their wound and and perform vaginal dilation in accordance as advised by their doctor 
• There may be swelling lasting 3-6 months following surgery 
• There may be reduced sensation in the area operated on, but this should return completely within 3-6 months. 
• There may be redness and swelling in the affected area for the first 1-3 months following surgery, but this should improve within 6-12 months 
• Patients should avoid exposure to direct sunlight for the first 3-6 months 
• Patients should be able to return to work within 4-8 weeks 
• Patients should avoid all forms of exercise for 4-6 weeks after surgery 

Despite various forms of gender affirmation surgery becoming ever more popular, they are extremely complex procedures that must only be performed after thorough consultations with doctors who have specific expertise in this field. It should then be left to similarly-experienced surgeons to perform the procedure, as they will be able to ensure the highest level of safety, minimal side effects and the most desirable outcome. 

Samitivej Plastic and Esthetic Surgery Institute is a full-service plastic surgery center in the heart of Bangkok, Thailand. Our qualified specialists from Board Certificated Plastic and Reconstructive surgeons performs a large selection of operations to help your outside look the way you feel on the inside with an excellence care on all surgical procedures. We specialize in breast surgeries such as breast augmentation, breast lift and breast reduction. Our plastic surgeons are also experienced in Face lift, body contouring procedures; body lifts surgeries after significant weight loss. We also do combination surgeries of breast, tummy and many other areas. 

Besides Plastic and Reconstructive surgeons, our interdisciplinary team including nurses, anaesthesiologists, cardiologist, and other subspecialist will make sure of your safety. 

Samitivej has a team ready to help and provide services for:  

• Treatment Plan Consultation with a doctor via online video-call (second opinion) 
• Treatment Planning if you have medical records or a price estimate from another hospital 
• Cost Planning by our Appraisals Team with price guarantee (only for procedure packages without complications) 
• Check Initial Coverage Eligibility with Thai and international insurance companies (only for insurance companies in contract with the Hospital)