In transgender women, or transfeminine people (MTF), the surgical procedures for transtition include breast augmentation, orchiectomy, scrotectomym vulvoplasty, vaginoplasty, facial feminization surgery, and hair removal.
Breast Augmentation is the surgical placement of silicone or siline breast implants to increase breast volume. Breast implants can be inserted through an incision under the breast, in the armpit, or around the nipple. Scarring and decreased nipple sensation may result.
Orchiectomy is the surgical removal of the testicles through an incision in the scrotum. By removing the testicles, the main source of testosterone is also removed. Thus, orchiectomy allows for the cessation of the use of androgen-blockers.
Scrotectomy is the surgical removal of scrotal tissue and can be done simultaneously with orchiectomy as long as future vaginoplasty is not desired.
Vulvoplasty is the construction of a zero-depth vagina and vulva with the scrotal and penile tissue.The scrotal tissue is used to create the labia majora, the glans of the penis is used to create a clitoris.
Vaginoplasty is the construction of a vagina. The scrotal tissue is used to create the labia majora, the glans of the penis is used to create a clitoris and penile shaft tissue and scrotal grafts are used to create the inner vaginal walls. The urethra is shortened and the opening positioned in the typical-female location. Fistula is always a risk with urethroplasty.
Facial Feminization Surgery is the contouring of bone of the face to present a more feminine structure. Check out informing consent's video of Dr. Satterwhite discussing forehead contouring here!
Electrolysis or Laser Hair Removal is the use of an needle with electric current passing through it, or laser, to ablate hair follicles so hair no longer grows from that follicle. This often requires multiple sessions and can be painful, so EMLA cream may be prescribed to numb the area prior to treatment. Electrolysis may be preferred for people with darker skin tones or very fine hair.
Not all transgender patients will want to have surgery as a part of gender transition, and for many it is not possible due to insurance or financial barriers. The risks, benefits and alternatives should be discussed with each individual along with their personal goals for transition to determine the right course.