Current Concepts in Feminizing Gender Surgery

Abstract

Learning Objectives: After reading this article and viewing the video, the participant should be able to: 1. Discuss appropriate treatment guidelines, including preoperative mental health and hormonal treatment before gender-affirmation surgery. 2. Name various surgical options for facial, chest, and genital feminization. 3. Recognize key steps and anatomy during facial feminization, feminizing mammaplasty, and vaginoplasty. 4. Discuss major risks and complications of vaginoplasty. Summary: Transgender and gender-nonconforming individuals may experience conflict between their gender identity and their gender assigned at birth. With recent advances in health care and societal support, appropriate treatment has become newly accessible and has generated increased demand for gender-affirming care, which is globally guided by the World Professional Association for Transgender Health. This CME article reviews key terminology and standards of care, and provides an overview of various feminizing gender-affirming surgical procedures.

Cirurgia de feminização facial em transexuais: reflexões éticas e forenses

“…In general, the procedures aim to improve the person's appearance without changing their identity. For the patient, undergoing feminization surgeries means starting a new life 9,23,25,42 .…”

“…However, one must consider that, like other procedures, FFC can cause complications, which must be informed and explained to the patient before surgery 25 . Damage to the supraorbital nerves may occur, causing loss of sensation, frontal sinus infections, hematoma and edema in the eyelids and ecchymosis 5 .…”

“…As much as the goal is to improve the patient's quality of life 45 , it is necessary to consider that aesthetic procedures not only change appearance, but also transform psychological aspects 9,15,23,25 . Safa and collaborators 25 recall that the physical changes resulting from FFS may not meet the person's expectations, causing frustration. Therefore, multidisciplinary work and communication with the patient must be adequate, considering the particularities of each case.…”

“…Surgical interventions to acquire new facial patterns can be indicated in different situations, as in cases of reconstruction of mutilated faces due to trauma [21][22][23] or pathology. There are also trans women -and, less often, cis women -who desire more feminine features because they believe their faces to be masculine 8,24,25 .…”

Coverage for Gender‐Affirming Voice Surgery and Therapy for Transgender Individuals

“…Gender dysphoria refers to the incongruence between an individual's gender identity and sex assigned at birth, leading to significant psychological distress. Gender‐affirming surgery can be an important treatment for gender dysphoria, by aligning physical appearance and function with gender identity to improve quality of life 1–4 . Genital and chest reconstructive surgeries have established benefits in alleviating symptoms of gender dysphoria, 5–9 and procedures for secondary sex characteristics such as facial feminization or masculinization, body contouring, and hair restoration/removal have profound impact on psychosocial adaptation 10–12 and quality of life 13–15 .…”