It’s a bit hard to find a resource that’s a really basic overview of what’s actually available and what happens. I know the average cis person isn’t likely to go looking for this kind of thing…but when people in my life ask, I’d like to have somewhere to send them to. Something to explain the basics.

Types of Surgery

Okay, so there isn’t one single end all be all surgery for trans people. So what   i s there?

I was born with a typical female body, so I’m only going to be discussing what’s available to someone in a similar situation to myself. There’s two different categories of surgeries for transition, top surgery and bottom surgery. Within each are different kinds of surgeries depending on body type and end goal.

Top Surgery

This is the general name for surgeries intended to create a more masculine appearing chest. Technically, it’s a mastectomy; the removal of breast tissue.  Like what they do with breast cancer patients. With trans patients though, the goal is a little different. It’s not about simply removing everything. After excess tissue has been removed, the plastic surgeon works to contour the chest area. There’s the option of putting in pectoral implants or resizing/shaping the nipple to achieve the desired appearance. There are different approaches each with their own pros and cons. Chest size will pretty much determine what methods are best, but there’s definitely room for discussion with your surgeon about what you want. With every surgery though, there is the possibility that revisions will be necessary. There’s no guarantee everything will heal correctly or smooth out. An extra surgery is sometimes necessary.

Here, I’m getting my information mainly from topsurgery.net. If you’re interested in more than what generally happens in each type of surgery, it’s a good resource to check out.

Double Incision

If you’ve ever heard about/seen someone who has had top surgery in the media, this is probably what you know. The big ugly scars across the bottom of the person’s chest and probably some transphobic punchline. This is basically a double mastectomy. The surgeon makes two horizontal incisions in each breast to remove tissue. Then they remove the excess skin in between and connect the two incisions together. In addition, the nipple is entirely removed and grafted back on during this process. Graphics here and here are two different approaches to illustrate the process. This process is one option for resizing/shaping the nipple. However, the nipple loses most sensation as it is separated from the nerves when it’s removed. There’s also a risk of losing the nipple entirely due to infection.

T Anchor

This method is similar to the double incision. The main difference is that the nipple is not removed. An extra vertical incision is made starting at the bottom of the areola and going down. This  allows for re-positioning and resizing. It’s an extra incision, leaving another scar. It doesn’t separate the nipple from the nerves though, so more sensation is likely to be retained. Illustration here.

Buttonhole

This one’s similar to the first two as well. Again, the difference is what the surgeon does with the nipple. The name says it all. After removing the breast tissue from the double incisions, the surgeon makes a circular incision where the nipple is going to be re-positioned. The nipple stays connected to the nerves and is brought under the skin and through the opening, like a button through a buttonhole. Illustration here.

The double incisions in each of these three methods allow for easier removal of large amounts of breast tissue. They’re typical methods for people with medium/large chests. The next couple methods don’t leave as much space to remove tissue. They’re more typical for smaller chests.

 Peri-areolar

With this one, the surgeon makes two circular incisions. One circle around the areola, and another bigger concentric circle. Skin and breast tissue are removed through there. Then the larger circle is pulled inwards to connect to the areola. The nipple can be resized, and sensation is likely to be retained. However, this method is one where revisions are more likely. Illustration here.

Keyhole

This surgery leaves the least scarring. Which also means it leaves the least amount of room to remove breast tissue. An incision is made along the underside of the areola. It is possible that an extra incisions will be necessary to remove enough. It could be under the arm, or a line out from the areola similar to the T technique. Illustration here.

Bottom Surgery

This can mean a couple different things. There’s the removal of reproductive organs with a hysterectomy and then the option for genital reconstruction surgery.

Hysterectomy

This is a pretty common surgery. It’s not specific to trans people or anything, plenty of cis women have it. For this one, I’m using information I’ve gotten through Kaiser and my surgeon. A total hysterectomy is a surgery to remove the uterus and cervix. A total hysterectomy with a bilateral salpingo-oophorectomy removes the fallopian tubes and ovaries as well. Bilateral– both sides salpingo– fallopian tubes oopho– ovaries rectomy– removal.

The most typical method nowadays is laparoscopic. They make an incision just under the bellybutton for the laparoscope. It’s basically a tiny lighted tube they can use to look around inside the abdomen. The surgeon makes a couple other small incisions for the various surgical instruments. From there, they just detach and remove everything out through the vagina. The big decision here is what to remove.

It’s totally personal preference and life goals. They can remove the fallopian tubes and ovaries, they can leave them in, or they can leave one ovary. Being able to have biological children is important to some people. Keeping one or both ovaries can leave the option to harvest eggs at a later date. Eggs can also be extracted and frozen prior to removing the ovaries (which can be expensive). Another concern is hormones. Removing both ovaries means there’s no more natural production of hormones. This can cause health problems without hormone replacement therapy, whether it’s testosterone or estrogen. If there’s any doubt about starting or continuing hormones, it’s best to leave the ovaries intact.

Genital reconstruction

Okay, this one I haven’t done much research on. I’m undecided where I want to go with it for myself and I’ve been a bit busy thinking about my upcoming surgery. I’ll come back to this one later.

~T

 

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