Other related procedures[edit]
Facial feminization surgery[edit]
Occasionally these basic procedures are complemented further with feminizing cosmetic surgeries or procedures that modify bone or cartilage structures, typically in the jaw, brow, forehead, nose and cheek areas (facial feminization surgery or FFS).
Breast augmentation[edit]
Breast augmentation is the enlargement of the breasts. Some trans women choose to undergo this procedure if hormone therapy does not yield satisfactory results. Usually, typical growth for trans women is one to two cup sizes below closely related females such as the mother or sisters. Estrogen is responsible for fat distribution to the breasts, hips and buttocks, while progesterone is responsible for developing the actual milk glands. Progesterone also rounds out the breast to an adult tanner stage 5 shape[citation needed] and matures and darkens the areola.
Voice feminization surgery[edit]
See also: Voice therapy (trans) ? Vocal surgeries
Some MTF individuals may elect to have voice surgery, altering the range or pitch of the person's vocal cords. However, this procedure carries the risk of impairing a trans woman's voice forever, as happened to transsexual economist and author Deirdre McCloskey. Because estrogens by themselves are not able to alter a person's voice range or pitch, some people proceed to seek treatment. Other options are available to people wishing to speak in a less masculine tone. Voice feminization lessons are available to train trans women to practice feminization of their speech.
Tracheal shave[edit]
Tracheal shave is also sometimes used to reduce the cartilage in the area of the throat to conform to more feminine dimensions, to greatly reduce the appearance of an Adam's apple.
Buttock augmentation[edit]
Because male hips and buttocks are generally smaller than those of a female, some MTF individuals will choose to undergo buttock augmentation. If, however, efficient hormone therapy is conducted before the patient is past puberty, the pelvis will broaden slightly, and even if the patient is past their teen years, a layer of subcutaneous fat will be distributed over the body rounding contours. Trans women usually end up with a waist to hip ratio of around 0.8, and if estrogen is administered at a young enough age "before the bone plates close",[citation needed] some trans women may achieve a waist to hip ratio of 0.7 or lower. The pubescent pelvis will broaden under estrogen therapy even if the skeleton is physically male.
Genital surgery[edit]
Main article: Vaginoplasty
When changing anatomical sex from male to female, the testicles are removed and the skin of foreskin and penis is usually inverted, as a flap preserving blood and nerve supplies (a technique pioneered by Sir Harold Gillies in 1951) to form a fully sensitive vagina (vaginoplasty). A clitoris fully supplied with nerve endings (innervated) can be formed from part of the glans of the penis. If the patient has been circumcised (removal of the foreskin), or if the surgeon's technique uses more skin in the formation of the labia minora, the pubic hair follicles are removed from some of the scrotal tissue, which is then incorporated by the surgeon within the vagina. Other scrotal tissue forms the labia majora.
In extreme cases of shortage of skin, or when a vaginoplasty has failed, a vaginal lining can be created from skin grafts from the thighs or hips, or a section of colon may be grafted in (colovaginoplasty). These linings may not provide the same sensate qualities as results from the penile inversion method, but the vaginal opening is identical, and the degree of sensation is approximately the same as that of most biological women so pleasure should not be less.[citation needed]
Surgeon's requirements, procedures and recommendations in the days before and after, and the months following these procedures vary enormously.
Plastic surgery, since it involves skin, is never an exact procedure, and cosmetic refining to the outer vulva is sometimes required. Some surgeons prefer to do most of the crafting of the outer vulva as a second surgery, when other tissues, blood and nerve supplies have recovered from the first surgery. This relatively minor surgery, which is usually performed only under local anaesthetic, is called labiaplasty.
The aesthetic, sensational, and functional results of vaginoplasty vary greatly. Surgeons vary considerably in their techniques and skills, patients' skin varies in elasticity and healing ability (which is especially affected by smoking), any previous surgery in the area can impact results, and surgery can be complicated by problems such as infections, blood loss, or nerve damage. However, in the best cases, when recovery from surgery is complete, it is often difficult to detect that someone has undergone vaginoplasty.[citation needed]
Supporters of colovaginoplasty state that this method is better than use of skin grafts for the reason that colon is already mucosal, where as skin is not. However, many post-op trans women report that the skin used to line their vaginas develops mucosal qualities from months to years post-op[citation needed]. For others, lubrication is needed when having sex and occasional douching is advised so that bacteria does not start to grow and give off odors.
Because the human body treats the new vagina as a wound, any current technique of vaginoplasty requires some long-term maintenance of volume (vaginal dilation), by the patient, using medical graduated dilators, dildos, or suitable substitutes, to keep the vagina open. It is very important to note that sexual intercourse is not an adequate method of performing dilation.
Regular application of estrogen into the vagina, for which there are several standard products, may help but this must be calculated into total estrogen dose. Some surgeons have techniques to ensure continued depth, but extended periods without dilation will still often result in reduced diameter (vaginal stenosis) to some degree, which would require stretching again, either gradually or, in extreme cases, under anaesthetic.
With current procedures, trans women do not have ovaries or uteruses. This means that they are unable to bear children or menstruate, and that they will need to remain on hormone therapy after their surgery to maintain female hormonal status.
Main article: Vaginoplasty
When changing anatomical sex from male to female, the testicles are removed and the skin of foreskin and penis is usually inverted, as a flap preserving blood and nerve supplies (a technique pioneered by Sir Harold Gillies in 1951) to form a fully sensitive vagina (vaginoplasty). A clitoris fully supplied with nerve endings (innervated) can be formed from part of the glans of the penis. If the patient has been circumcised (removal of the foreskin), or if the surgeon's technique uses more skin in the formation of the labia minora, the pubic hair follicles are removed from some of the scrotal tissue, which is then incorporated by the surgeon within the vagina. Other scrotal tissue forms the labia majora.
In extreme cases of shortage of skin, or when a vaginoplasty has failed, a vaginal lining can be created from skin grafts from the thighs or hips, or a section of colon may be grafted in (colovaginoplasty). These linings may not provide the same sensate qualities as results from the penile inversion method, but the vaginal opening is identical, and the degree of sensation is approximately the same as that of most biological women so pleasure should not be less.[citation needed]
Surgeon's requirements, procedures and recommendations in the days before and after, and the months following these procedures vary enormously.
Plastic surgery, since it involves skin, is never an exact procedure, and cosmetic refining to the outer vulva is sometimes required. Some surgeons prefer to do most of the crafting of the outer vulva as a second surgery, when other tissues, blood and nerve supplies have recovered from the first surgery. This relatively minor surgery, which is usually performed only under local anaesthetic, is called labiaplasty.
The aesthetic, sensational, and functional results of vaginoplasty vary greatly. Surgeons vary considerably in their techniques and skills, patients' skin varies in elasticity and healing ability (which is especially affected by smoking), any previous surgery in the area can impact results, and surgery can be complicated by problems such as infections, blood loss, or nerve damage. However, in the best cases, when recovery from surgery is complete, it is often difficult to detect that someone has undergone vaginoplasty.[citation needed]
Supporters of colovaginoplasty state that this method is better than use of skin grafts for the reason that colon is already mucosal, where as skin is not. However, many post-op trans women report that the skin used to line their vaginas develops mucosal qualities from months to years post-op[citation needed]. For others, lubrication is needed when having sex and occasional douching is advised so that bacteria does not start to grow and give off odors.
Because the human body treats the new vagina as a wound, any current technique of vaginoplasty requires some long-term maintenance of volume (vaginal dilation), by the patient, using medical graduated dilators, dildos, or suitable substitutes, to keep the vagina open. It is very important to note that sexual intercourse is not an adequate method of performing dilation.
Regular application of estrogen into the vagina, for which there are several standard products, may help but this must be calculated into total estrogen dose. Some surgeons have techniques to ensure continued depth, but extended periods without dilation will still often result in reduced diameter (vaginal stenosis) to some degree, which would require stretching again, either gradually or, in extreme cases, under anaesthetic.
With current procedures, trans women do not have ovaries or uteruses. This means that they are unable to bear children or menstruate, and that they will need to remain on hormone therapy after their surgery to maintain female hormonal status.
