For over a decade, Dr. Christopher Salgado has established himself as one of the leading specialists in Gender Confirmation Surgery (GCS). Formerly known as Sexual Reassignment Surgery, GCS oversees a series of surgeries that allow transgender men to become their ideal selves.
Gender Confirmation Surgery corrects the body by sculpting a neo-penis from your existing genitalia. In addition, the changes will alleviate the anguish you feel from Gender Dsyphoria (Gender Identity Disorder).
If you are a transgender man and are in need of bottom surgery, Dr. Salgado and his multidisciplinary team of experts are here to complete your transition.
FEMALE to MALE (F2M) GENDER CONFIRMATION SURGERIES
This series of procedures uses tissues harvested from the forearm and other parts of the body to create a functional and aesthetically correct neo-penis. Because of the nature of these procedures, crafting the neo-penis will take a lot of time, so it is very important to stay patient and give your body the time that it needs to heal.
REMOVAL OF UTERUS & OVARIES
A Hysterectomy and Oophorectomy removes the uterus and ovaries. This can be performed as a minimally invasive technique during your chest masculinization. Commonly these reproductive organs are removed if a patient is to undergo metoidplasty or phalloplasty with vaginectomy.
A neo-penis is sculpted by releasing the clitoris from the labia majora. Labial tissue is used to enlarge the phallus or hypertrophic clitoris. An unobstructed urine flow is made possible by keeping the labia majora partially closed. Unfortunately, the results from this procedure can not be used for penetrative sex prompting many patients to desire phalloplasty.
Metoidioplasty is an outpatient procedure with results that may reach a patient’s expectations of urinating in the standing position. The procedure can also be performed with a Vaginectomy if urethral lengthening is not desired and can later be enhanced through a Phalloplasty.
This procedure enables for a natural standard size penis with the ability to urinate in the standing position and to allow for penetrative vaginal or anal intercourse.. It will commonly require a prosthesis or bone may be harvested with the flap so that the patient enjoys an erect penis at all times. Tissue from the forearm, thigh or back are common donor sites of tissue that may be used for this construction.
In order to minimize the risk of urethral complications, Dr. Salgado approaches the surgery in two stages:
STAGE 1 PHALLOPLASTY
The vaginal walls are removed and the vagina and perineum are surgically closed. This anterior wall of the vagina is used for the lengthening of the urethra. The vaginectomy is not a requirement, however urination in the standing position will not be obtained if this is important to the patient.
Also known as a Primary Urethral Lengthening, this procedure should allow transgender men to stand and urinate once the Phalloplasty has been performed.
The phallus is created from a section of the forearm during the second stage of the procedure. Before this happens, the penile urethra is created by using mucosa from the vagina or mouth and wrapped around a tube. This tube is then placed under the forearm skin to allow for tissue ingrowth and survivability over the next three months.
Irrigation of the catheter in the forearm is important to avoid infection.
STAGE 2 PHALLOPLASTY
The second stage transfers the skin flap to the genital region and involves two additional procedures: Scrotoplasty and Glansplasty. This operation lasts 8 to 12 hours and will require a two-week stay at the hospital.
This step oversees the construction of the scrotal sac which is formed from the labia majora. We commonly have used an expendable thigh muscle, gracilis muscle, to augment the blood supply of the urethral anastomosis and this has also served to augment the neoscrotum. This maneuver has obviated the use of implants and testicular implants are frought with complications. In addition, we have also employed fat transfer techniques for augmentation of the neoscrotum. If Testicular implants are desired they are often placed after two months.
The final part of the procedure is the creation of the glans penis, the sensitive and bulbous section at the tip (also known as ‘the head’). This creates an anatomically correct penis. This may or may not include the creation of a urethral opening. Some transgender men will have their neo-penis tattooed to give the area natural coloring and depth.
FEMALE TO MALE GENDER CONFIRMATION SURGERY
Before your surgery, Dr. Salgado and his team at the University of Miami will meet with you to discuss the procedure and what you can expect during the recovery phase. You will be instructed to provide a detailed medical history and your current health will be evaluated at this time. It is important that you maintain realistic expectations about the procedure.
If you are a smoker or a drinker, Dr. Salgado will advise you to refrain from your vices in the month before your surgery. It is best to cease until you have completed your surgical treatments. The negative effects of smoking and drinking will interfere with anesthesia and can delay your recovery. Medications such as aspirin and ibuprofen may cause complications unless prescribed by Dr. Salgado.You must also clear your digestive system. While you may be allowed to consume liquid, solid food may complicate your surgery. You will also be advised to consume a laxative or an enema to ensure that your body is waste-free when surgery begins. If you will undergoing bottom surgery with an intestinal vaginoplasty our patients will have a formal bowel preparation.
Recovery from Female to Male Gender Confirmation Surgery will leave serious long-term psychological and physical ramifications as you recover. That is why it is vital that you take these steps:
- Limit your movements and avoid activities such as heavy lifting and strenuous exercise.
- Be sure to get a lot of rest.
- Refrain from drinking and smoking to allow your body to heal properly.
- Avoid baths. You can take showers again after the first week. It is advised to pat the genitals dry with a clean towel gently.
- Remember to take your medications regularly, as prescribed by Dr. Salgado and his team.
Because of the number of surgeries needed to complete your neo-penis, it will take roughly six months to a year before your body begins to settle.
Depending on the frequency of your procedures, you may slowly return to work after at about two weeks following Stage I surgery and 2-3 months following stage II.
To ensure the best results possible, you must avoid any activities that may put pressure on your genitals or result in a wound, including:
- Sports or exercises that may cause the genitals to stretch
- Any activity that may require direct pressure against the genitalia (bike riding, etc.)
It is important to wash your hands before and after you make contact with your neo-penis. It is advised to wash and wipe from front to back to avoid bacterial contamination from the anus.
Because of the number of surgeries needed to complete the neo-penis, scarring is to expected. While the effects are permanent, the incisions will heal after six months. They are hardly visible after a year.
Results will become prominent as your body recovers. Overall, it will take a period of six months for your neo-penis to settle. You can expect gradual sensation as your body recovers with increasing sensation to ¾ or the tip of your penis, and you will be able to enjoy sexual activity in time, including intercourse. A penile implant is often placed once sensation in the penis is recovered at about 9-10 months.
GENITALIA GENDER CONFIRMATION SURGERY COSTS
We strongly encourage our patients to get medical insurance to cover their gender surgery. If paying out of pocket the cost will depend on:
- The professional surgeon fee
- Medical center facility fee
- Anaesthesia fee
FINANCING AND INSURANCE OPTIONS
During your consultation, Dr. Salgado and his University of Miami team will guide you through a number of financing option for your procedures.
THE BENEFITS OF GENITALIA GENDER CONFIRMATION SURGERY
Gender Confirmation Surgery of the Genitalia works by immediately correcting the gender you were assigned with at birth, thereby ensuring your body is perfectly aligned with your gender identity. For many transgender men, having a body that corresponds to the way they feel about themselves is incredibly profound.
THE RISKS OF GENITALIA GENDER CONFIRMATION SURGERY
It is important to remember that the results from bottom surgery are not reversible. So before undergoing surgery, it is essential to discuss the risks with Dr. Salgado and your team before going through with the procedures and two letter are obtained from your mental health therapists recommending you for surgery.
ARE YOU A CANDIDATE FOR GENDER CONFIRMATION SURGERY?
If you are a transgender man who wishes to undergo Gender Confirmation Surgery, it is imperative that you are in good health, are aware of the risks, and have realistic expectations about the results of your surgery. Candidates must:
- Have spent at least one year taking Hormone Replacement Therapy (HRT)
- Are cleared by a licensed therapist that specializes in gender transition with two letters recommending you for surgery.
HOW TO CHOOSE A GENDER CONFIRMATION SURGEON
To ensure you get the best results from bottom surgery, it is recommended you find a board-certified surgeon who:
- Is certified by the American Board of Plastic Surgeons
- Has spent years training and specializing in Gender Confirmation Surgery
- Is easy to talk to and listens to your concerns
- Has a high rating of patient success