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How does male-to-female (MTF) surgery work?

Male-to-female (MTF) surgery, also known as transfeminine gender affirmation surgery, involves a series of medical procedures that help transgender women match their physical bodies with their gender identity. MTF gender affirmation surgeries are performed by a specialized medical team that can include a gynecologist, a urologist, and a reconstructive plastic surgeon. Procedures can include breast augmentation, facial feminization, and reconstructive surgeries that modify the genitalia, such as vaginoplasty. 

The goal of MTF gender affirmation surgery is to alleviate the distress of gender dysphoria, a significant disconnect between the sex assigned at birth and a person's gender identity. The physical changes help individuals feel more congruent with their identity. 99.7% of patients report being satisfied with their gender affirmation surgery.

Gender-affirming surgery does more than improve self-esteem — it dramatically enhances mental health and quality of life. Research shows that transgender patients who undergo gender-affirming surgeries experience substantial health benefits: 

• a 42% reduction in psychological distress;
• a 35% decrease in tobacco use;
• a 44% reduction in suicidal thoughts.

What types of procedures do MTF surgeons offer patients globally?

Doctors performing MTF surgery offer a comprehensive array of reconstructive and cosmetic procedures tailored to meet the needs of trans women. These gender affirmation surgeries aim to transform both physical and functional aspects of the body to correspond more closely to a traditionally female physique. 

Here’s a breakdown of the main types of MTF gender-affirming surgeries that doctors provide globally:

Top Surgery (Breast Augmentation)

This type of gender affirmation surgery involves the placement of breast implants to give the patient's chest a more feminine appearance. Patients have two options:

• saline implants, which are filled with sterile salt water, require smaller incisions and cost less;
• silicone implants, known for their soft, natural feel and realistic texture.

Bottom Surgery (Genital Surgery)

This category includes surgical procedures that transform the male genitalia to have a look and sometimes functionality of female reproductive organs. Bottom surgery comes in several forms:

• Vaginoplasty is a genital reconstruction procedure that forms a vagina using penile and scrotal skin or other grafts, resulting in fully functional female genitalia.
• Vulvoplasty is a less invasive gender-affirming surgery that creates a vulva without a vaginal canal, precluding the option of penetrative sex.
• Orchiectomy removes the testicles and can be performed alone or as part of genital reconstruction.

Facial Feminization Surgery (FFS)

MTF surgeons perform facial surgery to soften facial features and create a feminine appearance. MTF facial procedures can include: 

• rhinoplasty;
• brow lift;
• forehead contouring;
• tracheal shave (Adam’s apple reduction); 
• jaw contouring;
• chin reduction;
• lip lift;
• cheek augmentation;
• cosmetic fillers;
• fat grafting;
• liposuction. 

Voice Feminization Surgery

This surgical procedure modifies the voice box, or larynx, to raise the pitch of the voice and make it sound more feminine. It is especially effective alongside voice therapy, which helps patients find their ideal pitch, prosody, and vocal resonance.

How doctors perform MTF gender confirmation surgery: A step-by-step guide

Before any surgical procedure begins, surgeons administer general anesthesia so you will fall asleep and won’t feel any pain throughout the operation.

Top Surgery Steps

1. Preparation. If breasts are not large enough for surgery after hormone therapy, the medical team inserts tissue expanders beneath the chest muscles to stretch the skin in preparation for the implants.
2. Incision. The surgeon makes strategic cuts around the areola, near the armpit, or in the crease under the breast.
3. Insertion of implants. Implants are then placed under the breast tissue or chest muscle.

Bottom Surgery Steps

1. Orchiectomy. The MTF bottom surgeon removes the testicles.
2. Penectomy. The surgeon removes most of the penis tissue.
3. Vaginoplasty. The surgical team creates a vaginal space and reshapes and inverts the penis skin to form the vaginal canal.
4. Clitoroplasty. A portion of the glans is used to create a clitoris with intact nerve and blood vessel connections to maintain sensation.
5. Labiaplasty. MTF bottom surgeons rearrange the skin from the scrotum to form the labia.

Voice Feminization Surgery Steps

1. The surgeon accesses the vocal cords either by inserting a small tube (laryngoscope) through your mouth or by making an incision on the neck.
2. Depending on the technique you choose with your surgeons, they may stitch together cartilage or the front part of the vocal tissues. If you opt for laser-assisted surgery, your surgeon will use a carbon dioxide laser to tighten parts of the vocal folds.

How to find the best transgender MTF surgeon?

🔎Research surgeons. Start by exploring the 22 top-ranking doctors specializing in gender affirmation surgeries on the Bookimed website. Look for those who have experience specifically with male-to-female procedures like facial feminization surgery (FFS), breast augmentation, and genital reconstruction.

🏛️Check professional memberships. Prioritize surgeons who are members of reputable organizations like:

• World Professional Association for Transgender Health (WPATH);
• American Society of Plastic Surgeons (ASPS);
• International Society of Aesthetic Plastic Surgery (ISAPS).

Such memberships confirm their adherence to high standards of care and ongoing education in transgender healthcare.

📝Read reviews. Look for reviews from other trans women who have undergone gender-affirming surgery with the doctors you're considering. Real-life experiences can give you valuable insights into the surgeon's skill and bedside manner.

📸Review before-and-after photos. Ask to see before-and-after photos of previous patients who have undergone male-to-female transformations with the surgeon. These will give you an idea of the surgeon's aesthetic style and the results you can expect.

🗺️Consider location. While it's essential to find the most skilled surgeon for your needs, also consider the location of their practice and the travel logistics, especially if the surgeon you prefer is far from your home. Factor in travel costs, accommodations, and post-operative follow-up visits.

🤝Ask about support services. Inquire about the support services offered by the surgeon's practice, such as pre-operative counseling, post-operative care, and access to support groups or resources for transgender patients.

🔖Look for package deals. MTF surgeons can offer package deals or bundled services for multiple procedures, which can help reduce costs and streamline the surgical process.

😌Trust your instincts. Ultimately, trust your instincts when choosing a transgender MTF surgeon. Pay attention to how comfortable you feel with the surgeon and their staff, as well as how well they listen to your concerns and address your questions.

Who are the top MTF surgeons worldwide?

Dr. Pichet Rodchareon

With over 30 years of experience in gender affirmation surgery, Dr. Pichet is considered one of the top MTF surgeons in Thailand. He is board-certified in plastic surgery and holds memberships in prestigious organizations such as ISAPS and WPATH. Dr. Pichet Specializes in a wide range of MTF surgeries, including breast augmentation, facial feminization surgery, body contouring, and vaginoplasty.

Dr. Barış Nuhoğlu

Dr. Nuhoğlu is a distinguished plastic surgeon, reconstructive urologist, and MTF bottom surgeon with 27 years of experience. He is a member of various medical associations, including the European Association of Urology and Endourological Society. The surgeon has made significant contributions to the medical field through over 100 publications and presentations, both national and international.

Dr. Ali Nurhan Özbaba

Dr. Özbaba’s illustrious career spans 35 years and over 30,000 successful treatments. He is an expert in plastic reconstructive surgery and male-to-female surgery. Dr. Özbaba is a member of the Turkish Society of Aesthetic Plastic Surgery (TSAPS).

Dr. Hakan Teymur

In over 20 years of practice, Dr. Teymur has performed around 1,000 operations and honed his skills in reconstructive and aesthetic surgery. He is proficient in such gender-affirming procedures as facial feminization surgery, breast augmentation, and MTF bottom surgery. This plastic surgeon holds memberships in several esteemed organizations, including:

• European Society of Aesthetic Plastic Surgery (ESAPS); 
• the European Board of Plastic, Reconstructive and Aesthetic Surgery (EBOPRAS).

How much does male-to-female surgery cost?

The cost of male-to-female (MTF) surgery can vary widely, typically ranging from $5,000 to $25,000. The variation in cost largely depends on the type of surgery performed, with bottom surgeries usually being the most expensive. The country you choose for surgery also significantly influences the price due to differences in healthcare systems and the cost of living.

Here's a comparison of average costs for MTF gender-affirmation surgery in different countries:

How long do I need to stay in the country for male-to-female surgery?

⏳Hospital stay: 3-7 days. This time allows your surgical team to perform the procedure, monitor your initial recovery, manage pain, and prevent complications. It also includes time for necessary medical exams before and after the gender-affirmation surgery.

⏳Stay in the country: 10-14 days. After your discharge from the hospital, staying in the country for an extra 2 weeks allows you to rest and heal, as well as attend follow-up appointments with your surgeon. 

What is the recovery time for male-to-female gender reassignment surgery?

The recovery time for male-to-female surgery varies by procedure type.

🗓️Top surgery: 1-3 weeks. The first 2 days after breast surgery are typically the most uncomfortable. Patients can usually return to work within a week. The swelling should decrease within 2-3 weeks, although it may persist for up to 4-6 months for some. 

🗓️Bottom surgery: 2-12 weeks. Patients often feel more comfortable by the second week. After vaginoplasty, it is important to avoid strenuous activities for about 6 weeks and sexual activities for 12 weeks. Full recovery from a vaginoplasty can take up to a year. 

🗓️Facial feminization surgeries: 0.5-4 months. The swelling usually subsides in 2 to 4 weeks for cheek and nose surgeries. In the case of chin and jaw procedures, the swelling may diminish within 2 weeks, but complete healing can take up to 4 months. 

🗓️Voice surgery: 1-3 weeks. Absolute silence is required for the first 7 days post-surgery. Full recovery takes about 3 weeks.

What are the risks of MTF top and bottom surgery?

MTF Top Surgery Risks

Male-to-female top surgery is a low-risk procedure. The majority of potential complications are the same as for any surgery: 

• reactions to anesthesia;
• blood clots;
• infections. 

Specific risks related to this surgical procedure include:

• loss of nipple sensation;
• asymmetric appearance of breast implants;
• implant deflation or rupture;
• implant changing their original position.

These complications are manageable through additional surgical procedures.

MTF Bottom Surgery Risks

Feminizing bottom surgery includes the following risks:

• changes or loss of sexual sensation;
• difficulty in completely emptying the bladder;
• narrowing or closure of the vaginal opening;
• breakdown of the new vaginal tissue;
• development of a rectovaginal fistula, a hole between the rectum and vagina;
• narrowing of the urethra.

The likelihood of these complications is very low in the hands of experienced MTF bottom surgeons.

How to undergo an MTF gender-affirmation surgery with Bookimed?

Starting your MTF surgical transition with Bookimed is simple. Here’s how it works:

💚Submit your request. Jumpstart your transformation by filling out a form on the Bookimed website.

💚Connect with a manager. A Bookimed manager will contact you to discuss your preferences, discuss available options, and answer your questions.

💚Choose your MTF surgeon and clinic. Your manager will help you pick the perfect destination and surgeon for your feminizing procedure.

💚Get a tailored quote. Once you pinpoint your clinic of choice, Bookimed will crunch the numbers and provide you with a detailed cost breakdown.

💚Plan your visit. Now it’s time to take a step towards a new chapter in your life with confidence and expert support every step of the way. Bookimed will help you organize a hassle-free journey.