What you can expect

Chest surgery

Top surgery for transgender men or masculinizing chest surgery involves the removal of your breast tissue (subcutaneous mastectomy). If your breast size is small, you might be able to have surgery that spares your skin, nipple and areola (nipple-sparing subcutaneous mastectomy). This procedure minimizes scarring, has a faster healing time and usually preserves sensation in the nipples. If you have larger breasts, you might need to have your nipples and areolas taken off, resized and grafted back into position. This causes more scarring and loss of sensation to the nipple.

If you are a carrier of genetic mutations that increase your risk of breast cancer, you might also choose to have your nipples and areolas completely removed and subsequent surgery or tattooing to recreate their appearance.

After surgery, you might need to stay in the hospital overnight. You'll likely have one or two small plastic tubes placed where your breasts were removed to drain any fluids that accumulate after surgery. You might not be able to bear weight on your upper body for six weeks.

Some breast tissue will likely remain regardless of the surgical technique. As a result, your doctor will talk to you about the need for continuing routine breast cancer screening.

Genital surgery

Metoidioplasty

Metoidioplasty is a procedure to increase the length of the clitoris without grafting tissue from other parts of the body. During surgery, the clitoris is freed from its attachment to your labia minora and a suspensory ligament. Your surgeon can also extend your urethra through your released clitoris using a graft typically taken from the lining of your mouth (urethral hookup). This will make standing urination possible.

This procedure typically results in a penis with an unstimulated length of between 1 and 3 inches (3 and 8 centimeters). Typically, full sensation and orgasmic function are retained.

It isn't necessary to have your vagina closed or removed before having metoidioplasty. Penetration and pap tests might not be possible afterward. As a result, your surgeon might recommend removing your uterus, cervix and ovaries during metoidioplasty.

After metoidioplasty, you'll have a tube (catheter) placed in your urethra to collect urine. Recovery might take up to two weeks.

Phalloplasty

Phalloplasty, the surgical creation of a penis, involves multiple procedures. During phalloplasty, large amounts of donor skin will be taken from other areas of your body, such as your forearm, calf or lower abdomen. This can cause significant scarring. The skin will be rolled into the shape of a penis and anchored into position above your clitoris. You might also have:

• Urethral lengthening to allow for urination through your penis
• Grafting of nerves and blood vessels to provide sensation in your penis
• A procedure to sculpt the head of your penis (glansoplasty)
• Medical tattooing to create a distinct difference between the head and shaft of your penis

After phalloplasty, you'll have a tube (catheter) placed in your urethra to collect urine. You'll likely need to stay in the hospital for a few days. Phalloplasty carries a high rate of complications and might require many follow-up surgeries. Depending on the procedures done, recovery might take up to 12 weeks. Your new penis will not be able to become erect with sexual stimulation. A penile implant will be needed to allow penetrative sexual intercourse.

Scrotoplasty

Scrotoplasty is the surgical creation of a scrotum. During scrotoplasty, egg-shaped silicone testicular implants are inserted into your labia. To prepare for the procedure, you'll have expanders placed under the skin in your labia. The expanders will be gradually filled with saline through an external port over a period of months. When your skin has been expanded enough, your surgeon will insert the implants.

Some people find the implants uncomfortable. It's possible for the implants to wear through surrounding tissue or become infected.