Transsexuality: female to male operations

Various operations are possible for a gender change from female to male. For example, you can opt for breast surgery, abdominal surgery, colpectomy, meta and/or fallo.

General

A trans man can undergo various operations. Not every trans man undergoes the same operations. Some trans men choose not to undergo surgery at all. Others choose to undergo all surgeries.

Breast surgery

Breast surgery is often the first operation. Sometimes this operation is done simultaneously with the abdominal operation. The breast surgery is usually done one year after the green light. During this operation, excess breast tissue is removed. Various techniques are possible for this.

Interview

Before breast surgery, an intake interview is first scheduled with the surgeon. During this conversation, the surgeon will make an assessment of which technique can be used.

Small cup

If the trans man has a small cup size, an incision around the nipple can be chosen. The advantage of this is that the scars are smaller. The disadvantage is that the areola and nipple often remain larger and can hardly be moved.

Around the nipple and under the breast

The second technique involves making an incision under the breast to remove all excess breast tissue. You can choose between a pedicled nipple or a free nipple graft. In the case of a pedicled nipple, the nipple and areola are reduced in size and secured through a new opening in the housing. The disadvantage of this is that the breast can be made less flat and the areola cannot be placed as far out. With a free nipple graft, the nipple is cut completely loose. The advantage of this is that the nipple can be made much smaller and flatter. This also allows the chest to be made flatter and the areola to be moved further out. The disadvantage, however, is that the feeling in the nipple disappears because the nerve pathways do not remain intact.

Third and fourth techniques

The third and fourth techniques are rarely used. The third technique involves making an incision around the nipple and horizontally across the breast. This technique is rarely used due to the placement of the scars. The fourth technique is around the nipple and across the breast. This technique is also rarely used due to the placement of the scars. With these two techniques, a pedicled nipple and a free nipple graft are also possible.

After the operation

To keep everything together and prevent swelling, a sturdy rib band is placed after the operation. This band should be worn for approximately four to six weeks. After the operation it is important not to strain the pectoral muscle. It is wise to have care available at home for the first week. About a year after breast surgery, it can be decided whether another breast correction is required.

Scars

The scars from breast surgery often fade slowly. If the scars do not fade sufficiently, a medical tattoo can be placed. A medical tattoo is placed in the same way as a regular tattoo. A medical tattoo is in principle permanent, but can sometimes fade slightly after years. The price of a medical tattoo depends on the size of the scars. The medical tattoo is usually not reimbursed by health insurance.

Abdominal surgery

Sometimes the chest surgery and the abdominal surgery are performed at the same time. If this is not the case, there must be at least three months between operations. This has to do, among other things, with the anesthesia, but of course also with the recovery process of the breast surgery. During abdominal surgery, the uterus and ovaries are removed. The operation is preferably done through the vagina, so that no external scars occur. If this is not possible, it can be done through an incision in the lower abdomen.

Interview

An intake interview will also take place before the abdominal operation. In some cases, the doctor will want to do an ultrasound to see what it looks like on the inside. The doctor can also opt for an internal examination. Blood is also often taken.

The operation itself

In almost all cases the operation is done under general anesthesia. Sometimes an enema must be taken the evening before the operation to empty the intestines. An enema is a soapy liquid that is injected into the intestines through the anus.

After the operation

Sometimes a medical tampon is inserted to prevent bleeding. This is removed shortly after the operation. It is advisable to wear sanitary towels for some time after the operation to prevent bleeding. For some trans men the bleeding stops after 3 to 4 days, for other trans men it takes two to three weeks. After abdominal surgery, many trans men experience a small physical growth spurt, because the female hormone is no longer produced and therefore testosterone is no longer counteracted.

Follow-up operations

More operations may follow after the abdominal operations. Not all trans men opt for the same operations. Some trans men find only the chest operation sufficient, or stop after the abdominal operation. After abdominal surgery, you can also opt for a colpectomy, meta or fallo.

Colpectomy

During a colpectomy, the entire vagina, including the vaginal wall, is removed. This is done under general anesthesia. This operation means that fluid can no longer be released during arousal. One of the disadvantages of this operation is that the erotically sensitive tissue of the vagina is removed. In addition, it is a difficult operation because the vaginal wall is very thin. This may cause damage to the bladder, rectum or anus during the operation. The operation itself takes about two hours and is often fully reimbursed by health insurance.

Meta

During the meta, the clitoris, which has already been elongated by the testosterone, is stretched and the urethra is repositioned. The labia majora are joined together to make a scrotum. The advantage of this operation is that there are no visible scars and the result looks realistic. The average penis length after this operation is 4-6 cm. Penetration is often difficult due to the short length. In addition, urinating while standing is not always possible.

Fallo

For a fallo, a piece of skin is removed from the forearm or upper leg. This creates a penis. The inner part of the piece of skin is used as a urethra. The penis is connected to the nerves around the clitoris and urethra. The labia majora are used to make a scrotum. The average length of a fallo is 13 cm. One of the advantages of this operation is that urination is possible while standing. One of the disadvantages, however, is that a large scar is created where the piece of skin has been removed.
Since there are no muscles in the piece of skin, the penis cannot become erect. It is possible to place an erection prosthesis later. An important condition for this is that there must still be feeling in the penis. During this operation, a pump system is placed in the penis, making it possible to achieve an erection.

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