Saturday, April 13, 2024

Post Op Bottom Surgery Ftm

Phalloplasty For Gender Affirmation

Transgender Post Op Pelvic Pain | Dr Rakhi Vyas | Pelvic Rehabilitation Medicine

Phalloplasty is surgery for masculinizing gender affirmation. Phalloplasty is a multistaged process that may include a variety of procedures, including:

  • Lengthening the urethra so you are able to stand to urinate
  • Creating the scrotum
  • Placing erectile and testicular implants
  • Skin grafting from the donor tissue site

Gender affirmation surgery is customized to each individual. Your surgical plan may include more or fewer of these steps and procedures. Fan Liang, M.D., medical director of the Center for Transgender Health at Johns Hopkins, explains what you should know.

What Can Phalloplasty Achieve

  • Standing Urination

    This allows patients to urinate standing up once they have healed from surgery. In fact, the first goal of phalloplasty is to enable the patient to urinate standing without leaks.

  • Erogenous Sensation

    Patients may be curious about what they will experience in terms of sensation with their reconstructed phallus. Because the sensitive nerves from the forearm are joined to the nerves of the clitoris, patients experience erogenous sensory recovery.

    This provides phalloplasty patients with the ability to feel sexual stimulation.

  • Penetrative Sex

    Sex is a major part of most peoples lives and relationships, and patients often wonder if they will be able to have penetrative intercourse after transgender bottom surgery.

    For patients who want the ability to have penetrative sex, a penile implant can be placed approximately one year after phalloplasty.

What Is a Phalloplasty Consultation Like?

A consultation with Dr. Boyd and Dr. Gladys Ng is necessary before undergoing phalloplasty. Dr. Ng is a UCLA urologist specializing in transgender surgery. Phalloplasty, together with vaginectomy, scrotoplasty, and urethral construction, is a complex surgery requiring the expertise of different dedicated specialties.

During your consultation, Dr. Boyd and Dr. Ng will perform a physical evaluation and discuss your goals for the procedure to determine if you are a candidate.

Insurance Coverage And Bottom Surgery

In the United States, the main alternatives to paying the high out-of-pocket costs include working for a company that follows the Human Rights Campaign Foundations standards for its Equality Index, or by living in a state that requires insurers to cover transgender care, such as California or New York.

In Canada and the UK, bottom surgery is covered under nationalized healthcare, with varying levels of supervision and wait times depending on the region.

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What Happens During Phalloplasty

During phalloplasty, surgeons take a large section of skin and tissue from another area of your body. After rolling it to form a shaft, they attach it to the groin.

Treatment may include additional procedures to:

  • Remove female genitals for patients undergoing FTM transgender surgery.
  • Extend the urethra , so you can urinate while standing.
  • Implant a device to enable erections.
  • Insert artificial testicles into the scrotum.

Can There Be Complications In The Postoperative Period Of Phalloplasty

1 year post

A member of the medical team will tell the patient how to avoid possible complications and how to act if a complication should arise. Regarding any doubts or anomalies after the operation, the patient should consult their doctor so that they can diagnose the patient and provide a solution.

Complications that may arise include:

  • An episode of bleeding may occur during or after the procedure.
  • Extrusion of the testicular prosthesis.
  • Urethro-cutaneous fistula communication of the urethra with the scrotal skin.
  • Urethral stricture a decrease in the urethras diameter.

Any doubts or discomfort that may arise should be discussed with your referring surgeon or with the patient care team. You have a phone number available 24 hours a day for any queries you may have.

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How To Take Care Of Your Skin Graft

Weeks 1 & 2 After Getting Out of the Hospital

Do these things every day:

  • Remove your old dressing
    • Get physical therapy for your hand/forearm
    • Dont lift anything heavier than 5 pounds with your arm that had the skin graft
    • Dont flex at your waist more than 90 degrees
    • Walk at least 4 times each day, for at least 10 minutes
    • Make sure you are urinating through the suprapubic catheter/leg bag system
    • Make sure you are moving your bowels at or close to your normal bowel habits . Stay hydrated, and use the stool softeners we gave you to help prevent constipation.

    What Results Should I Expect After Transmasculine Bottom Surgery

    The final results of transmasculine bottom surgery can help alleviate the feelings of gender dysphoria that some individuals may experience.

    Although most transmen choose to have their ovaries removed, some do not. The amount of ovarian growth as a result of testosterone therapy is small, the risk of developing ovarian cancer is not zero. Careful monitoring of ovarian health through exam is essential to your long-term health.

    A prosthesis is usually placed in the penile tissues at a later date to provide rigidity to the tissues.

    When you go home, if you experience shortness of breath, chest pains, or unusual heartbeats, seek medical attention immediately. Should any of these complications occur, you may require hospitalization and additional treatment.

    The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure and another surgery may be necessary.

    Following your physician’s instructions is key to the success of your surgery. It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. Your doctor will give you specific instructions on how to care for yourself.

    Next: Glossary of Terms

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    Gender Reassignment Surgery Female To Male

    For transmen surgery, the process of gender confirmation journey begins with 2 major steps:

    • Hormone therapy
    • Supportive counseling

    Indeed! These 2 factors are the major step for starting the surgical plan for the desired transition you want to get. No doubt, with every person it is their wish whether they want to get it done or not and how it can prove beneficial to their mental and overall health. During the initial consultation, it will be checked whether you meet the eligibility requirement or not. Dr. C Vijay Kumar is here giving you all the best of services to assist you better and make you comfortable with your transition of gender change journey from female to male.

    Making The Decision To Get Srs

    Dr. DuPéré LIVE Surgery: Top Surgery (FTM)

    Sexual pleasure was never a factor in my decision around surgery.

    My surgeon told me I would probably be able to climax, and he was right. But I had no option, mentally, to not go ahead.

    The constant fear of being unmasked, the desire to wear a swimming costume by the pool, instead of denim shorts, the realisation that any relationship with a man was partially dependent on me having the female parts, along with my long term wellbeing, were the bigger driving forces.

    Although there were occasional times that I thought I might not go ahead with lower surgery.

    It was more from the fear of dying on the operating table. Imagine leaving behind a bereft young family. I knew I needed surgery for me to feel I was as complete a woman as I could be.

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    Surgical Options For Trans Masculine Individuals

    In transgender men, or transmasculine people , the surgical procedures for transtition include top surgery , hysterectomy and/or oophorectomy, metoidoplasty, scrotoplasty, uretheroplasty, vaginectomy, and phalloplasty.

    Top Surgery is by far the most frequently required surgery for transmasculine individuals. A variety of techniques can be used including peri-areolar, keyhole, or double incision technique. Scarring and decreased nipple sensation may result. Testosterone is not a requirement to undergo top surgery. Check out the different techniques via Peri-Areolar and Double Incision.

    Hysterectomy/Oophorectomy is also fairly common for people who have dysphoria from the presence of reproductive organs, and/or other painful gynecological issues that exacerbate dysphoria. They do have the option of keeping one or both ovaries–if testosterone is not being used or will potentially not be used in the future, keeping one or both ovary may be advantageous so that the body has some hormones available to regulate other important biological processes like maintaining bone density. Hysterectomy is usually required prior to undergoing vaginectomy, scrotoplasty, and phalloplasty.

    Scrotoplasty is the construction of a scrotum, usually using labia majora tissue and silicone testicular implants. This procedure is usually performed in conjunction with either a metoidioplasty or phalloplasty procedure.

    Physical Therapy For Your Hand

    • Keep the splint that the hospital gave you on your hand until your hand therapy follow up appointment . Its OK to move your fingers, but dont lift anything heavier than 5 pounds
    • Week 2-3 youll start working with a hand therapist to improve your range of motion at your fingers and wrist. Hand therapy usually lasts for 2-4 weeks, but depends on your progress.
    • Find a list of certified hand therapists in your area by visiting the Hand Therapy Certification Commission website

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    How To Prepare For Bottom Surgery

    Leading up to bottom surgery, most people require hair removal via electrolysis.

    For vaginoplasty, hair will be removed on the skin that will eventually comprise the lining of the neovagina. For phalloplasty, hair is removed on the site of the donor skin.

    Your surgeon will require you to stop HRT two weeks before surgery, and refrain for two weeks after surgery. Talk to your surgeon about other medications that you take regularly. Theyll let you know if you need to stop taking them before the surgery, too.

    Some surgeons require a bowel prep before bottom surgery as well.

    Our Surgery Center Offers Exclusivity & Privacy In Close Proximity To Manhattan

    ftm top surgery

    The heart of The Aesthetic Center is our private operating suite in Darien, CT. We are conveniently located in Fairfield County, just a short distance from New York City.

    The facility is clean and modern, outfitted with the latest surgical equipment, state-licensed, and nationally accredited. Beyond the operating room, we offer a private, safe, and comfortable place for our transgender patients to feel at home, without fear of judgment.

    Unlike large hospital settings that have a high turnover of staff and lack of privacy, you can expect a warm and inviting atmosphere. While hospitals have high-risk contamination from sick patients, our surgical center caters exclusively to plastic surgery clients. Thus, our facility is safer and more sterile than public hospitals. We have the lowest infection rate in Connecticut.

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    What Kind Of Sensation And Feeling Can I Expect

    Sensation recovery varies by patient. Nerve regeneration can begin as early as three weeks after surgery, but it can take longer in some patients. Sometimes sensation can take up to a year or longer. Return of nerve sensation is not guaranteed. As nerves regenerate and strengthen connections, you might experience shooting pain, tingling or electrical sensations. As time goes on, the tingling feeling begins to subside.

    Informed Consent Vs Wpath Standards Of Care

    Leading transgender healthcare providers will either follow an informed consent model or the WPATH standards of care.

    The informed consent model allows the physician to inform you of the risks of a certain decision. Then, you decide for yourself whether to proceed without any input from any other healthcare professional.

    The WPATH standards of care requires a letter of support from a therapist to begin HRT, and multiple letters to undergo bottom surgery.

    The WPATH method draws criticism from some people in the transgender community. They believe it takes control out of the hands of the person and implies that the transgender person deserves less personal authority than a cisgender person.

    However, some care providers argue that ethical standards dont contradict informed consent . Requiring letters from therapists and physicians appeals to some hospitals, surgeons, and care providers, who may look at this system as legally defensible if necessary.

    Both of these methods are considered by some in the transgender community to be an improvement of the previous and widespread gatekeeper model. This model required months or years of real-life experience in their gender identity before they could have HRT or more routine surgeries.

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    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.

    When Can A Person Have Sex

    The neovaginal microbiome of transgender women post-gender reassignment surgery

    Recovery times after surgery can vary for each individual, so it is important that people follow the specific advice of a healthcare team.

    If people have undergone a metoidioplasty, they may gradually return to their usual activities in the 6 weeks after surgery.

    People may need to avoid or restrict sexual activity, heavy lifting, and exercise during this recovery time. They will need to consult a doctor about when it is safe to have sex.

    People who have had a phalloplasty may be able to return to their usual activities 68 weeks after surgery. It may take longer than this before people can do certain activities, including sex, heavy lifting, and driving. A doctor will let people know when they can safely have sex.

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    Will I Need A Catheter

    During your inpatient stay for stage 1 surgery, you will have a suprapubic tube that goes directly into your bladder and another catheter in your native urethra for at least five days. It is typically removed in the hospital before you go home.

    If you decide not to have urethral lengthening as part of stage 2, you will have a Foley catheter placed in the operating room and removed before you leave the hospital. If you decide to have urethral lengthening, you will go home with a Foley catheter in the new urethra and a suprapubic tube. A clamp ensures that the urethra does not leak urine.

    What Is The Recovery From Ftm Bottom Surgery Like

    Before each stage of your FTM bottom surgery, you will need to secure a comfortable space to recover. This can be your home, a close friend or family members home, or recovery center. It is important that you have someone who can assist you with everyday tasks for the first few days following surgery. At your pre-op visits, you will be given detailed before and after care instructions and Dr. Sinclair will address any questions or concerns you may have.

    Dr. Sinclair and his staff will be available to speak to you by phone, in person, or by e-mail should you have any questions or need support before or after surgery. When your surgical date comes, you will be confident, comfortable, and knowledgeable on what to expect.

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    When Will My Spt Be Removed

    Before the SPT is removed, around four weeks after surgery, a urologist will perform a retrograde urethrogram. This involves putting dye into the bladder through the new urethra. An X-ray tracks the dye to see if the new urethra is open and ready for urination. If so, the doctor will clamp the SPT and you will be allowed to urinate from your new urethra. If everything looks good after a few days, the SPT is removed.

    What Is A Musculocutaneous Latissimus Dorsi Flap

    2 years post

    The stages of the MLD phalloplasty are similar to the RFFF and ALT. However, the area from which the back tissue is taken usually does not require a skin graft and can be closed in a straight line. The scar can be covered with a shirt. Patients may experience some initial weakness raising their arm, but this improves with time.

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    Will I Have To Be Admitted To The Ward After The Phalloplasty

    After the phalloplasty, the patient must remain in hospital for at least a week in order for the IM Gender Unit medical team to better monitor the patients evolution, while offering both the patient and his companion the necessary setting and comfort to make a speedy recovery.

    Forty-eight hours after surgery, the patient will be allowed to move around.

    Days 1 & 2 In The Hospital

    • After your first 24 hours in the hospital youll slowly be given a diet to make sure you are not nauseated.
    • You will be given sequential compression devices on your legs, which gently squeeze your legs and help prevent blood clots.
    • Youll start taking home medications as soon as possible, depending on what these medications do.

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    Urethral Lengthening Before Phalloplasty

    Not all patients choose to have urethral lengthening however, this will be a necessary step if you want to stand when you urinate. It is also important to know that if you decide not to have urethral lengthening in stage 1 of your phalloplasty, it will not be possible to have the lengthening procedure later.

    Complications of Urethral Lengthening

    The most common complications for urethral lengthening include urethral strictures , fistula and diverticula . This may require an additional surgical procedure to fix.

    What Is A Radial Forearm Free Flap

    Part 4: A transgender woman undergoes her gender confirmation surgery

    During your surgical consultation, the doctor will check the blood flow to your arm and hand noninvasively. This involves temporarily putting pressure on arteries then releasing the pressure to test blood distribution in the arm and hand.

    There are three stages to this procedure.

    • Stage 3: The third stage of surgery involves putting in place testicle implants and an erectile device to help the patient achieve an erection. The third stage typically takes place 12 months after the second.

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