Male to Female Gender

Confirmation Surgery:

Vaginoplasty

Thomas Satterwhite, MD

Plastic SurgeonBrownstein & Crane Surgical Services

Surgical Options: MTF

Vaginoplasty

Breast Augmentation

Facial Feminization Surgery

(FFS)

Genital Reconstruction:

Vaginoplasty

Multidisciplinary Care

Psychiatrist/Psychologist

Social Worker

Endocrinologist

Primary Care Physician

Lawyer

Ancillary Specialists

Gynecologist

Urologist

Surgeon

Mental Health Professional1. Assess and diagnose gender dysphoria

2. Provide information for treatment

3. Assess co-existing mental health concerns

4. Referral for hormone therapy

5. Referral for surgery

2 referral letters(+ 1 from hormone-prescriber)

Social Support

Establish Safe Housing

Emergency Contact

Accompanied by friends/family

Initial Visit

History and Physical

Medical History

Surgical History

Medications

Smoking

BMI

Insurance coverage

Hair removal months in advance

Stop Estrogen 2 weeks prior

Bowel prep day before

Pre-Operative Instructions

General Anesthesia

One-Stage Procedure: Penile Inversion

Vaginoplasty

Orchiectomy

Penectomy

Construction of Vagina

Up to 4-5 hours

During the Operation

Natural

Convincing

Minimal “upkeep”

Sexual intercourse

Erogenous

Lubrication

Ideal Vagina

Whitney.org

Georgia O’Keefe

homeandskincandeez.blogspot.com

Courtesy of Conrad Wenzel. 1

http://www.rebecca-betts.com/MTF2.swfx

Courtesy of Conrad Wenzel. 2

http://www.rebecca-betts.com/MTF2.swfx

Courtesy of Conrad Wenzel. 3

http://www.rebecca-betts.com/MTF2.swfx

Courtesy of Conrad Wenzel. 4

http://www.rebecca-betts.com/MTF2.swfx

Courtesy of Conrad Wenzel. 5

http://www.rebecca-betts.com/MTF2.swfx

Courtesy of Conrad Wenzel. 6

http://www.rebecca-betts.com/MTF2.swfx

Hospital 3 days POD1: Ambulation

Pain control: Percocet. Oxycodone and Dilaudid for breakthrough

Nutrition

Bowel regimen: Miralax, Colace

Standard Foley care

DVT prophylaxis: SCD’s

Wound care: prn ABD pad changes over bolster. Ice.

POD3: D/C home Foley teaching, extra dressings

POD5-7: Return to clinic Packing and Foley catheter out

Dilation

Re-start hormones

Transition from Percocet to Motrin

Return to clinic every week x 2 weeks,

then Q3 months

After the Operation

4 weeks post op: return to work

6 weeks post op: return to vigorous physical activity

3 months post op: engage in penetrating sexual intercourse

9 months to 1 year post op: final results

Recovery

Wound care

Douching

Dilation

Taking care of the neovagina

Complications

Wound breakdown

Bleeding/Hematoma

Urinary retention

UTI

Granulation tissue

Need for revision/re-operation

Infection

Hypersensitivity

Loss of Sensation

Anorgasmia

Excessive erectile tissue

Inadequate depth

Loss of skin graft/necrosis

Scarring

Stenosis

Prolapse

Rectal or urethral injury

Fistula

Urethral stenosis

Mental health issues

Unresolved gender dysphoria

Hematoma/Bleeding

Occurs in first 24-48 hours

Urethra

10% rate

Measures to minimize bleeding:

Bedrest POD0

Lay flat, legs closed

Keep comfortable and pain-free

Continuous ice

Thank you.

It’s been a pleasure!

thomas@brownsteincrane.com

www.brownsteincrane.com

(415) 625-3230

thomas@brownsteincrane.com

www.brownsteincrane.com

(415) 625-3230