male to female gender confirmation surgery: vaginoplasty · male to female gender confirmation...
TRANSCRIPT
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.
