Gender Affirmation | David M. Whitehead, MD, MS
Helping the Body Match the Soul
The goal of subtotal mastectomy, or chest masculinization surgery, is to remove the majority of the breast tissue in order to give the chest a more masculine contour. Although the majority of breast tissue is removed, some may be left behind to optimize the chest wall contour, protect the blood supply to the skin, or, if the nipple-areolar complex is repositioned without free nipple grafting, to maintain blood supply to the nipple and areola.
There are two main techniques I use to perform subtotal subcutaneous mastectomy. The method I will recommend will depend on how much excess skin is present. For individuals with a significant amount of excess skin, I recommend a double incision technique. Those who have a small amount of excess skin and good skin elasticity may be candidates for a limited incision technique.
There are a few ways to perform breast augmentation. During our meeting, I want to make sure that I get an understanding of what your goals for the augmentation are, as well as which sort of physical activities in which you engage in (especially with regard to the upper extremities) in order to help recommend a type of implant and a surgical technique that will work best for you.
Vaginoplasty is an operation for creating both the external (vulva) and internal (vagina) components of the genital anatomy. The penile inversion method is the most commonly-used technique for vaginoplasty. Other techniques include the intestinal vaginoplasty, which is more commonly reserved for those undergoing revision procedures, or for those who lack sufficient genital skin to line a vagina of appropriate dimensions.
The purpose of metoidioplasty is to make the penis (of individuals designated female at birth) longer and more visible. This is accomplished by releasing some of the structures which keep it in an folded position. Many individuals who undergo metoidioplasty also seek to combine the procedure with urethral lengthening and/or masculinization of the perineum (the area between the penis/genitalia and the anus)
The goal of phalloplasty is to transfer sufficient tissue to the genital area to create a phallus (penis) of appropriate dimensions to allow for meaningful penetrative intercourse.
The techniques used for facial feminization depend on the areas of the face that are of particular concern to each individual patient. Often, these techniques are directed at reducing the appearance of the structural and soft tissue changes associated with testosterone exposure.