What is gender reassignment surgery?

Genital reassignment surgery, more than a single procedure, is actually a set of surgical techniques designed to help people who experience a mismatch between their sex assigned at birth and their gender identity, which may cause distress or discomfort. This condition is known as gender dysphoria. Through these procedures, it is possible to reassign a patient’s sex to align with their gender identity.

The surgeries applied for gender affirmation depend on whether the person is transitioning from male to female or from female to male. These surgeries aim not only for aesthetic results but also for functionality.

As we mentioned, there are different surgeries depending on whether the transition is from male to female, or female to male. Let’s begin with male-to-female gender reassignment.

The surgical treatments that a transgender woman may undergo to change her genital appearance include:

Vaginoplasty

This is the most well-known procedure, also referred to as feminizing genitoplasty. It involves reconstructing a functional vagina with proper aesthetics and includes the removal of the phallus and testicles.

There are several surgical techniques developed that differ in how the vaginal cavity is created. The choice depends on two key factors assessed by the surgical team:

1. The desired vaginal depth to create a wide vaginal tunnel that allows for satisfactory sexual intercourse.
2. The availability of tissue in the area.

From this, the following techniques arise: penile inversion vaginoplasty, colovaginoplasty, peritoneal vaginoplasty, and graft vaginoplasty.

• • Penile inversion vaginoplasty: The vaginal canal is created using the inversion of the penile skin alone. Therefore, sufficient quantity and good quality penile skin are required.
  • Graft vaginoplasty: Adds skin grafts from the patient to increase the depth and size of the vaginal cavity.
  • Colovaginoplasty: The most commonly used when penile skin is insufficient, such as after circumcision. It has become more common due to early hormone therapy that suppresses pubertal genital development, leaving no skin for inversion. This technique uses a segment of colon to line the vaginal canal.
  • Peritoneal vaginoplasty: Uses abdominal tissue (not colon) to form the vaginal canal. It also requires adequate penile skin, making it a hybrid technique between penile inversion and colovaginoplasty.

Vulvoplasty

Vulvoplasty, also called “zero-depth vaginoplasty,” is an alternative that achieves the same external appearance and sensitivity as vaginoplasty but without creating a vaginal tunnel. The procedure involves constructing the labia minora, labia majora, clitoris, and vaginal introitus. Externally, it looks like a vagina, but penetration is not possible.

Breast augmentation

This is one of the most requested procedures for chest feminization. Hormone therapy alone often does not provide sufficient breast volume or aesthetic shape. Breast augmentation allows for increased volume, projection, and a more feminine contour.

The operation is performed under general anesthesia and lasts 1-2 hours. There are three main approaches:

• • Axillary incision: The implant is inserted through the armpit, leaving the scar hidden.
  • Areolar incision: The implant is inserted through an incision at the border of the areola, where the scar blends with the change in pigmentation.
  • Inframammary incision: The incision is made in the fold beneath the breast, concealing the scar in the natural crease.

Recovery requires relative rest, though the postoperative period is not complex. This surgery is often combined with genital surgery in the same session.

Body surgery: Liposculpture, buttock augmentation, waist narrowing with rib remodeling

Body surgery involves techniques to reshape the body and highlight feminine contours.

• • Liposuction can reduce waist and chest size.
  • Gluteal fat transfer provides more defined curves by increasing buttock volume using the patient’s own fat or implants (or a combination).
  • For waist definition, rib remodeling can be performed, treating ribs 11 and 12 (sometimes also rib 10) to achieve a narrower waistline.

Phalloplasty

This reconstruction allows the creation of a functional and sensitive neophallus with testicles, usually in several stages. The first step is phallus creation using a microsurgical technique under general anesthesia. A radial forearm flap is commonly used, ensuring vascular and nerve connections for sensitivity. This procedure lasts 8–10 hours and requires about a week of hospitalization. Additional surgeries may include testicular implants and urethral reconstruction, which are less complex and require shorter recovery.

Metoidioplasty

An alternative to phalloplasty, this is technically simpler as it does not involve microsurgery. It usually lasts 2-6 hours.
In this procedure, the clitoris is used to create a micropenis with erotic sensitivity, though penetration is not possible. A urethral extension is created, allowing urination while standing.

Trans mastectomy

A key step in female-to-male transition, often performed first. It removes most breast tissue and reshapes the chest to achieve a masculine appearance. The surgery lasts 2–3 hours under general anesthesia.

Gender affirmation may also be supported by aesthetic treatments to enhance facial features in line with the patient’s gender identity.

Options vary depending on the patient. Facial feminization surgeries aim to achieve facial harmony and feminine traits. The face can be divided into three thirds:

• • Upper third (forehead): Hairline advancement, brow ridge reduction, and eyebrow lift.
  • Middle third (nose and cheeks): Feminizing rhinoplasty reduces overall size and refines shape. Cheek augmentation may be achieved with fillers or implants.
  • Lower third (jaw and chin): Jaw and chin contouring can refine angles, and chin projection may be modified with implants or bone advancement. Lips may also be reshaped with fillers or surgical lifts.

Recovery is not usually painful, though swelling can cause temporary discomfort.

Facial masculinization typically focuses on emphasizing a square jawline and a more prominent chin, often using implants or bone remodeling.

As with any surgery, gender reassignment carries risks. Patients must be informed beforehand and weigh pros and cons. Risks include:

• • Bleeding
  • Infections
  • Fever
  • Hematomas
  • Poor wound healing
  • Blood clots
  • Urinary problems (such as incontinence)
  • Fistula formation

At IM Gender, we ensure maximum safety by performing thorough preoperative and postoperative monitoring. Following the surgeon’s recommendations is key for a faster and more successful recovery.

Recovery time depends on the procedure and the patient’s health. After surgeries like vaginoplasty or phalloplasty, hospitalization usually lasts about 7 days. During this time, vital signs are monitored, diet is progressively increased, painkillers and antibiotics are administered, and other necessary care is provided.

Gender reassignment is a long and complex journey, requiring the support of a multidisciplinary team: surgeons, gynecologists, urologists, endocrinologists, and psychologists.

If you are considering taking the step toward gender transition, at IM Gender we are a clinic specialized in gender reassignment surgery and complementary feminization and masculinization treatments. For more information, book an appointment with us. Our surgeons and medical team will provide you with personalized advice, recommending the best options for your case while taking all your expectations into account.