Gender reconstructive surgery – winning the waiting game

When it comes to gender reconstructive surgery, if you could sum-up the patient experience in one word, chances are you’d use ‘waiting’.

The patient may have known from their early teens they weren’t comfortable in their own skin, yet they were forced to wait until they could do anything about it. If they initially sought help on the NHS, they’d have typically waited for up to two and a half years just to get an initial consultation at the gender identity clinic (GIC).

If they’ve then sought private help, armed with their all-important GIC referral, they may have then had to wait many years until saving enough money to afford the surgery.

They patiently wait for a date for their operation, all the while nursing a deep, often excruciating longing for change. And they then wait once more while their bodies recover from the surgery so that they can embark on the next exciting chapter in their lives.

As surgeons, anything we can do to help win this ‘waiting game’ will surely be beneficial to the patient. But how do we go about doing it?

For female to male patients (FTM), there may be an answer. While many gender reconstructive surgeons are not yet doing so, it’s my passionate belief that both ‘top’ and ‘bottom’ surgery can be undergone at the SAME time, putting two potential recovery periods into one time frame while also reducing the cost of hospital fees.

Indeed, recent reports have shown that it is safe to combine these procedures with significant benefits for patients. The most commonly requested ‘top’ surgery for gender dysphoria is mastectomy – re-sculpting the breasts to create a flatter, ‘male’ chest appearance.

While ‘bottom’ surgery typically involves hysterectomy to remove the womb, and oophorectomy to remove the ovaries. Top surgery usually takes around two hours to complete, while hysterectomy with oophorectomy takes roughly 90 minutes.

So in combining the two procedures, this will involve around four hours of anaesthesia. You would need to be in good health, with no significant risk factors, to undergo this combined surgery. And your multidisciplinary team would need to assess your suitability.

But it could be a real leap forward in patient treatment times. I prefer to perform the top surgery, or bilateral mastectomy, first, and then our gynaecologist (Mr Adrian Lower) performs the hysterectomy and oophorectomy. Most patients are suitable for keyhole or laparoscopic hysterectomy and oophorectomy with significant benefits for their recovery.

Combining Top surgery and hysterectomy and oophorectomy will require an overnight stay in hospital. You will then require two to four weeks off work, depending on your profession. And there will be moderate pain from both procedures, which will require suitable pain medication.

The frustration for many may be in finding surgeons who can work together to combine these two procedures into one hospital operation, and who are competent in performing transgender surgery in the first place. But chances are, combined surgery is the best option for you.

Christopher Inglefield is a highly experienced Consultant Plastic and Transgender Surgeon and Medical Director of London Transgender Clinic. He is a member of the World Professional Association for Transgender Health , the UK Association of Aesthetic Plastic Surgeons and the International Society of Aesthetic Plastic Surgeons