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About
TRANSGENDER
Top Surgery
transgender
Gender dysphoria describes a group of individuals who are dissatisfied with their anatomic gender and want to acquire the secondary sexual characteristics of the opposite gender
Prevalence
1 in 11 900 males
1 in 30 400 females
CRITERIA FOR DIAGNOSIS
Desire to dress and live as opposite gender (and make his/her body a closer resemblance to the opposite gender)
Gender identity present for > 6 months
Not a symptom of another genetic or psychiatric disorder
Mental health professionals for psychotherapy
Patients need to have life-experiences in their desired gender role
Hormone therapy (monitored by medical physicians)
TREATMENT REQUIRES A MULTIDISCIPLINARY TEAM
Feminization: via suppression of androgens and induction of female characteristics (i. GnRH antagonists ii. Estrogens )
Special consideration needs to be taken for adolescents, and puberty suppression may be indicated
Surgeon
Transition surgery in Ontario must be pre-approved and is covered under the provincial plan (OHIP) Referrals are accepted once approval is received by the primary care provider for the transgender person. We primarily provide top surgery only. Referral out of Northern Ontario is required for facial feminization/masculinization or bottom surgery.
Patient – 23 yrold Transgender Male
Pre and 3 months post bilateral nipple-sparring mastectomy.
Typically, the first surgical procedure in these patients
Need to decrease breast/skin, obliterate IMF, reduction of nipple/areola
Incision choices depend on amount of ptosis
Subcutaneous keyhole or periareolar mastectomy for small breasts with minimal skin excess
Double incision mastectomy with free nipple grafts for medium and large/ptotic breasts
A small revision for skin excess may be required, contour issues are a major side effect of these procedures
Compression garment/wrap recommended for first 4-6 weeks, avoiding heavy lifting/elevated blood pressure as there is a high risk of bleeding/hematoma after this surgery.
MALE TO FEMALE
Breast augmentation
Some breast growth from hormones
Different that natal female: chest is wider, nipple to IMF distance is less, areolae are smaller, pectoralis major more developed
Implant can be placed pre- or sub-pectoral
Any incision is ok: peri-areolar, IMF (most common)
Areolar tattoo (to enlarge)
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