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Gender Affirming Surgeries
Toby R Meltzer, MDScottsdale, Arizona
Biography BS Louisiana State University Baton Rouge MD Louisiana State University Medical School General Surgery Residency, Charity Hospital of New Orleans Plastic and Reconstructive Surgery, University of Michigan Medical School Fellowship in Burn Surgery, Wayne State University Board Certification in Plastic Surgery and General Surgery Assistant Professor of Surgery, Oregon Health Sciences University (1990-
1996) Chief of Plastic Surgery at Veterans Administration Hospital of Portland
(1990-1995) President, Oregon Society of Plastic Surgeons (1995-1997) Private Practice, Eastmoreland Hospital Portland Oregon 1996-2003 Private Practice, Honor Health 2003-Present
Pre-operative Requirements World Professional Association of Transgender Health
(WPATH) Psychotherapy Hormone Therapy Real Life Experience
Hospitalization Why?
Major surgery with life threatening risks
Regular after-care Rapid treatment of
complications
Why not? Reduced costs?
Self-insured Insurers
Hospital acquired complications
Hospitalization Why?
Major surgery with life threatening risks
Regular after-care Rapid treatment of
complications
Why not? Reduced costs?
Self-insured Insurers
Hospital acquired complications
Greenbaum Surgical Specialty HospitalHonor Health System
GENDER CONFIRMING SURGERY FOR TRANS FEMALES
Modern Vaginoplasty Technique Penile Inversion
Clitoroplasty Sensate Flap from Glans of
Penis
Modern Penile Inversion Vaginoplasty
Penile Skin Vaginal Lining
Scrotum Labia Minora/Major
Glans Penis Clitoris
Embryologic Equivalents
Goals of Vaginoplasty Safe Operation with Minimal Morbidity
Adequate Depth and Width for Intercourse
Cosmetically pleasing and Close as Possible Anatomically
Vaginoplasty
Vaginoplasty
Vaginoplasty
Vaginoplasty
Clitoroplasty
Vaginoplasty
Single Stage Vaginoplasty
Labiaplasty
Labiaplasty
Vaginoplasty with Labiaplasty
Patient E Patient F
Vaginoplasty with Labiaplasty
Patient G Patient H
Vaginoplasty and Labiaplasty
Labiaplasty Why?
Labia Majora too far apart No labia minora Minimal or deficient clitoral
hood Everyone doesn’t heal perfectly
Why not? “Not necessary”
Viewer discretion High revision rate Labiaplasty or “revision
optional” Another operation
Minor procedure One night hospital Short recovery period
Added cost?
Dr. Meltzer did not perform this operation
Secondary Labiaplasty
Dr. Meltzer did not perform this operation
Vaginal Dilators
Skin Graft Donor Site
Electrolysis
Preoperative Electrolysis Why?
Very unlikely to eliminate all follicles at surgery
Why not? Painful Another “procedure” Delays surgery Hair doesn’t cause physical
problems
Sigmoid Colon Vaginoplasty
Sigmoid Colon Vaginoplasty
Dr. Meltzer did not perform this operation
BREAST RECONSTRUCTION
Breast Reconstruction
Breast Reconstruction
BODY FEMINIZATION
Liposuction
Liposuction
Mini Abdominoplasty
Mini Abdominoplasty
Abdominoplasty
Abdominoplasty
Lipoinfiltration of Buttocks
Lipoinfiltration of Buttocks
Lipoinfiltration of Buttocks
Sub-Fascial Gluteal Implants
Sub-Fascial Gluteal Implants
FACIAL FEMINIZATION
Feminization of the Neck
Thyroid Cartilage Reduction
Thyroid Cartilage Reduction
Thyroid Cartilage Reduction
Pre-Op Post-Op
Thyroid Cartilage Reduction
Post-Op
Voice Modification Surgery
Cephalometrograms
Forehead Feminization
Forehead Feminization
Forehead Feminization
Feminization of the Jaw(Mandibular Reduction and Genioplasty)
Surgery of the Jaw
Mandibular Reduction and Genioplasty (Li et al, PRS 2011)
Mandibular Reduction
Vertical Reduction and Narrowing Genioplasty
Vertical Reduction and Narrowing Genioplasty
Facial Feminization
Facial Feminization
Facial Feminization
GENDER CONFIRMING SURGERY FOR TRANS MALES
CHEST RECONSTRUCTION
Minimal Incision
Minimal Incision
Minimal Incision
Minimal Incision
Minimal Incision
Excision with Free Nipple Grafts
Excision with Free Nipple Grafts
Chest Reconstruction
Surgical Team for Genital Surgery
Plastic Surgeon
Urologist
Gynecologist
Metoidioplasty Advantages
Minimally invasive Sensation is unaffected Natural Appearance Urethral Lengthening
reliable
Disadvantages Small Size Not Suitable for all
Patients
Metoidioplasty, post-expansion, now with permanent prosthesis
Pumping and Metoidioplasty
Scrotal Expanders
External Scrotal Expanders
Local Flaps (Groin Flap) Advantages Large Size Donor Site Acceptable Can Be Implanted with
Erectile Device
Disadvantages Limited Erogenous Sensation Requires Multiple Procedures Requires Radial Forearm for
urethra
Groin Flap Phalloplasty
Inset of Clitoris
Radial Forearm Flap for Urethra
Anterior Lateral Thigh Flap
ALT Donor Site
Radial Forearm Flap Advantages:
Sensate Large Size Urethral Lengthening More
Reliable Can Be Implanted with Erectile
Device Best Cosmetic Appearance
Disadvantages Donor Site High Initial Complication Rate Expensive
Radial Forearm Flap
Radial Forearm Phalloplasty
Radial Forearm Flap
Groin Flap with Erectile Pump
Radial Forearm Phalloplasty with Malleable Rods
Urethral Hair
Thank you!
tmeltzer@tmeltzer.com
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