Editing Gender-affirming surgery (section)

== Surgical procedures ==
{{main|Feminizing gender-affirming surgery|Masculinizing gender-affirming surgery}}The best-known gender-affirming procedures are those that reshape the genitals, which are also known as ''genital reassignment surgery'', ''genital reconstruction surgery'', ''sex reassignment surgery,'' and ''bottom surgery'' (the latter is named in contrast to ''top surgery'', which is surgery to the breasts). However, the meaning of "sex reassignment surgery" has been clarified by the medical organization, the [[World Professional Association for Transgender Health]] (WPATH), to include any of a larger number of surgical procedures performed as part of a medical treatment for [[gender dysphoria]].{{update inline|date=December 2022}}<!--Previous text relies on SOC7, not SOC8.-->

WPATH says medically necessary gender-affirming surgeries include "complete hysterectomy, bilateral mastectomy, chest reconstruction or augmentation ... including breast prostheses if necessary, genital reconstruction (by various techniques which must be appropriate to each patient ...)... and certain facial plastic reconstruction."<ref name="WPATH Clarification">{{Citation |title=Clarification on Medical Necessity of Treatment, Sex Reassignment, and Insurance Coverage in the U.S. |url=http://www.wpath.org/documents/Med%20Nec%20on%202008%20Letterhead.pdf |access-date=7 October 2011 |archive-url=https://web.archive.org/web/20110930040306/http://www.wpath.org/documents/Med%20Nec%20on%202008%20Letterhead.pdf |archive-date=30 September 2011 |publisher=WPATH}}</ref> Other non-surgical procedures are also considered medically necessary treatments by WPATH, including facial hair [[electrology|electrolysis]].<ref name="WPATH Clarification" />

=== Genital surgery ===
==== Feminizing====
{{further|Feminizing gender-affirming surgery#Vaginoplasty}}
For [[trans women]] and [[Transgender#Other terms|transfeminine people]], genital reconstruction usually involves [[vaginoplasty|surgical construction of a vagina]]. The most common techniques are [[penile inversion]], [[Gender-affirming surgery (male-to-female)#bowel vaginoplasty|rectosigmoid vaginoplasty]] and [[Gender-affirming_surgery_(male-to-female)#Peritoneal_vaginoplasty|peritoneal pullthrough vaginoplasty]] (PPT).<ref>{{Cite web |title=Overview of Sigmoid Colon Vaginoplasty for MtF (Sigmoid Colon SRS) |url=https://www.transgendersurgerythailand.com/blog/an-overview-of-sigmoid-colon-vaginoplasty-for-mtf-sigmoid-colon-srs.html |access-date=September 30, 2024 |website=Estetica Thailandia}}</ref> Another technique, the non-penile inversion technique, uses perforated scrotal tissue to construct the vaginal canal.<ref>{{Cite web |title=Dr. Chettawut's Skin Graft Technique for SRS {{!}} Chettawut Plastic Surgery |url=https://www.chet-plasticsurgery.com/skin-graft-technique-for-srs/ |access-date=2024-09-30 |website=Dr.Chettawut- Sex reassignment and Facial feminization surgery center |language=en-US}}</ref> A less invasive procedure with reduced postoperative care requirements is [[vulvoplasty]], which creates external female genitalia without a vaginal canal. The downside of this procedure is that it does not allow for penetrative sex.  

====Masculinizing====
{{further|Masculinizing gender-affirming surgery#Genital reassignment}}
For [[trans men]] and [[Transgender#Other terms|transmasculine people]], genital reconstruction may involve the construction of a penis through either [[phalloplasty]] or [[metoidioplasty]], which is less invasive but results in a smaller penis. 

====Non-binary people====
[[Non-binary gender|Non-binary]] people may elect to get any of the surgeries listed above, depending on their [[sex assignment]]. They may also opt for bigenital or gender nullification surgeries. Bigenital operations include androgynoplasty, a procedure that retains the penis,<ref name="Vincent_2019">{{cite journal | vauthors = Vincent B | title = Breaking down barriers and binaries in trans healthcare: the validation of non-binary people | journal = The International Journal of Transgenderism | volume = 20 | issue = 2–3 | pages = 132–137 | date = 2019-07-03 | pmid = 32999601 | pmc = 6831034 | doi = 10.1080/15532739.2018.1534075 }}</ref> or vagina-preserving phalloplasty.<ref name="Baum_2022" /> These procedures tend to be rarely performed.<ref name="Baum_2022" /> In 2017, one of the leading UK trans surgeons, [[James Bellringer]], commented that he had never received a request for it.<ref>{{Cite book | vauthors = Bellringer J |chapter=Surgery for Bodies Commonly Gendered as Male | veditors = Richards C, Bouman WP, Barker MJ | language=en| year=2017| title=Genderqueer and Non-Binary Genders |publisher=Springer |pages=247–263 |doi=10.1057/978-1-137-51053-2_12|isbn=978-1-137-51052-5 }}</ref>

====Other considerations====
Genital surgery may also involve other medically necessary procedures, such as [[orchiectomy]], [[penectomy]], or [[vaginectomy]]. Complications of penile inversion vaginoplasty are mostly minor; however, rectoneovaginal fistula (abnormal connection between the neovagina and the rectum) can occur in about 1–3% of patients. These require further surgery to correct.<ref name="Gaither_2018">{{cite journal | vauthors = Gaither TW, Awad MA, Osterberg EC, Murphy GP, Romero A, Bowers ML, Breyer BN | title = Postoperative Complications following Primary Penile Inversion Vaginoplasty among 330 Male-to-Female Transgender Patients | journal = The Journal of Urology | volume = 199 | issue = 3 | pages = 760–765 | date = March 2018 | pmid = 29032297 | doi = 10.1016/j.juro.2017.10.013 | url = https://escholarship.org/uc/item/3gp4s8p0 | url-status = live | access-date = 23 May 2021 | s2cid = 42635923 | archive-url = https://web.archive.org/web/20220311010924/https://escholarship.org/uc/item/3gp4s8p0 | archive-date = 11 March 2022 }}</ref>

=== Other surgeries ===
[[File:Double mastectomy.jpg|thumb|Transgender man with healed [[mastectomy|double incision]] [[chest reconstruction]], 2020]]

As underscored by WPATH, gender transition may entail a variety of non-genital surgeries that change primary or secondary sex characteristics, any of which are considered "gender-affirming surgery" when done to affirm a person's [[gender identity]].<ref>{{cite journal | vauthors = Coleman E, Radix AE, Bouman WP, Brown GR, de Vries AL, Deutsch MB, Ettner R, Fraser L, Goodman M, Green J, Hancock AB, Johnson TW, Karasic DH, Knudson GA, Leibowitz SF, Meyer-Bahlburg HF, Monstrey SJ, Motmans J, Nahata L, Nieder TO, Reisner SL, Richards C, Schechter LS, Tangpricha V, Tishelman AC, Van Trotsenburg MA, Winter S, Ducheny K, Adams NJ, Adrián TM, Allen LR, Azul D, Bagga H, Başar K, Bathory DS, Belinky JJ, Berg DR, Berli JU, Bluebond-Langner RO, Bouman MB, Bowers ML, Brassard PJ, Byrne J, Capitán L, Cargill CJ, Carswell JM, Chang SC, Chelvakumar G, Corneil T, Dalke KB, De Cuypere G, de Vries E, Den Heijer M, Devor AH, Dhejne C, D'Marco A, Edmiston EK, Edwards-Leeper L, Ehrbar R, Ehrensaft D, Eisfeld J, Elaut E, Erickson-Schroth L, Feldman JL, Fisher AD, Garcia MM, Gijs L, Green SE, Hall BP, Hardy TL, Irwig MS, Jacobs LA, Janssen AC, Johnson K, Klink DT, Kreukels BP, Kuper LE, Kvach EJ, Malouf MA, Massey R, Mazur T, McLachlan C, Morrison SD, Mosser SW, Neira PM, Nygren U, Oates JM, Obedin-Maliver J, Pagkalos G, Patton J, Phanuphak N, Rachlin K, Reed T, Rider GN, Ristori J, Robbins-Cherry S, Roberts SA, Rodriguez-Wallberg KA, Rosenthal SM, Sabir K, Safer JD, Scheim AI, Seal LJ, Sehoole TJ, Spencer K, St Amand C, Steensma TD, Strang JF, Taylor GB, Tilleman K, T'Sjoen GG, Vala LN, Van Mello NM, Veale JF, Vencill JA, Vincent B, Wesp LM, West MA, Arcelus J | title = Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 | journal = International Journal of Transgender Health | volume = 23 | issue = Suppl 1 | pages = S1–S259 | date = 19 August 2022 | pmid = 36238954 | pmc = 9553112 | doi = 10.1080/26895269.2022.2100644 }}</ref> For trans men, these may include [[mastectomy]] (removal of the breasts) and [[chest reconstruction]] (the shaping of a male-contoured chest), or [[hysterectomy]] and [[bilateral salpingo-oophorectomy]] (removal of ovaries and [[fallopian tube]]s). For some trans women, [[facial feminization surgery]], [[hair transplant]]s, and [[breast augmentation]] are also aesthetic components of their surgical treatment.<ref>{{Cite web |title=What Do I Need to Know About the Transitioning Process? |url=https://www.plannedparenthood.org/learn/sexual-orientation-gender/trans-and-gender-nonconforming-identities/what-do-i-need-know-about-transitioning |url-status=live |archive-url=https://web.archive.org/web/20190505022744/https://www.plannedparenthood.org/learn/sexual-orientation-gender/trans-and-gender-nonconforming-identities/what-do-i-need-know-about-transitioning |archive-date=5 May 2019 |access-date=5 May 2019 | work = Planned Parenthood Federation of America, Inc. (PPFA) }}</ref> Voice feminizing surgery is a procedure in which the overall pitch range of the patient's voice is reduced.<ref>{{Cite web |title=Voice feminizing therapy and surgery – Mayo Clinic |url=https://www.mayoclinic.org/tests-procedures/voice-feminizing-therapy-and-surgery/about/pac-20470545 |url-status=live |archive-url=https://web.archive.org/web/20210523024145/https://www.mayoclinic.org/tests-procedures/voice-feminizing-therapy-and-surgery/about/pac-20470545 |archive-date=23 May 2021 |access-date=23 May 2021 |work=Mayo Clinic |language=en}}</ref> Adam's apple reduction surgery ([[chondrolaryngoplasty]]) or tracheal shaving is a procedure in which the most prominent part of the thyroid cartilage is reduced.<ref>{{cite journal |vauthors=Cohen MB, Insalaco LF, Tonn CR, Spiegel JH |date=October 2018 |title=Patient Satisfaction after Aesthetic Chondrolaryngoplasty |journal=Plastic and Reconstructive Surgery. Global Open |volume=6 |issue=10 |pages=e1877 |doi=10.1097/GOX.0000000000001877 |pmc=6250475 |pmid=30534483}}</ref>

There is also Adam's apple enhancement therapy, in which cartilage is used to bring out the Adam's apple in female-to-male patients.<ref>{{Cite web |title=Facial Masculinization Surgery (FMS) |url=https://constructivesurgery.org/ftm-facial-masculinization-surgery/ |url-status=live |archive-url=https://web.archive.org/web/20210523025647/https://constructivesurgery.org/ftm-facial-masculinization-surgery/ |archive-date=23 May 2021 |access-date=23 May 2021 |work=Constructive Surgery}}</ref>{{Better source needed|date=July 2023}}