What to know about female-to-male surgery
Medically reviewed by Stacy Sampson, D.O. — By Jayne Leonard on October 8, 2019
Surgery
Recovery
What to expect
Outlook
Female-to-male surgery is a type of sex reassignment surgery, which is also called gender affirmation surgery or gender-affirming surgery.
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This can take different forms, including the removal of breasts — a mastectomy — and the altering of the genital region, known as “bottom” surgery.
Examples of bottom surgery include:
removal of the uterus, known as a hysterectomy
removal of the vagina, known as a vaginectomy
construction of a penis through metoidioplasty or phalloplasty
In this article, we describe female-to-male gender-affirming surgeries. We also discuss recovery and what to expect from a transgender penis.
Surgery
Before having female-to-male gender-affirming surgery, a person will receive testosterone replacement therapy.
They may then undergo one or more of the following types of procedure.
Chest restructuring
A person undergoing surgery to transition from female to male typically has a subcutaneous mastectomy to remove breast tissue. The surgeon will also make alterations to the appearance and position of the nipples.
Meanwhile, testosterone therapy will stimulate the growth of chest hair.
Removal of the uterus, ovaries, and fallopian tubes
A person may wish to undergo this type of surgery if they are uncomfortable having a uterus, ovaries, or fallopian tubes, or if hormone therapy does not stop menstruation.
In a partial hysterectomy, a surgeon will remove only the uterus.
In a total hysterectomy, they will also remove the cervix.
A bilateral salpingo-oophorectomy, or BSO, involves the removal of the right and left fallopian tubes and ovaries.
Metoidioplasty
A metoidioplasty is a method of constructing a new penis, or neopenis.
It involves changing the clitoris into a penis. A person will receive hormone therapy before the surgery to enlarge the clitoris for this purpose.
During the procedure, the surgeon also removes the vagina, in a vaginectomy.
In addition, they lengthen the urethra and position it through the neopenis. To achieve the lengthening, the surgeon uses tissues from the cheek, labia minora, or other parts of the vagina. The aim of this is to allow the person to urinate while standing.
Another option is a Centurion procedure, which involves repositioning round ligaments under the clitoris to increase the girth of the penis.
A metoidioplasty typically takes 2–5 hours. After the initial surgery, additional procedures may be necessary.
A Centurion procedure takes approximately 2.5 hours, and removing the female reproductive organs will add to this time.
An advantage of a metoidioplasty is that the neopenis may become erect, due to the erectile abilities of clitoral tissue.
However, a neopenis resulting from a metoidioplasty is often too small for penetrative sex.
Phalloplasty
A phalloplasty uses grafted skin — usually from the arm, thigh, back, or abdomen — to form a neopenis. Doctors consider taking skin from the forearm to be the best optionTrusted Source in penile construction.
Compared with a metoidioplasty, a phalloplasty results in a larger penis. However, this neopenis cannot become erect on its own.
After a period of recovery, a person can have a penile implant. This can allow them to get and maintain erections and have penetrative sex.
During a phalloplasty, the surgeon performs a vaginectomy and lengthens the urethra to allow for urination through the penis.
Disadvantages of a phalloplasty include the number of surgical visits and revisions that may be necessary, as well as the cost, which is typically higher than that of a metoidioplasty.
Scrotoplasty
A person may decide to have a scrotoplasty — the creation of a scrotum — alongside a metoidioplasty or phalloplasty.
In a scrotoplasty, a surgeon hollows out and repositions the labia majora to form a scrotum and inserts silicone testicular implants.
Recovery
The recovery time from female-to-male surgery varies, depending on the type of procedure and factors such as the person’s overall health and lifestyle choices.
For example, smoking slows downTrusted Source recovery and increases the risk of complications following surgery. If a person smokes, vapes, or uses any substance with nicotine, a medical team may consider them less eligible for this type of surgery.
Following gender-affirming surgery, most people need to stay in the hospital for at least a couple of days.
After leaving the hospital, the person needs to rest and only engage in very limited activities for about 6 weeks or longer.
Also, when a person has had a urethral extension, they need to use a catheter for 3–4 weeks.
Some complications of a metoidioplasty or phalloplasty include:
urethral fistula — a tunneled connection that forms between the urethra and another part of the body
urethral stricture — a narrowing that causes a blockage of urine flow within the urethra
A person who has had a phalloplasty may experience:
scarring in the area where the graft was taken
skin graft failure or tissue death
Risks of a scrotoplasty include rejection of the testicular implants.
All gender-affirming surgeries carry a risk of:
infection
bleeding
reactions to anesthesia
dissatisfaction with the results
What to expect
A person who undergoes a metoidioplasty may have erections and enjoy more sensation in their neopenis. However, the penis will be relatively small in size.
A neopenis that results from a phalloplasty is usually larger, though it may be less sensitive. To have erections, a person will need a penile implant.
If a person has urethral extension, the goal is to be able to urinate while standing after a full recovery from the procedure. Some studiesTrusted Source report a high number of urological complications following phalloplasties. It is important to attend regular follow-ups with a urologist.
A 2005 study of 55 people who underwent gender-affirming surgery — including 23 female-to-male participants — notes that 80% of all participants reported “improvement of their sexuality” following surgery.
Transgender men tended to report more frequent masturbation, sexual satisfaction, and sexual excitement than transgender women. They also reported reaching orgasms more easily than they had before surgery and a tendency toward “more powerful and shorter” orgasms.
Transgender men with penile implants for erections experienced pain more frequently during sex than those without implants. However, they also reported that their sexual expectations were more fully realized, compared with participants who had not received implants.
A 2018 studyTrusted Source found that 94–100% of participants who had undergone gender-affirming surgery reported satisfaction with the surgical results, with the variance depending on the type of procedure.
The 6% of people who reported dissatisfaction or regret did so as a result of preoperative psychological symptoms or complications following the procedures.
Outlook
The outlook for female-to-male surgery depends on the type of surgery, the person’s health, and other factors. Most people report satisfaction following the procedure.
However, the complication rate is relatively highTrusted Source, especially in relation to urinary health.
Therefore, it is important to work closely with a qualified plastic surgeon, urologist, gynecologist, and mental health professional to ensure the best outcome.
It is also essential to follow recovery guidelines and attend all follow-up appointments.
Last medically reviewed on October 8, 2019
SurgeryCosmetic Medicine / Plastic SurgerySexual Health / STDsLGBTQIA+
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What to know about a pleurectomy
Medically reviewed by Adithya Cattamanchi, M.D., Pulmonology — By Hana Ames on January 11, 2023
Purpose
Types
Candidates
Procedure
Preparation
Recovery
Outcomes
Risks
Benefits
Outlook
FAQ
Summary
A pleurectomy is a surgical procedure to remove part or all of the pleura, a membrane that lines the lungs and chest cavity. The procedure treats empyema — an infection of the pleural cavity — and other lung conditions.
The pleural cavityTrusted Source is the space between the outer and inner layers of the pleura.
A pleurectomy involves the removal of part of the outer or inner pleura. A pleurectomy/decortication (P/D) involves removing both the inner and outer pleura, along with any tumors or fibrous tissue.
This article looks at pleurectomy procedures, the risks, purposes, what to expect, and more.
What is the purpose of a pleurectomy?
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During a pleurectomy, surgeons remove the inner or outer pleura, or both.
Depending on the reason for a pleurectomy, the surgery may aim to:
relieve symptoms of certain conditions by removingTrusted Source fluid buildup in the pleural cavity
obtain biopsies to diagnose certain conditions
treat cancers such as mesothelioma by removing tumors in the case of a P/D
Types of pleurectomy
There are many different techniques for performing a pleurectomy. They include:
Partial pleurectomyTrusted Source: This is a procedure wherein surgeons remove excess tissue from the pleural cavity. This may be an emergency surgery when there are lung complications. It may also be a planned operation for people with ongoing lung problems.
P/D: In this technique, surgeons remove the inner and outer pleura and any tumors or fibrous tissue. They will notTrusted Source remove the diaphragm or the pericardium, the membrane that covers the heart.
Extrapleural pneumonectomy: Surgeons will removeTrusted Source the inner and outer pleura, as well as part of the lung on the affected side. They will also remove the diaphragm and the pericardium.
Extended P/D: Surgeons remove the inner and outer pleura and any tumors, as well as the diaphragm and pericardium.
Who is eligible?
Not everyone is eligible for a pleurectomy.
Candidates for this procedure must be in relatively good health and should not smoke. If they do, they will need to quit smoking well before the operation.
Eligibility also depends on the purpose of the pleurectomy. For example, if the aim is to treat mesothelioma, the cancer must not have spread too far out of the lungs. Otherwise, surgeons may be unableTrusted Source to remove all of the cancer cells, and the risks of the surgery would outweigh the benefits.
What to expect during a pleurectomy
Before surgery, the person will receive general anesthesia so that they will be unconscious.
Then, a healthcare professional will intubate the person, inserting a tube through their mouth and into the throat to help them breathe during surgery. Medical professionals will positionTrusted Source the person on their side to give the surgeon easy access to the operating area.
Surgeons may use a keyhole surgery method for the procedure. This involves the surgeon making several small incisions instead of one large cut and performing the surgery through these small openings.
If the person requires a more complex operation, surgeons may make a bigger incision. They will slowly and carefully open the ribs before removing parts or all of the pleura.
Before the operation, a team of medical professionals will tell the person exactly what will happen during their surgery. They will be available to answer any questions a person may have about their specific procedure.
How to prepare
A person’s surgical team will advise on any steps they may need to take in preparation for a pleurectomy. For example, a doctor may recommend a person avoid eating anything the night before the operation.
Additionally, in some cases, doctors may advise that a person stop taking certain medications for some time before the procedure.
These may include blood-thinning medicines or nonsteroidal anti-inflammatory drugs. People must discuss any medications that they take with a healthcare professional.
People who smoke and require a pleurectomy will need to quit smoking well before the procedure, as smoking complicatesTrusted Source lung diseases and can slow a person’s recovery after surgery.
Recovery
According to Cancer Research UK, most people will stay in the hospital for around 7–15 days following a pleurectomy, depending on the technique their surgeons use.
It states that it can take a person 4–8 weeks to fully recover after surgery, meaning it may be a while before they are ready to return to work or resume their daily activities.
How effective is a pleurectomy?
Many studiesTrusted Source have demonstrated the effectiveness of a pleurectomy in prolonging the life of people with conditions such as mesothelioma.
ResearchTrusted Source also suggests that those who receive a pleurectomy may have a better quality of life and fewer postoperative complications than those who had a procedure to remove the lungs.
Risks and side effects
As with any surgery, a pleurectomy has some risks and side effects.
The risks of a pleurectomy mainly relate to complications from the anesthesia, such as breathing difficulties or allergic reactions. Other risks include infection, bleeding, and lung complications.
The side effects relate more to the effects of the procedure itself. They include pain or discomfort in the chest area, swelling in the affected lung or chest cavity, and difficulty breathing due to decreased lung capacity.
For most people, postoperative pain and discomfort will eventually subside. A doctor will likely prescribe pain medication to make a person more comfortable after surgery.
What are the benefits of a pleurectomy?
The main goal of this procedure is to improve breathing and reduce pain by removing diseased tissue from the lung. However, surgeons can also use it to aid diagnoses.
Other benefitsTrusted Source of a pleurectomy include the following:
preventing the lungs from collapsing and making breathing easier
improving the quality of life for those with cancer by reducing shortness of breath, coughing and wheezing, and other symptoms
assisting with cancer removal and diagnosis
This surgery can cure some early cancers. Doctors may also recommend it as a palliative procedure to alleviate symptoms if they cannot remove the whole tumor.
Outlook
The prognosis for people undergoing a pleurectomy depends on the underlying issue doctors are using the surgery to treat.
It usually does not cure the underlying condition. However, it may improveTrusted Source a person’s quality of life significantly.
Frequently asked questions
Read on to find answers to some commonly asked questions about a pleurectomy.
Is a pleurectomy a major surgery?
Yes, a pleurectomy is a major surgery.
Surgeons typically conduct this procedure when a person is under general anesthesia. It can take several hours.
The recovery time for this type of surgery may be up to 8 weeks. After this time, a person should generally be able to return to work or resume their daily activities.
Can your lung collapse after a pleurectomy?
It is possible for the lung to collapse after a pleurectomy. The medical term for a collapsed lung is pneumothorax.