Professionals at the barnaclinic+ Gender Identity Clinic offer multi-disciplinary and integrated treatment for transsexualism, ensuring the patient receives maximum medical care guarantees.
The medical team of this clinic comprises professionals who are highly qualified and specialized in the various fields of gender reassignment surgery: a cosmetic and reconstructive surgeon, gynecologists and digestive tract surgeons. Here at the barnaclínic+ Gender Identity Clinic we also have endocrinologists, psychologists and psychiatrists specializing in gender dysphoria who offer their support to patients.
Transsexualism or gender identity disorder are synonymous words used to describe severe dissatisfaction or dysphoria with one's birth gender. Transsexualism manifests itself as a desire to live, dress and be treated as a member of the opposite sex. Gender Reassignment Surgery aims to achieve harmony between gender and sex by adapting birth genitalia to the desired gender.
A male-to-female transsexual, i.e. change from a biological man to a transsexual woman, is conscious that she is a male, anatomically speaking, but considers herself to be a woman, i.e. her gender is female. Likewise, a female-to-male transsexual, i.e. change from a biological woman to a transsexual man, is born with complete female genitalia but his behavior is clearly masculine as he feels like a man.
In both cases, these people try to permanently hide their sexual characteristics from birth (male or female) and most seek hormone treatment and gender reassignment surgery to attain suitable genitalia for the gender they belong to.
Anyone wishing to undergo gender reassignment surgery must meet the following requirements as the changes faced by the patient are irreversible. These procedures form part of the protocol for treating gender dysphoria:
- To be of legal age (adult)
- To be in contact with a psychologist or psychiatrist to rule out the possibility of a transient psychological disorder and certify that the case is effectively a true transsexualism process.
- To have a certificate issued by a psychiatrist accrediting the diagnosis of true transsexualism (indispensable legal requirement for surgery). This certificate is the result of a psychological-psychiatric analysis and acceptance by the patient of the role of the opposite sex for a long period of time, during which time the patient must behave, dress and change his/her name (if this has not been done already) according to the gender he/she wishes to become.
- To have undergone hormone treatment, under the guidance of an endocrinologist, for a minimum period of 9 months prior to surgery; and also to have undergone pre-operative testing, the results of which are confidential.
- To sign an informed consent form, of which he/she can request a copy, which informs the patient of both the irreversible nature and potential complications of the surgery.
LIST OF SERVICES AND SURGICAL TECHNIQUES
FEMALE-TO-MALE TRANSSEXUAL (from a biological woman to a transsexual man)
- Bilateral subcutaneous mastectomy
A bilateral mastectomy is the surgical procedure to remove breast tissue. The aim of this operation is to achieve a symmetrical, flat chest that is anatomically and aesthetically male.
- Hysterectomy and Oophorectomy
Hysterectomy and oophorectomy are the surgical procedures to remove the womb and ovaries. The aim of this operation is to prevent the effects of female hormones produced by the ovaries and any possible diseases that may affect the female internal reproductive organs, which seem to get worse when consuming male hormones. Furthermore, it forms the basis for subsequent gender reassignment surgery.
The aim of female-to-male gender reassignment surgery is to create a male body with appropriate external genitalia. This genitalia should permit normal urinary function (i.e. urination while standing) and satisfactory erogenous stimulation. Metoidioplasty allows reconstruction of a microphallus or neopenis some 3 to 6 centimeters in length and 1.5 to 2 centimeters in diameter. This neopenis meets most of the functional requirements and is erogenous but the result does not allow sexual penetration.
The aim of female-to-male gender reassignment surgery is to create a male body with appropriate external genitalia. In the case of a phalloplasty, this genitalia should permit normal urinary function (i.e. urination while standing) and the possibility of penetration. The phalloplasty surgical technique, which allows creation of a penis measuring some 12 to 13 cm in length that is capable of penetration thanks to a prosthesis, involves constructing a neopenis from fasciocutaneous flaps from various parts of the body that is then attached to the genital area.
MALE-TO-FEMALE TRANSSEXUAL: from biological man to transsexual woman
Gender Reassignment Surgery
- Penile inversion vaginoplasty
The standard vaginoplasty procedure involves creating a cutaneous neovagina using inverted penile and scrotal skin. The aim is to create a genital complex that is as female as possible from an anatomical, aesthetic and functional point of view.
- Sigmoid colon vaginoplasty
Sigmoid colon vaginoplasty is a surgical procedure that involves using a section from the terminal end of the large intestine (sigmoid colon) to create a neovagina. This technique is only performed in cases where the penile inversion vaginoplasty is not possible, either because the penis does not have enough skin, the patient has been circumcised or for other reasons. In these cases, the penile inversion technique would not allow adequate vaginal depth and therefore the sigmoid colon technique is used.
- Vaginal aesthetics
The aim of gender reassignment surgery is to achieve genitalia that are female not only from an anatomical and functional point of view but also from an aesthetic point of view.
During the vaginoplasty operation (whether by penile inversion or sigmoid colon transplant), the surgeon will perform the so-called 'aesthetic vaginal surgery', which involves designing and constructing the inner labia, the clitoris and a hood to cover the latter.
Body feminization surgery
- Three-dimensional liposuction
Hormone therapy causes changes to the body of a transsexual women which brings her closer to having a natural feminine shape but is not sufficient to produce a completely female figure. Body fat is not distributed in the same way in men and women. Three-dimensional liposuction allows the body to be molded into truly feminine curves. This technique allows body fat located in specific areas of the body (chin, double chin, cheeks, arms, chest, abdomen, buttocks, hips, thighs, calves and ankles) to be removed, although waist liposuction is the most common, allowing the transsexual woman's curves to be molded to resemble a biological woman.
- Breast augmentation or augmentation mammaplasty
Although hormone therapy notably helps the breasts to develop, it is often not enough or does not give patients the desired results. In these cases, breast augmentation (augmentation mammaplasty) is recommended, which can be performed before vaginoplasty and will help transsexual women assume their female role. Thanks to implants or prostheses, augmentation mammaplasty or breast augmentation helps increase the volume of the breasts whilst giving them an aesthetically feminine appearance. Although there are different ways of inserting the implant (areolar and breast fold), the most common surgery tends to be axillary breast augmentation. The latest generation prostheses (high-quality, cohesive silicone gel), which are currently also the safest on the market, are used.
- Abdominoplasty or dermolipectomy
Transsexual women may tend to accumulate body fat in the abdominal area. This build-up cannot be eliminated by dieting or exercise. Sometimes these fat deposits are made worse by stretched abdominal muscles which further accentuates the 'saggy tummy' appearance. An abdominoplasty, or tummy tuck, is the surgical technique used to get rid of excess skin and fat from the abdominal area and improve contour (particularly the waistline). It also tightens abdominal wall muscles.
- Buttock augmentation
It is indisputable that the buttocks of men and women constitute different shapes and sizes. Hormone therapy manages to give transsexual women curves that closely resemble those of biological women but in some cases the final shape of the buttocks is not satisfactory or does not meet her expectations. Plastic surgery makes it possible to enlarge the buttocks, give them more volume or reshape the contour of the buttocks in those transsexual women with gluteal atrophy. This operation uses implants, although it is sometimes necessary to combine this surgery with liposuction and reshaping of the area to achieve an optimum result.
Facial feminization surgery
- Feminizing rhinoplasty
Rhinoplasty or nose reconstruction surgery is a procedure that allows you to increase or reduce the size of your nose, changing its contour (the shape of the bridge or tip), the size of the nostrils or the angle between the nose and the upper lip. It is also used to correct birth defects or accident trauma and nasal breathing problems. Rhinoplasty is one of the most common facial feminization procedures and can now create completely natural noses in line with the new harmony of the face. Thanks to this procedure, patients can get gentler features, giving a more youthful aspect with finer, more feminine features. This operation can be performed before or after a vaginoplasty.
- Adam's apple reduction or thyroplasty
One of the procedures most commonly requested by transsexual women, after vaginoplasty and breast augmentation, is the Adam’s apple reduction. The prominence of this cartilage is characteristic of biological men and therefore, when this prominence is particularly large, it is advisable to undergo this procedure prior to real-life experience to help achieve better adaptation. Although the choice of anesthetic will depend on the assessment of the surgeon and medical team, Adam’s apple reduction or thyroplasty is usually carried out under local anesthetic with sedation and tends to take around an hour.
- Cheek augmentation
Cheek augmentation is a procedure designed to increase the size of the cheeks using prostheses to make the patient’s face and profile more harmonious. This operation tends to be combined with rhinoplasty, mentoplasty, facelift or blepharoplasty. Cheek augmentation helps give gentler features while giving the patient’s face a more sensual and feminine appearance. It also helps highlight the patients eyes and expression. Cheek augmentation, or cheek implants, is a procedure that generally requires a local anesthetic or a local anesthetic with sedation and it usually lasts between 30 and 45 minutes, if not combined with other operations.
- Mentoplasty and facial profile feminization
Mentoplasty is a procedure designed to increase or reduce the size of the chin to make the patient’s face and profile more harmonious. This operation, which tends to be combined with rhinoplasty, involves implanting a prosthesis or sliding a bone fragment forwards to make the chin more prominent or reduce the jawbone, depending on the desired results. This procedure helps give a gentler profile, highlight the mouth and lips and give more feminine and balanced features to patients whose chin is small in comparison with their nose and the rest of their face, or reduce the size of the chin in patients with a very prominent jawbone.
- Feminizing facelift
One of the procedures that helps shape the face and therefore give it more feminine features is without a doubt, a facelift or rhytidectomy. It also helps remove facial wrinkles, giving the face a youthful, smoother appearance. A facelift or rhytidectomy is a procedure designed to lift and tighten the skin of the face and neck to reduce creases and wrinkles. In transsexual patients, this technique can also be used to reshape the face to give it more feminine features.