Posted: December 13, 2017
A lot of FTM and non-binary transgender patients, will want surgical options to help treat their dysphoria. The most common options are a mastectomy for top surgery, and a hysterectomy as a part of bottom surgery, so the question I am most frequently asked is…. Is it possible and safe to do these procedures at the same time? The simple answer is yes. It certainly is. This requires more surgery and a longer operative time. Most top surgeries take about 2 hours and most hysterectomies take about 90 minutes, so in combining the two surgeries, usually you are signing up for about 4 hours of anesthesia. As long as your doctor considers you to be fit and healthy enough to undergo this, both procedures at the same time can be possible.
Usually the patient will undergo the top surgery or mastectomy first, as this is seen as the more sterile or ‘clean’ part of the case, and then the hysterectomy will follow. Luckily, most patients can now have a hysterectomy done laparoscopically or robotically with small incisions; however there are several different techniques by which a hysterectomy can be offered. These options would need to be discussed with your gynecologist to determine the right one for you.
Every patient who has both procedures will require an overnight stay, for most people just one night in hospital is recommended. In order to recover from both surgeries most patients will require about two weeks off work. There will be some increased pain from having both incisions on the chest and on the belly, but most patients find this quite tolerable.
A challenge for many transgender patients is to find surgeons who can work together in order to combine the cases, and are competent in performing transgender procedures. So if this procedure is right for you, usually a large hospital or university setting will be the best bet to make this happen. An additional bonus is that if you have insurance benefits, many doctors in these large institutions will accept your insurance and facility costs are often reduced by only having one surgery.
Not every patient will be the right fit to combine these two surgeries, and care for each patient has to be individualized with safety being the most important. Please consult with both of your physicians to see if this combined surgery option is right for you.
Dr. Sidhbh Gallagher
University Gender Affirmation Surgery