Gender Affirming Surgery: Assigned Female at Birth

Abstract

The acronym AFAB refers to those persons who have been ‘Assigned Female at Birth’. AFAB persons who, later in life, do not identify as female, are said to present a condition named ‘Gender Incongruence’ (GI). They might identify as men, or as non-binary. Persons presenting the condition of GI might experience a Gender Dysphoria (GD), which is defined as the discomfort due to the mismatch between their anatomical characteristics and the gender in which they are self-identifying. Thus, patients with GD are requesting surgical procedure (s) in order to align one’s body—mostly chest and genitals—to best match with one’s identity. The final aim is to reduce one’s dysphoria.The World Professional Association for Transgender Health currently publishes a series of guidelines, which are named as Standards of Care, for patients presenting GI.In this chapter, we provide an overview on surgical planning and technics, and possible outcomes for Chest-Contouring-Mastectomy (CMM) and genital surgery (metoidioplasty and phalloplasty). Nearly all trans men, and many non-binary AFAB individuals might seek for CCM; the surgery mostly consists in (partial) removal of the breast glandular tissue and, often, reduction of the Nipple-Areola-Complex. Some AFAB individuals with GI are also interested in penis reconstruction: metoidioplasty consists in the surgical enlargement of an hypertrophic clitoris, while phalloplasty consists in the construction of a penis with either larger, local, or distant flaps (including free flaps). Limitations and complications of the different surgical approaches are also presented.