Surgery for Trans Women and Non-binary People Assigned Male at Birth
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Surgery for Trans Women and Non-binary People Assigned Male at Birth

There are many surgical options available. It is important to remember that each individual will have different needs, desires, and ability to undergo these procedures. An individualised care plan should be developed for each trans person; this care plan may change over time. Procedures can happen in many different orders and configurations.

In Malta, there is no linkage between accessing legal gender recognition procedures and a history of surgical interventions; it is illegal to require surgeries or proof of treatment in the process of legal gender recognition.

Breast augmentation
In the majority of trans women and non-binary people assigned male at birth, even after years of hormonal therapy, too little breast tissue may be present to address feelings of discomfort. That is why breast aug​mentation is often desirable. If desired, this can be performed together with vaginoplasty. Until recently, a trans person had to interrupt hormonal therapy for a surgical procedure because of the feared risk of a venous thromboembolism (VTE), which is the formation of a blood clot(s). Hormonal therapy was allowed to continue after the procedure, and more specifically, as soon as the patient was back on their feet.

New reliable scientific studies have made it clear that the risk of VTE in transgender individuals is not higher than expectations in the general population, even when the transgender individuals remained on sex hormone treatment throughout. In light of these new scientific insights, the practice was recently adapted. In concrete terms, a trans person under hormonal therapy does not have to stop taking hormones prior to undergoing an operation. After surgery, the anti-androgen treatment in trans women will be stopped, because testosterone suppression is no longer required.

Breast augmentation for trans women and non-binary people assigned male at birth is largely the same as for cisgender women. Breast prostheses are usually placed behind the chest muscle, because of the better positioning of the prostheses and higher likelihood of supple breasts. The prostheses are filled with silicone gel or physiological serum. Silicone gel has the advantage that it may feel a bit smoother, but the disadvantage is that it can migrate during rupture. Prostheses filled with physiological serum have the advantage that they are safer, but the disadvantage is that they may feel slightly less natural. With trans women and non-binary people assigned male at birth, prostheses with a somewhat broader base are usually chosen. They are inserted as close as possible to each other in the middle, which is limited by the slightly more outward or lateral placement of the nipples and the slightly wider chest., As a result, the augmented breasts may be slightly further apart than for cisgender women. The volume of filler in the prostheses can be adjusted to the existing mammary gland tissue and according to the person’s wishes.

Genital surgery
There are a number of different vaginoplasty surgeries, which can currently only be accessed abroad. The main types of vaginoplasty are intestinal, peritoneal, McIndoe, buccal mucosa, and penile-inversion (see). Detailed pre- and post-operative care should be discussed with the surgeon and an endocrinologist. Trans people may also need or desire counselling before and/or after genital surgeries. You may find a comprehensive list here​.

It is also possible to opt to first (or only) remove the testicular tissue (orchidectomy). A vaginoplasty can be performed later - if this is desired.

While orchidectomies are provided on the NHS through the Gender Wellbeing Clinic, other surgical interventions such as vaginoplasties are not yet covered and travelling abroad in order to access such services might be needed.