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WPATH Standards of Care for FTM/N ‘Sex Reassignment Surgery’

WPATH

The World Professional Association for Transgender Health (WPATH) periodically publishes Standards of Care (SOC) based on the consensus of the best available science and expert professional studies related to the health and care of transgender, non-binary, and gender nonconforming people. The most current edition is the Seventh Edition, released in September 2011. The SOC is an important reference to assist both individuals experiencing gender dysphoria and those in medical and other support roles who seek to understand the many varied aspects of the trans experience. The entire edition is freely available for anyone to read and download in 19 languages.

It’s important to note that the SOC refers to Gender Confirming Surgery as “Sexual Reassignment Surgery.” The term Sexual Reassignment Surgery will be used intermittently on this website for the sole purpose of referencing the content in the 2011 SOC .

Gender Confirmation Surgery Standards

WPATH SOC guidelines are a useful starting point for anyone interested in gender transition. In seeking the services of a board certified plastic surgeon  to perform gender affirming surgeries, it is vital to know what questions to ask regarding the surgeon’s expertise and experience and their ethical standards and procedures regarding transgender surgery. A willingness on the part of the surgeon to work together with the patient’s other healthcare professionals to coordinate pre- and post-op treatment is an important element in achieving a successful surgical outcome.

Once the plastic surgeon is assured in writing of the necessity of the surgery, they still have the additional ethical and legal responsibility of carrying out an informed consent process, both in writing and in face-to-face consultations with the patient. The surgeon must also be convinced that the information relayed is understood and accepted by the patient.

The information should include:

• Various surgical techniques, with their advantages and disadvantages
• Limitations of the procedures, including viewing of ’before and after’ photos illustrating both successful and unsuccessful outcomes.
• Risks of the surgery, including general complication rates and the surgeon’s own success rate in performing the procedure.
• A candid discussion of what results can realistically be expected.

The surgeon should be convinced that the patient has been given sufficient time to absorb the information presented and has realistic expectations regarding the outcome of the surgery.

What is Cosmetic Surgery and What is Reconstructive Surgery?

Some plastic surgery procedures are clearly cosmetic and others clearly reconstructive, but there is frequent overlap, especially in sex reassignment surgery to treat gender dysphoria.

The WPATH reports that FTM/N chest reconstruction is more easily defined as a reconstructive procedure to treat gender dysphoria than other masculinizing procedures such as hair implants or chin, pectoral, or nose enhancements.

The guidelines for FTM/N chest reconstruction are:

• Persistent, well-documented gender dysphoria
• Capacity to make a fully informed decision and to consent for treatment
• Be of the age of majority in the country of surgery (and follow SOC rules for children and adolescents)
• Significant medical or mental health concerns, if present, must be reasonably well controlled at the time of surgery

It is important to note that neither hormone therapy nor living as a man for a specific period of time are prerequisites for chest reconstruction surgery. However, it is recommended that physical and mental health professionals examine a prospective surgical patient and make recommendations tailored to their experiences and needs regarding hormone therapy and/or living in the chosen gender identity.

There should be no doubts on the part of a patient, understanding that the operation is irreversibly removing any capability to breast feed in the future. As emphasized in Section IV, the social aspects of changing gender identification may be more challenging than the physical recovery from surgery or changing outward appearance. There can be unexpected consequences in patients’ interpersonal relationships and family, social, economic or legal hurdles, which is why experiencing a period of time in their chosen gender is recommended before embarking on a permanent physical body alteration.

Finding the Right Surgeon

For chest reconstruction plastic surgery, you should use the services of a board certified plastic surgeon  with specialized training in chest reconstruction surgery and a proven track record of successful outcomes. San Francisco board certified plastic surgeon, Dr. Scott Mosser, has the training, experience and expertise as well as an awareness and understanding of the special needs of gender dysphoric patients seeking plastic surgery in the course of gender and sex transition.