Gender Affirmation Clinic - Aham

We offer a range of procedures including top surgery (breast augmentation or removal), bottom surgery (vaginoplasty or phalloplasty), facial feminization, and voice surgery.

Breast augmentation may involve fat injection or breast implants, depending on individual preferences and hormonal therapy history.

Transwomen can undergo vaginoplasty using penile and scrotal skin or colon, while transmen can opt for metoidioplasty or phalloplasty.

Ideally all patients should have had hormonal therapy which also increases the size of the breast. In 25% there is no need for any additional breast augmentation. In rest with a good volume of breasts, slight augmentation may be done by fat injection.
 

People who do not want hormonal therapy or are wanting a larger breast than what can be expected with fat injection can go in for breast implant

Breast implants are surgically placed either subfascially or under the muscle, with options for personalized size and projection based on patient preferences.

Bottom surgery refers to the surgical procedures involved in the gender-affirming transformation of a transgender woman, which entails altering the external genitalia from male to female. This process is also known as gender affirmation surgery or sex reassignment surgery (SRS). 

Yes, SRS, or sex reassignment surgery, is synonymous with gender affirmation surgery (GAS). GAS is the latest terminology used to describe procedures aimed at aligning a person's physical anatomy with their gender identity. It involves changing the external genitalia from one sex to the other, emphasizing the importance of gender affirmation in the surgical process.

Yes, approximately 25% of transgender women who have developed good-sized breasts through hormone therapy may undergo breast augmentation.

Breast augmentation involves fat injection, where fat harvested from areas like the waist is injected into the breasts. Multiple sessions, around every three months, may be needed, with about 30% of the injected fat typically being naturally absorbed by the body.

Breast implants are typically placed either subfascially or under the muscle. The procedure is commonly conducted as a day care procedure, allowing patients to return home the same day of surgery.

During breast implant surgery, the appropriate size and projection of the implant are determined in consultation with the patient. We use advanced 5th generation implants known for minimal risk of complications such as capsular contracture and ALCL lymphoma. To minimize contact with the skin, patients may opt for implant insertion using a funnel technique, ensuring direct placement into the surgically created pocket. Additionally, all patients are offered an erector spinae block for pain management during the post-operative period, along with pain patches applied to the skin to ensure a comfortable recovery phase lasting up to a week.

The transformation typically entails changing from male genitalia to female genitalia through various surgical procedures.

 The clitoris is reconstructed using the glans penis, with the natural appearing hood often created using part of the foreskin.

In transgender women, the direction of urine passage is changed from forward to downward, with a decrease in the length of the urine tube. The opening of the urine tube is enlarged to prevent stenosis.

Neovagina creation can be done using penile and scrotal skin or colon. While penile and scrotal skin offer simplicity, there's a risk of shrinkage and the need for daily cleaning. Colon provides natural lubrication but may result in excess discharge and odor.

 Candidates for colon vaginoplasty typically have a BMI of less than 32, ensuring optimal surgical outcomes and reduced risks.

Considerations include skin length and lubrication. Penile and scrotal skin require adequate length and regular cleaning, while colon offers natural lubrication but may result in discharge and odor.

Facial feminization surgery is categorized as a reconstructive procedure rather than a cosmetic one for transgender women.

The main areas addressed during facial feminization surgery include the fronto-orbital complex (above the eyes), the nose, and the jawline and chin.

Surgical techniques may involve incisions made in the hairline or just in front of it to flatten the frontal sinus area and reduce frontal bossing. Eyebrows are elevated and rounded, and hair transplant may be performed to hide scars and lower the hairline.

Rhinoplasty or nose surgery is commonly performed to decrease the height of the nose and achieve a more feminine contour.

Breast removal during top surgery for transgender men is typically performed either through a circumareolar incision or via a double incision.

Circumareolar incision is preferred for small to medium-sized breasts as it allows for a hidden scar. In cases where a wider scar develops, scar revision or tattooing may be options. Double incision mastectomy with nipple-areolar grafting is performed in one sitting, but there may be risks of hyperpigmentation and hypertrophy of scars, as well as settling issues with nipple-areolar complex grafts.

Female-to-male gender affirmation bottom surgery options include metoidioplasty and phalloplasty.

Metoidioplasty is a single-stage procedure aimed at achieving good cosmesis, enabling the ability to urinate in a standing position, and preserving or enhancing sexual function. It involves straightening and lengthening the clitoris (which is naturally bent), advancing the urethral opening to the tip of the clitoris for standing urination, and creating a neo phallus, though its length may be inadequate for penetrative intercourse.

Phalloplasty is typically performed using skin tissue from the forearm or thigh. Forearm flaps, such as the ulnar or radial artery forearm flaps, offer good length and shape, with sensations reconstructed using the forearm's nerve supply. However, there may be issues with skin grafting on the forearm. Thigh tissue, while thicker, presents challenges for tube-in-tube reconstruction and may require additional flaps, with higher risks of complications like strictures and fistulas.

The radial forearm flap is preferred for its thin and pliable nature, accommodating tube-in-tube reconstruction. It includes multiple sensory nerves, facilitating good-quality protective and erogenous sensations. Additionally, it can effectively accommodate erectile prostheses, allowing for penetrative sex, and can be shaped to reproduce a natural penis.

Tattooing is often used to hide the skin graft on the forearm, providing a cosmetic solution to minimize its visibility.

Thigh tissue, while thicker than forearm tissue, presents difficulties for tube-in-tube reconstruction and may require additional flaps. There is a higher risk of complications such as strictures, fistulas, and decreased sensation. Additionally, the shape reproduction may be less accurate compared to forearm flaps.

The phalloplasty surgical team often includes urologists, gastrointestinal surgeons, and maxillofacial surgeons, collaborating with plastic surgeons to achieve the best possible outcomes for patients.