Transgender medical procedures complicated and costly, says plastic surgeon at Hollywood conference

For every week of the year, Swedish plastic surgeon Dr. Gennaro Selvaggi operates on a transgender man or woman seeking to match their body to their gender identity.

“I performed 52 cases in 2013,” said Selvaggi, one of more than 600 doctors and other medical professionals at the Westin Diplomat Resort & Spa in Hollywood through Sunday for the 30th annual scientific meeting of the American Academy of Cosmetic Surgery.

Half of his transgender patients were male-to-female patients; the other half female-to male, said Selvaggi, 40, who heads the gender unit at Sahlgrenska University Hospital in Gothenburg, Sweden.

Many of his patients are in their 20s, he said.

Transgender people frequently have hormone therapy. Not all patients seek or need surgery, but many do, Selvaggi said.

The types of surgical procedures depend on the patient, said Selvaggi, who received the plastic surgeons’ conference’s 2014 award for teaching excellence.

Nearly all female-to-male patients request mastectomies, he said.

“For a lot of female-to-male patients, the breast surgery is considered the most important,” he said. “They can go to the gym, they can shower. Their social lives are very much improved after surgery.”

Mastectomy procedures cost more than $10,000, he said.

Only half of Selvaggi’s male-to-female patients request breast augmentation procedures, however. Those surgeries can cost about $7,000.

Fewer transgender people have genital surgeries, which are much more expensive and complicated.

Vaginoplasty involves removing the penis and testicles and creating a vagina for male-to-female patients.

“Part of the glans is preserved,” Selvaggi explained. “With part of the glans we make the clitoris. “By stimulating the neo-clitoris, the patient can achieve orgasm.”

Vaginoplasty can cost more than $20,000. The surgical procedure takes about three hours and requires about a week in the hospital.

Phalloplasty, surgical creation of a penis, is much more complicated and expensive, costing up to $70,000.

“For female-to-male, we preserve the clitoris and relocate it to the base of the penis. Then they can achieve orgasm,” Selvaggi said. “Phalloplasty is not performed in one stage, but usually in several stages. You’re under direct care for one or two years. It takes nine hours of surgery and three weeks in the hospital. We transplant skin from the forearm to the pubic region.”

Most people know little about the medical procedures involved in gender transition, said Harper Jean Tobin, 32, policy director for the National Center for Transgender Equality in Washington, D.C.

“It’s natural for people to be curious about things that are new to them or outside their experience, but it’s also important to respect people's personal boundaries, especially in a work setting,” Tobin said. “It often has to do with parts of the body we don’t normally talk about with co-workers or acquaintances. People feel it’s very private.”

Throughout Europe, many countries pay for sex reassignment surgery, according to Selvaggi.

However, in the United States it’s very common for insurance plans to specifically exclude surgical care that transgender people might need, Tobin said.

“That’s left over from a time many years ago when there was not much known about these issues and treatments and they were viewed as cosmetic,” she said. “But for years, there’s been a clear medical consensus that these are treatments that are effective, beneficial and necessary for some people.”

Tobin said “what's most important is to just understand that not everyone needs these procedures, but for those who do need them, it makes a tremendous difference to live a long and healthy, productive life.”

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