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 being carried out on the health and care of transsexual, transgender, 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 and varied aspects of transsexualism. The entire edition is freely available for viewing on line.
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 .
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 transmasculine procedures 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 health care professionals to coordinate pre- and post-op treatment is an important element in achieving a successful surgical outcome.
For surgery related to sex reassignment, Section VII the SOC mandates that the patient be assessed by qualified mental health professionals and that such surgery be documented as medically necessary to treat gender dysphoria (formerly called gender identity disorder, or GID).
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:
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.
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:
It is important to note that neither hormone therapy nor is living as a man for a specific period of time are prerequisites for chest reconstruction surgery. However, recommendation is made for an individualized approach to determine the best course of treatment in each case, advising that physical and mental health professionals examine the prospective surgical patient and make recommendations regarding hormone therapy or living in the chosen gender identity be achieved for a period of 12 months or longer before surgery.
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.
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.