Transgender Surgery: What to Expect on the Day of Surgery

Transgender surgery usually involves multiple procedures that are spread out over time. Most procedures will occur in a hospital setting. Your surgical team will give you specific instructions for what to expect on the day of the surgery and how to prepare.

Before Surgery

Before your transgender surgery, you will have time to prepare for the procedure. On the day of the surgery, you will go to the hospital and be put in a preoperative room. Once you are in the preoperative room, you will change into a hospital gown. 

A nurse will check your vitals, such as heart rate and blood pressure, and monitor them. You may also receive an intravenous (IV) line to get medications and fluids during and after surgery. Your surgical team may check in with you and talk about the upcoming procedure. 

You may have to sign some consent forms and paperwork before the surgery. This is a good opportunity to ask any final questions.

During Surgery 

During the surgery, you will be in an operating room in the hospital. You will receive general anesthesia to make you sleep, so you will not feel any pain. You may have a breathing tube connected to a ventilator placed through the mouth and into the airway. The ventilator controls your breathing. Your vitals will be monitored during the entire procedure. 

There are various techniques for transgender surgery, and the type you have will depend on many factors. In general, the surgery can be categorized into transfeminine and transmasculine procedures. 

Transfeminine procedures include: 

• Facial feminization surgery to make masculine facial features more feminine
• Transfeminine top surgery to change and enhance the breasts to make the chest look more feminine
• Transfeminine bottom surgery to remove male genitalia and reconstruct them into female genitalia
  

Transmasculine procedures include:

• Facial masculinization surgery to make feminine facial features more masculine
• Transmasculine top surgery to remove the breasts and make the chest look more masculine
• Transmasculine bottom surgery to change the female genitalia into male genitalia
  

During the procedure, your surgeon may make one or more incisions (cuts). Tissues or bones may be removed, shaved, rearranged, or cut. You may have screws, plates, or implants inserted.

Once the procedure ends, the incision areas will be stitched up. You may have bandages placed over the incisions. Your breathing tube will be removed. 

After Surgery

After your surgery, you will be moved to a recovery room for careful monitoring. You will wake up from the anesthesia. Your vitals, including heart rate and blood pressure, will be checked and continue to be monitored. You may stay in the recovery room for one to two hours. 

Next, you will be transitioned to a regular room. Your hospital stay will depend on the type of procedure you had and your recovery process. For example, after transmasculine top and bottom surgery, you may be in the hospital for up to six days.

After transgender surgery, your doctors may recommend: 

• Only having ice chips immediately after the procedure
• Only having clear liquids the day after the procedure
• Starting to eat normal food once your medical team approves 
  

Pain Management 

It is normal to have pain, swelling, tightness, or fluid draining after surgery. You should tell your medical team how you feel as the anesthesia wears off so they can best address your pain, and maintain open communication throughout your post-op recovery for help in managing your symptoms.

You will typically receive:

• Pain medications through an IV during your hospital stay
• Oral pain medications once you can eat
• Stool softeners to counteract constipation caused by pain medications 
  

Usually, pain and swelling will start to decrease four to five days after surgery. However, you may need to continue to take some type of pain medication for days or weeks after surgery until your body has fully recovered from the procedure.

Discharge Process 

Your activities may be restricted for the first two to three days in the hospital. This means you may have to remain in bed and rest. Then, you will be allowed to get up, sit, and walk gently. Your activity levels will increase as you get closer to discharge. Follow the advice of your healthcare team to avoid disrupting any stitches as they heal.

You may have a catheter that may need to be removed before discharge. You may also have drains, bandages, and gauze packing. Your surgical team will explain how to take care of your incision areas and set up follow-up appointments.

If you are experiencing a medical emergency after transgender surgery, call your doctor or 911 right away for help.  

A Word From Verywell

Everyone's experience with transgender surgery can be different. Although it is important to prepare and understand what to expect on the day of the surgery, events may happen that change things. The risk of delays or complications always exists when undergoing surgery, so you should discuss your options and preferences with your surgical team. 

Having a support system you can rely on during this process is also important. Reach out to friends and family who understand and care about you so that you are not facing transgender surgery alone.