What Are The Different Names of Transgender Surgeries?
Transgender surgery, gender affirming surgery, sex reassignment surgery, gender confirmation surgery… what’s the difference? Well, it’s mostly just a matter of nomenclature.
Transgender surgery is a general colloquial term for all types of surgeries that a transgender person may undergo.
Gender Affirming Surgery (GAS) and Gender Confirmation Surgery (GCS) are equivalent.. There exists five main categories of Gender Affirming Surgery / Gender Confirmation Surgery.
Finally, Genital Reconstructive Surgery is specifically the procedure that aesthetically transforms male genitalia into female genitalia, or vice-versa.
Sex Reassignment Surgery is an aged term to designate transgender surgeries (although it is still used medically).
What Is The Purpose of Gender Affirming Surgeries?
Most transgender people feel ill at ease in their bodies; that is called “gender dysphoria” (“gender incongruence” is the psychiatry term). Some of them decide to change their bodies with surgeries, in order to look like the gender they are.
They may choose to do all, or some surgeries, with any combination generally possible. Usually (but not always), Gender Affirming Surgeries are preceded by Hormone Replacement Therapy (HRT), where transgender women take female hormones and vice-versa.
Note also the case of non-binary people. They can also elect to get certain surgeries, and get HRT. It’s all up to the individual and, to some extent, the assessment of their mental and medical practitioners.
Types Of Gender Affirming Surgeries
Genital Reconstructive Surgery
Genital Reconstructive Surgery is the most well-known, but least common Gender Affirming Surgery. It is also colloquially called “bottom surgery”. For transgender women, it consists of removing testes and inverting the penis into a vagina, with the scrotum becoming the vulva. For transgender men, it consists of removing the uterus and ovaries and elongating the clitoris into a penis, often with the addition of a skin graft from another place of the body (usually the arm or thigh). It is an extremely invasive series of surgeries, rarely done all at once.
Mastectomy / Breast Augmentation
Probably the most common Gender Affirming Surgery, a mastectomy is the removal of the mammary glands and fat in the chest tissue, and often downsizing and replacement of the nipples and areolas. Sometimes, the nipples are left as is, and sometimes removed altogether. Different types of incisions exist depending on the size and the degree of sagging of the breasts: keyhole, periareolar incision, double incision, inverted T’s… It is similar to a mastectomy for a breast cancer patient.
Breast augmentation in transgender women is similar to breast augmentation in cisgender women. It consists of inserting a silicon, saline, or “gummy bear” implant of a certain size into the patient’s chest. If the patient is not under estrogen-based HRT or has not had any growth, a tissue expander may be inserted some time before the surgery to make room for the implant. The nipple and areolas may also be reconstructed. The incision location differs from patient to patient. The implant may be put under or over the muscle layer.
Facial Reconstruction Surgery
Facial feminization (more common) or masculinization surgeries are one or several surgeries done to reshape the face to fit the general standards of feminine and masculine faces. Facial reconstruction surgeries are the same, but inverted, for transgender men and women, and may include buccal fat removal / addition; jaw, forehead, nose, chin, or brow bone reconstruction; improving or reducing the prominence of an Adam’s apple. These procedures can also be accompanied or replaced by implants.
Transgender Body Contouring
A procedure also done by cisgender people but known as Fat Transfer Surgery, transgender body contouring consists of changing the location of the fat in one’s body in order to better fit the standards of male and female bodies. For example, for a transgender man, fat may be moved from the buttocks, thighs, and, more rarely, breasts, into the waist, to give a straighter body shape. For transgender women, it’s the contrary: fat is removed from the waist and abdominal belt and put into the buttocks, thighs, and, rarely, breasts. These procedures can also be accompanied or replaced by implants. There exist a surprising variety of them nowadays.
Vocal Cord Surgery
This surgery is done to feminize or masculinize an individual’s voice. The cartilage where the muscles attach to the vocal cords is modified to change their tension. There may also be a shortening or elongating of the vocal folds. Think about the cords of a guitar, for example! The principle is similar.
Gender Affirming Surgeries in Japan
How Common are Gender Affirming Surgeries in Japan?
Gender Affirming Surgeries are not that common in Japan. However, as Japan’s law evolves, we are hoping that more specialists and facilities will be introduced.
Where Can I Get Gender Affirming Surgeries in Japan?
Gender Affirming Surgeries are generally offered in big cities, such as Tokyo and Osaka, but some locations on this list might surprise you. In any case, especially if you want several different surgeries, you might have to travel a lot, which is not uncommon for people seeking Gender Affirming Surgery around the world.
Genital Reconstructive Surgery
Nagumo Clinic (Tokyo, Nagoya, Osaka, Fukuoka)
This uber-famous “chain” of clinics operates all over Japan: Tokyo, Nagoya, Osaka, and Fukuoka. They offer a variety of Gender Affirming Surgery and will appear several times on this list. They perform Genital Reconstructive Surgery for both sexes. They do not speak English, but interpreters are welcome.
General Homepage: https://www.gidcenter.com/ 052-229-6533
Tokyo: https://nagumo.or.jp/tokyo 03-6261-325
Nagoya: https://nagumo.or.jp/nagoya 052-229-0555
Osaka: https://nagumo.or.jp/osaka 06-6346-0555
Fukuoka: https://nagumo.or.jp/fukuoka 092-722-0555
Okayama University Hospital (Okayama)
This hospital in Okayama provides Genital Reconstructive Surgery for both sexes. Note that the waitlist is about two years, and extensive prior decision-making is necessary. They seem to have interpreters available, but it seems safer to check in advance.
https://www.okayama-u.ac.jp/user/hospital/en/index457.html
+81-86-223-7151
kokusai-shinryou@adm.okayama-u.ac.jp
Mastectomy / Breast Augmentation
Since breast augmentation is not a sex-specific procedure, it is likely that a lot of clinics that do it for cisgender women will do it for transgender women as well. On the contrary, mastectomies are seen as destructive, and are rarely authorized electively outside of gender incongruence.
Nagumo Clinic (Tokyo, Nagoya, Osaka, Fukuoka)
They have locations in Tokyo, Nagoya, Osaka, and Fukuoka. They perform mastectomy and breast augmentation. They do not speak English.
General Homepage: https://www.gidcenter.com/ 052-229-6533
Tokyo: https://nagumo.or.jp/tokyo 03-6261-3251
Nagoya: https://nagumo.or.jp/nagoya 052-229-0555
Osaka: https://nagumo.or.jp/osaka 06-6346-0555
Fukuoka: https://nagumo.or.jp/fukuoka 092-722-0555
Ebisu TG Clinic
They offer mastectomy, hysterectomy (as of now, necessary to legally change genders in Japan) and HRT for trans males. They do not speak English but are foreigner-friendly.
03-6721-7512 E-mail and Line contact available
Jiyugaoka MC Clinic
This small clinic offers mastectomies for trans men, as well as HRT for both genders. They do not speak English but will gladly welcome you if you bring an interpreter.
03-3717-3514
Facial Reconstruction Surgery
Although no known clinic offers specifically facial masculinization or feminization surgeries, it is hopeful to think that clinics which offer facial plastic surgeries can help you reach your goals.
Department Plastic & Reconstructive Surgery, Metropolitan Police Hospital (Tokyo)
Dr. Kitaro Ohmori seems to have experience with facial feminization surgery. They do not speak English.
https://www.keisatsubyoin.or.jp/shinryoka/keisei/
03-5343-5611
Kansai Medical University Hospital (Osaka)
Dr. Shigeo Kyutoku seems to have experience with facial feminization surgery. They do not speak English.
https://hp.kmu.ac.jp/treatment/departments/plastic_reconstructive/
072-804-0101
Iwate Medical University (Iwate)
Dr. Seiichiro Kobayashi seems to have experience with facial feminization surgery. They do not speak English.
https://www.hosp.iwate-med.ac.jp/doctors/kobayashi-s/
019-613-7111
Vocal Surgery
Kyoto ENT Surgicenter (Kyoto)
This clinic offers vocal cords surgery specifically for trans women and trans men. To our knowledge, it is the only one in Japan. They do not speak English.
https://en.kyoto3387.jp/surgery/gender.html
Sanno Medical Center (Tokyo)
Although not specifically for transgender people, this clinic offers vocal cords surgery. They have an English website, but in practice the staff speaks very little English.
https://www.sannoclc.or.jp/mc/english/department/voice_c/
03-3402-5581
Transgender Body Contouring
Although no known clinic in Japan does specifically body contouring for transgender people, some clinics offer general body contouring, which can apply to transgender people.
Bianca (Tokyo)
This clinic offers facial and body contouring. They have stores in Ginza and Omotesando. They are English-speaking and have a majority of foreign patients.
https://biancaclinic.jp/global/introduction/
050-3196-4834
Biyo Cosmetic and Plastic Surgery (Tokyo, Kanazawa, Kyoto, Sapporo)
These clinics offer facial and body contouring. They have an English website, but in practice the staff speaks very little English.
https://www.otsuka-biyo.co.jp/en
Otsuka,Tokyo 011-81-120801611
Ginza,Tokyo 011-81-8002221611
Sapporo 011-81-8008881611
Kanazawa 011-81-8008881614
Kyoto 011-81-8008881615
Preparation for Gender Affirming Surgeries in Japan
What is the Procedure to Get Approved for Gender Affirming Surgeries?
The process for Gender Affirming Surgery depends on the type of procedure done and the clinic at which it is done.
For Genital Reconstructive Surgery, the process is generally extensive. The patient should receive a Gender Incongruence Disorder (GID) certificate, see a mental health professional for counselling, see several doctors for examinations and design. Keep in mind that Genital Reconstructive Surgeries are actually several surgeries that are very invasive and take a long time to recover from.
For mastectomies, it truly depends on the clinic. Nagumo Clinics require a Gender Incongruence Disorder certificate, while Jiyugaoka MC Clinic does not. In general, they seem quite loose on the process, compared to other countries, and the waitlist is not so long.
For breast augmentations, facial reconstruction surgeries, and transgender body contouring, no prior authorization is required (as is the case for all cosmetic surgeries in Japan). Although, it is highly recommended to see your general practitioner and a mental health professional before making those life-altering decisions.
For vocal surgery, we could not find any information online about the prior process.
What Else To Know Beforehand?
Japan is a country that aims for natural results with cosmetic surgeries. This means that a breast augmentation may be on the smaller side of things, a mastectomy may not give a perfectly flat chest, facial feminization surgeries will not make you look like Gigi Hadid.
This is something you need to discuss with your doctors extensively, depending on your aesthetic goals. Check their previous works before making any decision.
What Happens After Gender Affirming Surgery?
In Japan, in-hospital recovery periods tend to be shorter. For example, both Jiyugaoka MC Clinic and Ebisu TG clinic send you home the same day after your mastectomy, whereas Western countries would keep you several days under observation.
This is something you need to consider as well. You need to have someone who can take care of you at home in the following days to weeks. It is better to live close to the clinic. Inform your doctor if you are prone to infections or drug allergies. Know the name, location, number of the nearest ER to your home, and check if they will be able to help you, given that you have just received a Gender Affirming Surgery.
Aside from the required processes by the clinics, you need to make sure to plan everything all the way through.
Conclusion
Often, Gender Affirming Surgeries are and must be considered life-saving healthcare. Some people cannot get Gender Affirming Surgery even though they want to, due to many reasons: medical, social, financial… The latter especially is the reason why many transgender people have GoFundMe pages. During Pride Month or Transgender Awareness Week, don’t donate to big corporations; consider those instead!
Japan Gay Guide is not affiliated with any of the clinics or doctors listed in this article.