In addition to hormonal treatments which increase the size and appearance of female breasts, many transwomen (male-to-female transsexuals) undergo a form of augmentation mammoplasty, more commonly known as breast implants. Tsroadmap.com notes that all people who undergo augmentation mammoplasty may have to have several surgeries to maintain or replace implants.
Transwomen may undergo a bilateral orchiectomy (surgical removal of the testicles) to facilitate hormone treatment (removal of the testicles reduces testosterone production) according to LGBT Health Channel. A further operation, vaginoplasty, may be performed to create a functioning vagina from the tissues of the penis (and sometimes other skin grafts). A vaginal cavity, labia, and clitoris and clitoral hood are formed from the skin and tissues of the penis, and nerves from the glans are used to promote sensitivity. The urethra is maintained (LGBT Health Channel).
Transmen (female-to-male transsexuals) might undergo a bilateral mastectomy, the removal or reduction of both breasts. There may also be skin grafting to create nipples that are more male-appearing, according to LGBT Health Channel.
Metoidioplasty and Phalloplasty
According to LGBT Health Channel, some transmen undergo either metoidioplasty, creation of a penis using clitoral tissue, or phalloplasty, creation of a penis with inner-arm and vaginal tissue. In metoidioplasty, the clitoris, which has been enlarged through testosterone treatment is made to appear larger by cutting away surrounding skin; to facilitate urination while standing, the labia may be used to create a scrotum into which testicular implants may be placed. In phalloplasty, the nerves of the clitoris are used to create sensation in a penis which is formed by using arm and vaginal tissue, including a new urethra. Erectile implants may also be used in phalloplasty, according to LGBT Health Channel. Fewer transmen undergo genital surgery than transwomen.