In January 2018, physicians in Boston Children’s Center for Gender Surgery performed the first hospital’s phalloplasty, or surgical creation of a penis. The procedure was groundbreaking: It was the first such surgery performed for a transgender patient at a major U.S. pediatric hospital. And it was a key step in the 24-year-old patient’s lifelong journey to align his body with his identified gender.
“Boston Children’s has a long tradition of bold surgical breakthroughs, of being willing to take risks and of doing the right thing for patients,” explains David Diamond, MD, one of the Center’s co-directors and the hospital’s urologist-in-chief. “This is an example of that.”
Now, two years after the Center’s launch, Diamond and his colleagues are reflecting on the experience while looking to the future.
Modifying surgical techniques
Phalloplasty is a procedure with a relatively high risk of complications — in particular, stricture and fistula of the urethra. To reduce the chances of such problems, Diamond and his colleagues have begun performing a staged construction of the urethra in these patients. In this approach, Diamond creates one half of a lengthened urethra, which is partially connected to a second half, created by plastic surgeons Drs. Amir Taghinia and Oren Ganor. Several months later, the halves are completely connected in a second procedure. This allows for both sections to establish a new blood supply, decreasing the likelihood of complications.
In addition to offer full genitoplasty, the team is now performing revisions of surgical procedures initially performed elsewhere. These include urethral fistulas and strictures, retained vaginal segments, and malpositioned testicular prostheses. In some cases, the center’s surgeons are partnering with other Boston Children’s clinicians to achieve optimal results.
For example, Diamond and the team recently collaborated with Richard Yu, MD, PhD, director of Boston Children’s Robotic Surgery Program to robotically revise an incomplete vaginectomy. This approach provides good visualization of the patient’s anatomy while resulting in minimal blood loss. “The results with a robotic approach were so impressive that we plan to incorporate this into our routine primary phalloplasties,” says Diamond.
Growing the team
The Center for Gender Surgery is expanding its team by adding two new clinicians. Erin McNamara, MD, MPH, joins Diamond in providing urologic and surgical care to patients undergoing phalloplasty or vaginoplasty, while Frances Grimstad, MD, serves as the center’s new gynecologist. “As a gynecologist, Dr. Grimstad provides expertise in female fertility preservation, and both she and Dr. McNamara can provide counseling related to sexual function for transwomen,” explains Diamond.
Gender surgery by the numbers*
Chest reconstruction: 186
Breast augmentation: 4
Chest reconstruction: 91
Breast augmentation: 3
Chest reconstruction: 30
Breast augmentation: 1
*through end of Q3 2019
Learn about the Center for Gender Surgery.
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