In foreign countries, general transsexual surgery costs 40,000 to 80,000 dollars. Tens of thousands of dollars in China. But it didn't work at once. Sometimes there may be some repairs, and whether there are complications is different. (1) indications for surgery: At present, there are different standards and requirements for surgery, but they all agree that: ① preoperative diagnosis should be clear; ② Strict selection of suitable surgical cases. According to the clinical practice and the actual situation in China, we have determined the following conditions for sex reconfirmation surgery: 1. The diagnosis of degeneration is correct; 2. The operation requires at least 5 years, and there is no repeated process; 3. Patients must live and work in public for at least 3 years with the gender of their choice; 4. Receive psychological and psychiatric treatment before operation for at least 1 year; 5. There must be hormone therapy for more than one year before operation; 6. Do not get married because of their anatomical gender; 7. The psychiatrist proves that his mental state is normal; 8. Must agree to postoperative follow-up; 9. Over 20 years old; 10. No criminal, drug or alcohol abuse history; 1 1. There are no obvious signs of male or female behavior; 12. Patients and operators have a unified opinion on the operation; 13. The local public security department conducted judicial expertise, and after the operation, it recorded on the ID card that it agreed to change the gender; 14. The next of kin has no objection; 15. The patient is very clear about the possible situation after operation and is psychologically prepared; 16. No surgical contraindications. (2) Basic requirements for surgical treatment of modern male and female transsexual diseases: With the continuous development of modern plastic surgery technology, people's requirements for surgical results are also increasing. Based on morphological and anatomical research and clinical practice, we think that the basic requirement of modern plastic surgery for male and female degeneration should be: 1. The reconstructed female vulva is vivid: 2. The vagina has enough depth and width after operation; 3. The clitoris and vagina have sensitive sexual sensory functions; 4. Breast shape is natural, harmonious and symmetrical; 5. The Adam's apple and beard disappear, and the craniofacial contour is feminine; 6. The postoperative scar is small and concealed; 7. No postoperative complications; After the operation, the patient's physiology and psychology were completely unified, and she successfully lived, worked and studied as a woman. (3) Plastic surgery for male and female degeneration: It mainly includes penis and testis excision, urethral displacement, artificial vagina plastic surgery, facial bone feminization surgery such as breast augmentation and nose plastic surgery, chin plastic, cheekbone and cheek plastic surgery, thyroid cartilage reduction plastic surgery, tone adjustment, electrolysis or surgical hair removal and other additional operations and treatments. Of course, not every patient needs to do all the above operations, and usually several operations are selected according to the actual situation. (4), surgical methods: 1, penis and testis resection, urethral transfer, artificial vagina and vulvoplasty: the patient took the bladder lithotomy position and performed the operation under general anesthesia or epidural anesthesia. (1) Suprapubic cystostomy, sterile urine bag and catheterization. ⑵ Formation of scrotum and penis flaps. ⑶ Excision of testis and epididymis. Anatomy and excision of bilateral testis and epididymis. ⑷ The urethral cavernous body was separated, and a long enough urethra was reserved for reduction. (5) Reconstruction of clitoris with island partial glans flap pedicled with neurovascular. [6] Cavernectomy. Once the vagina is reconstructed. (8) Reconstruction and shaping of female vulva. Levies iodoform gauze strips are filled in the vagina, and the dressing in the operation area is shaped and bandaged. 2, breast augmentation, silicone prosthesis implantation: male and female transsexuals, less breast tissue, wide chest, so generally choose a larger breast prosthesis. The incision was designed in the anterior axillary fold to cover the postoperative scar. The prosthesis was implanted under the pectoralis major muscle. The operation steps are basically the same as those of female breast augmentation. 3. Feminization of facial contour: After the whole facial design is completed, it will be gradually carried out: forehead plastic surgery, nose plastic surgery, chin plastic, cheekbone cheek plastic surgery and other facial bones and soft tissues feminization. 4. Thyroid cartilage reduction and plastic surgery: an incision was designed at the transverse skin of the base of the jaw and separated subcutaneously. After the thyroid cartilage is fully exposed, the most prominent part of the wing plate of the thyroid cartilage on both sides (that is, the Adam's apple) is exposed, which is removed and the incision is sutured in layers. (5) Plastic surgery for changing from female to male: it mainly includes hysterectomy and ovariectomy, penile plasty, mastectomy and additional plastic surgery for abdomen and buttocks. In view of the fact that the artificial penis with good shape and function can not be formed for female transsexuals at present, many scholars disapprove of penile plasty, believing that it is not only ineffective, but also has many complications. (6) Complications: Surgery for degenerative diseases, like other surgical operations, will also have some complications. Generally speaking, it can be divided into two categories: (1) complications caused by the operation itself; ⑵ Complications related to improper case selection or poor surgical results. www.20tom.com