A shift in transgender surgery
Not all transgender individuals opt for surgery. “Every transition is individual and unique; it cannot be standardized. Each person knows what they need at each stage, and their decisions must be respected. Transition doesn’t have to involve surgery, nor does it necessarily require hormone therapy. It’s a unique, private journey for everyone. For minors, it’s essential to accompany them, not impose or insist—just support and provide the help they need,” explains Dr. Ivan Mañero, a plastic surgeon and pioneer in gender-affirming surgery in the country.
This reflects the diverse ways transgender individuals experience their transition, the phase in which they express and define their gender identity.
Early care for transgender individuals
Over the past 25 years, early care for transgender individuals has evolved, allowing younger individuals to receive support at specialized centers. Many begin during adolescence with puberty blockers, which prevent physical changes like facial hair, breast development, voice deepening, and fat distribution. This significantly eases their transition, boosting self-esteem and emotional well-being.
New surgical techniques
From vaginoplasty to colovaginoplasty
One of the clearest examples is vaginoplasty, the surgical technique used to create a vagina for transgender women. Early hormone therapy can sometimes result in underdeveloped genitalia, prompting a shift in vaginoplasty techniques.
Historically, penile inversion vaginoplasty, which uses penile skin to create a vaginal canal with sufficient width and depth for normal sexual intercourse, was the most commonly used technique. However, colovaginoplasty has become more prevalent when the penis is too small—often due to puberty blockers used during adolescence. This method uses a section of the sigmoid colon (terminal large intestine) alongside penile skin to create a vagina with adequate depth.
An IM GENDER study found that in 2002, only 14% of transgender women undergoing vaginoplasty required colovaginoplasty. By 2023, that percentage had risen to 68%. Over these two decades, IM GENDER has performed gender-affirming surgeries on more than 3,500 transgender individuals.
Scar-free trans mastectomy
For trans men seeking surgical transition, mastectomy is often the most significant procedure. Early care may lead to less pronounced breast development, enabling the use of less invasive techniques compared to traditional transgender mastectomy, which often leaves noticeable scars on the chest.
At IM GENDER, a scar-free mastectomy technique has been developed. This method removes the breast tissue through a small, 3-4mm incision in the armpit, strategically hidden within natural skin folds. Through this incision, both the fat and mammary gland are removed. Combined with radiofrequency, the skin adheres to its new position, achieving a smooth, masculine chest.
“This is a significant advancement. For small breasts in trans men, it avoids more invasive surgery and larger, more visible scars,” explains Dr. Trinidad Labanca, a gender surgery specialist at IM GENDER.
Less invasive facial feminization surgery
Facial feminization surgery comprises various techniques designed to enhance feminine features in a face. During adolescence, certain facial characteristics develop that distinguish an adult male face from a female one. Early hormone therapy can prevent these features from developing in transgender women, such as pronounced brow ridges, squared eye sockets, or certain hairline shapes.
This simplifies transitions for transgender women and often eliminates the need for facial surgery altogether.
IM GENDER: 25 years of leadership in gender affirmation surgery
With over 25 years of experience and more than 3,500 patients treated, IM GENDER has established itself as a leader in gender-affirming surgery. Led by Dr. Ivan Mañero, the clinic has developed and perfected innovative surgical techniques. Their multidisciplinary approach ensures every patient receives the necessary support during their transition, respecting their individuality and specific needs.
IM GENDER continues to research transgender surgery to offer the most advanced techniques and the best results to every transgender individual seeking surgery.
If you have further questions about trans vaginoplasty or are considering it as part of your transition, contact the expert team at IM GENDER for an initial consultation.