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Seeing the Whole Person: Plastic and Reconstructive Surgery for Transgender Patients

Care is at the heart of the Washington University Transgender Center’s mission.

 

The Washington University Transgender Center—the only center of its kind in the region—offers multidisciplinary team care for transgender, non-binary and genderqueer individuals in an accepting and respectful environment. This care is comprehensive and personalized, addressing the unique needs of each individual with a range of available services.

The care providers at the Transgender Center understand that there is no single path that is appropriate for all patients. Each person has different goals, needs and interests when they visit the Center. The purpose of the first visit is to understand these goals and discuss the best options to meet the individual’s needs.

“It is a group decision and collaborative effort to make sure we do what’s best for the patient,” says Transgender Center Co-director Christopher Lewis, MD. In a Radio Rounds podcast, Lewis, Instructor in Pediatrics from the Division of Endocrinology, and co-director Sarah Garwood, MD, emphasize that all people are welcome at the Center, which offers pediatric, adolescent and adult services.

Available services include gender-affirming hormones that help a person’s physical body match their gender identity, counseling to determine the best transitioning plan, mental health care, speech therapy and dermatology. Any and all of these services can play an important role in achieving a person’s goals at the Transgender Center, and specialists in each area have training specific to gender topics. Typically, younger patients receive support through gender-affirming therapy to promote positive mental health as they develop. Gender-affirming hormones become a care option around puberty for those who want them. Another important service for many individuals at the Transgender Center is surgery.

Helping Everyone Feel Whole

Alison K. Snyder-Warwick, MD, is expanding the options available for those seeking surgical care at the Transgender Center. Snyder-Warwick, Assistant Professor in the Division of Plastic and Reconstructive Surgery, has partnered with Gino J. Vricella, Assistant Professor in the Division of Urologic Surgery, to perform bottom surgery as part of the Transgender Center’s mission to provide the best, most comprehensive care for all patients.

Alison Snyder-Warwick is expanding surgical options for patients at the Transgender  Center.

There are many surgical procedures an individual might choose as part of their care. Facial contouring procedures can help a person achieve a more masculine or feminine facial structure, matching their outward appearance to their gender identity. Dennis Nguyen, MD, joining the faculty this fall, is excited to build this practice in conjunction with Kamlesh B. Patel, MD. Top surgery reconstructs the chest with masculinization or breast augmentation, according to the patient’s goals. As part of the Transgender Center, plastic and reconstructive surgeons—including Snyder-Warwick; Patel, Associate Director of the Plastic Surgery Residency Program; and both Terence M. Myckatyn, MD, and Marissa M. Tenenbaum, MD, at West County Plastic Surgeons of Washington University—have performed these procedures.

Since May of 2019, Snyder-Warwick and Vricella have added bottom surgery—procedures that create appropriate form and function to match a person’s genitalia to their gender—to the Center’s services.

Snyder-Warwick was first approached to perform bottom surgery in 2017. As a specialist in nerve reconstruction and microsurgery, Snyder-Warwick possessed the necessary skills to perform these complex and important procedures.

She and Vricella got to work, learning from experts with busy practices, visiting institutions that specialized in these procedures and reading the literature. They trained across the nation with surgeons from New York University, the Buncke Clinic in San Francisco and in courses at national conferences. Combining their respective expertise in plastic and reconstructive surgery and urologic surgery, Snyder-Warwick and Vricella were committed to providing the best care for all patients seeking all bottom surgery options.

“Helping patients achieve their goals is very rewarding,” Snyder-Warwick attests. Putting in the necessary preparations before offering these procedures was of the highest importance. “We have put a lot of planning and preparation into this practice to make sure our patients receive care that meets their goals.”

Snyder-Warwick and Vricella provide procedures that use embryologic equivalents to reconstruct the genitalia. This means that they use existing structures that are similar, biologically, to create the new structures. Helping patients understand their options, and how each of these options differs in terms of form, function, recovery time and other factors is a large part of the process. For the patients, understanding how the reconstruction will take place helps them make an informed decision about what procedure is right for them.

“In many ways, the same surgical principles apply to gender affirming operations as to procedures Dr. Vricella and I have done for years,” Snyder-Warwick asserts. While these operations serve a specific purpose for patients, they technically resemble other procedures Snyder-Warwick and Vricella have done throughout their career. “We have learned to translate these skills to meet the needs of our patients.”

Gino J. Vricella, MD, brings expertise in Urologic Surgery to the Transgender Center’s expanding portfolio.

The Washington University Transgender Center is committed to caring for individuals at any stage in their transition process. As faculty like Snyder-Warwick, Vricella and their colleagues from across departments, divisions and sections continue to collaborate for patient care, the Center serves as an innovative example of what can be achieved by multidisciplinary, team care.

Division Chief of Plastic and Reconstructive Surgery Justin M. Sacks sees Snyder-Warwick’s involvement with the Transgender Center as an example of the innovation on the horizon for his division. He is emphatic that transgender patients receive the best care.

“Patients deserve and require this to be done well, in a collaborative environment where you have all the experts together,” Sacks says. “Dr. Snyder-Warwick is expanding our portfolio in gender affirming surgery because it’s what our patients deserve: the best head to toe cosmetic and reconstructive surgery.”

Snyder-Warwick and Vricella have seen a rise in appointments, and look forward to growing their practice further. As the team at the Transgender Center continues to grow, the mission remains focused on providing care in a respectful, welcoming environment for all individuals.

“Everyone should have the opportunity to feel whole,” Snyder-Warwick says. “That’s what we do for all of our patients. Whether it’s cancer reconstruction, nerve repair, a wound or traumatic defect, aesthetic surgery or gender affirmation: our goal is always to make the person feel whole.”