About Benjamin's Syndrome
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Genital Reconstruction Surgery And Mastectomies
Mastectomies
For men with Benjamin's Syndrome, a mastectomy is often the most urgently desired operation. The presence of breasts can be the most obvious symptom of the syndrome, and getting rid of them is both psychologically beneficial and helps other people see you as a man. It is possible to have your breasts surgically removed, and your chest resculpted into a typically masculine appearance (often called "top surgery"). This can include reduction and repositioning of the nipples. The degree of scaring, preservation of sensitivity, and overall aesthetic satisfaction of the result depends on the skill and experience of the surgeon. There can be a significant amount of pain after the operation, and it may take a few weeks to fully recover. It often takes a year to regain sensitivity in the chest, and nipple sensitivity can be lost permanently. It might help to work out afterwards to build up chest muscles. It is possible that better results are obtained by undergoing chest surgery before starting HRT.
Men with Benjamin's Syndrome often settle for chest surgery only, as it is relatively affordable and effective compared to GRS, and has more visible results. Whether this is sufficient for legal purposes is highly variable; some jurisdictions or individuals accept this as adequate for legal recognition as a man, while others insist that some form of GRS (or at least a hysterectomy) is necessary. And unfortunately, in some cases no recognition is possible no matter what surgeries you've had. On average, top surgery costs something in the vicinity of US$6,000, though prices for specific surgeons vary.
Hysterectomies
Removal of the uterus and ovaries is done for medical, legal, and psychological reasons. It is expensive and invasive surgery, but brings significant benefits. It improves the safety and effectiveness of HRT, eliminates the risk of ovarian cancer or other problems with the reproductive system, and provides a permanent end to periods. It may be a requirement for legal recognition as a male, depending on where you live. The cost tends to be around US$15,000, give or take $5,000, maybe cheaper if combined with GRS.
GRS Overview
Genital Reconstruction Surgery (GRS) corrects one of the clearest physical symptoms of Benjamin's Syndrome by constructing a penis and scrotum from the existing genital and other tissue. There are two main types of GRS, or "bottom surgery", with many variations. The simplest is metaoidioplasty, in which the clitoris is freed to make a small penis. Creating a larger penis requires a more complicated phalloplasty. Either type can be combined (possibly in more than one operation) with hysterectomy, removal of the vagina, and conversion of the labia into a scrotum. Creating a scrotum takes time, as the skin of the labia needs to be stretched gradually with expandable implants. Once the stretching is complete, permanent artificial testicles can be inserted (unfortunately they're purely cosmetic and don't produce testosterone). GRS for men tends to be more difficult and expensive than for women, and the results are generally less satisfactory.
Metaoidioplasty
The easiest form of GRS involes freeing the clitoris from the surrounding tissue to extend its length, after it has already been enlarged by testosterone. The degree of enlargement from testosterone varies widely between individuals. The result can be a natural-looking, sensitive, erectile penis, but even the best results are very small. Sexual intercourse is unlikely to be practical. Optionally, the urethra can be extended along the length of the penis, allowing normal urination. This is obviously a very desirable feature, but has a relatively high risk of complications. Though simpler than the phalloplasty, the technique is a more recent development. A metaoidioplasty might cost something around US$12,000 on average, though that varies a great deal between surgeons.
Phalloplasty
A phalloplasty involves using tissue from other parts of the body to construct a penis. A common technique uses skin, muscle, and a major nerve from the forearm, and skin from elsewhere to cover the forearm. Though it can result in something closer in size to a normal penis, the appearance is generally less natural, sensitivity is unlikely to be very good, and there is no inherent erectile capability. There is also often severe scarring on the doner sites. It usually involves multiple operations, with long recovery times, and a variety of complications are possible including total rejection of the tissue graft. On the plus side, normal urination is a standard feature. Erections can be simulated by insertion of a rod or use of an internal pump system, allowing intercourse. Some surgeons attempt to connect nerves from the citoris to the penis. A phalloplasty may cost anything from US$15,000 to ten times that, or even more. Most decent surgeons are likely to charge tens of thousands at least.
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