[Ethical issues of gender reassignment surgery]. / Enjeux éthiques de la chirurgie de réassignation sexuelle.

Gender reassignment raises complex ethical issues. It questions gender identity and the right to self-determination. Some highlight the right to access the medical care necessary to live according to one's perceived gender. Others worry about the potential rush into major medical decisions, especially among minors. The need for a medical diagnosis of gender dysphoria can be seen as pathologizing. The requirement for surgery for marital status change, while not mandatory in many places, remains controversial. The balance between informed consent and access to treatment, as well as stigma and discrimination, contribute to the complexity of ethical issues. Finally, the issues surrounding the competence of health professionals, the quality of care and the integration of individual needs make these decisions particularly sensitive from an ethical point of view.

[Thoracic reassignment surgeries]. / Chirurgie de réassignation : techniques chirurgicales pour le thorax.

Thoracic reassignment surgeries are the most common gender reassignment surgeries. They represent the first and sometimes the only step in the reassignment process for transgender patients. Surgical techniques for thoracic reassignment derive from those used for the cisgender population and are accessible to plastic surgeons who do not usually treat transgender patients. On the other hand, there are some anatomical differences between men and women that they should understand, for instance, the positioning of the neo-NAC, the neo-inframammary fold and the scars. It is therefore important to understand these anatomical differences in order to optimize the cosmetic results of these surgeries so that they correspond to the expectations of these patients. In addition, the plastic surgeon will also have to be careful to adapt his approach to the relational level, with these patients, such as avoiding misgendering or using the "dead name". Finally, even if these operations are theoretically covered at 100% by the French health insurance, a request for prior agreement may be required in certain cases.

[Vulvoplasty after gender-affirmating genital surgery]. / Vulvoplastie chez les patientes en incongruence de genre.

Functional and aesthetic results after vaginoplasty in sexual reassignment surgery have improved in recent years. Improved surgical techniques, well-established expert teams and a growing demand for and interest in this type of surgery are some of the reasons for these results. However, there is a growing demand for genital cosmetic surgery, not only among cis women, but also among trans women. The main shortcomings in results are therefore presented and listed. The aesthetic revision surgery techniques specifically indicated are described. Labiaplasty and clitoridoplasty appear to be the two main requests for secondary surgery following trans vaginoplasty.

Modificação do corpo e binariedade: de Lili Elbe a Paul B. Preciado / Body modification and binarity: From Lili Elbe to Paul Preciado / Modificación del cuerpo y binariedad: De Lili Elbe a Paul B. Preciado / Modification du corps et binarité: De Lili Elbe à Paul B. Preciado

Para contribuir à reflexão sobre as questões de gênero, a autora examina, com mais de um século de distância, a evolução dos discursos e das representações e como essas transformações impactam as formações subjetivas. Menciona o primeiro caso transgênero (homem a mulher) do qual temos o testemunho: Lili Elbe. Lili Elbe deixou escritos sobre seu percurso marcado por uma determinação que não aceitava limites. Examina, então, como a questão é abordada hoje, por meio do particular exemplo de Paul B. Preciado (ex-Béatriz), cuja abordagem da noção de gênero está no limite das performances artísticas dos proponentes da arte corporal. Dois mundos que parecem estar separados por anos-luz, passando de uma concepção absolutamente binária, em que se é homem ou mulher, e a técnica médica concebida apenas como uma reparação por erro da natureza, para uma concepção em que as recusas às "atribuições" são produzidas por uma cultura comum, todas as formas intermediárias podem ser consideradas, até mesmo o recurso a manipulações farmacêuticas fora do campo médico.

In order to contribute to the reflection on gender issues, the author examines, from a distance of over a century, the evolution of discourses and of representations as well as how these transformations impact subjective formations. She mentions the first transgender case (male to female) of which we have testimony: Lili Elbe. Lili Elbe left behind writings about her journey, which was marked by a determination that accepted no limits. The author then examines how the issue is addressed today, through the particular example of Paul B. Preciado (formerly known as Béatriz), whose approach to the notion of gender lies in the limit of the artistic performances of proponents of body art. Two worlds light years away from each other, going from an absolutely binary conception, in which one is a man or a woman, and the medical technique conceived only as a compensation for nature's error, to a conception in which the refusal of the "attributions" is produced by a common culture, all intermediate forms can be analyzed, even the use of pharmaceutical manipulations outside of the medical field.

Para contribuir a la reflexión sobre cuestiones de género, la autora examina, desde hace más de un siglo, la evolución de discursos y representaciones y cómo estas transformaciones impactan en las formaciones subjetivas. Menciona el primer caso transgénero (de hombre a mujer) del que tenemos testimonio: Lili Elbe. Lili Elbe dejó escritos en su camino marcados por una determinación que no aceptó límites. A continuación, examina cómo se aborda el tema en la actualidad, a través del ejemplo particular de Paul B. Preciado (ex-Béatriz), cuyo acercamiento a la noción de género se encuentra en el límite de las representaciones artísticas de los defensores del body art. Dos mundos que parecen estar separados por años luz, pasando de una concepción absolutamente binaria, en la que se es hombre o mujer, y la técnica médica concebida sólo como reparación por el error de la naturaleza, a una concepción en la que las negativas a "Las atribuciones" son producidas por una cultura común, se pueden considerar todas las formas intermedias, incluso el uso de manipulaciones farmacéuticas fuera del campo médico.

Pour contribuer à la réflexion sur les questions de genre, l'auteur examine l'évolution des discours et des représentations depuis plus d'un siècle et comment ces transformations impactent les formations subjectives. Elle évoque le premier cas transgenre (homme à femme) dont nous avons le témoignage: Lili Elbe. Lili Elbe a laissé des écrits sur son chemin marqué par une détermination sans limite. Elle examine ensuite comment la question est abordée aujourd'hui, à travers l'exemple particulier de Paul B. Preciado (ex-Béatriz), dont l'approche de la notion de genre est à la limite des performances artistiques des adeptes de l'art corporel. Deux mondes qui semblent séparés par des années-lumière, passant d'une conception absolument binaire, dans laquelle on est un homme ou une femme, et d'une approche médicale conçue uniquement comme la réparation d'une erreur de la nature, à une conception dans laquelle devient possible le refus des assignations produites par une culture commune et où toutes les formes intermédiaires peuvent être envisagées, même l'utilisation de manipulations pharmaceutiques en dehors du domaine médical.

[Facial feminization surgery - middle and inferior thirds]. / Chirurgie de féminisation du visage ­ tiers moyen et inférieur.

The authors present the surgical techniques of facial feminization of the middle third and the inferior third in the context of sexual reassignment surgery. These techniques adapted to patients 'male to female' are proposed to strong masculine facial features of patients and are based in the middle third of the remodeling of the malar region by fat grafting, reduction and/or deprojection techniques in rhinoseptoplasty and upper lip surgery. Concerning the inferior third, remodeling of the mandibular angles, genioplasty and chondrolaryngoplasty are adapted.

[Facial feminization surgery - upper third]. / Chirurgie de féminisation du visage ­ tiers supérieur.

The authors present the upper third of the facial feminization techniques in the context of transgender surgery. These techniques adapted to patients "male to female" are proposed to strong masculine facial features of the patients and for the upper third of the face, based on transfer of adipose tissue, fronto-orbital remodeling and correction of the hairline by scalp advance.

[Transsexualism]. / Le transsexualisme.

UNLABELLED: Transsexual conditions need to be assessed for a psychological, hormonal and surgical evaluation. A multidisciplinary consent is required to perform hormonal and surgical treatment. METHOD: A critical overview has been performed (PubMed) and the main guidelines have been summarised. RESULTS: Hormonal treatments include suppression of the naturally secreted hormone and the administration of hormone of the desired sex. The main comorbidity is thrombo-embolic complications for patients under oestogene therapy. The main surgical treatment for female to male (FtM) surgery are: periareolar mastectomy if possible, hysterectomy, ovariectomy and vaginectomy and phallic reconstruction including metaidioplasty and forearm or suprapubic phalloplasty dependant of patient's wishes. The main treatments for male to female (MtF) surgery are: prosthesis mammoplasty and vaginoplasty and for some facial feminisation. The results in term of global satisfaction are high despite a relatively high rate of complications as well. CONCLUSION: Results in terms of well-being and psychological improvement justify this treatment despite its relatively high morbidity.