If Something Goes Wrong: Complications and Revision Surgery

If something goes wrong after gender-affirming surgery, the most important thing you can do is recognise the warning signs and contact your surgical team early, because most complications are easier to treat when caught quickly. Outcomes are generally good, but complications happen, and revision surgery is a recognised, planned part of the field, not a sign of failure. Regret across gender-affirming surgery is low, about 1 in 100¹, and a complication is not the same as regret. This guide explains what to watch for, how to get help, and how revision works.

Nobody wants to read this section before surgery, and it is exactly the one I most needed: calm, specific, and honest about what can go wrong and what is done about it. Here it is, reviewed by a consultant gender-affirmation surgeon. For the wider journey, see the pillar guide to gender-affirming surgery.

Knowing the warning signs

Acting early is the single most valuable thing you can do, so learn the signs that need attention. General warning signs after any major surgery include heavy or new bleeding, high fever, spreading redness, severe or increasing pain, and discharge with an unusual odour. Seek urgent care for severe symptoms, and contact your surgical team promptly for anything that worries you rather than waiting for the next appointment.

The instinct to stay quiet and hope is understandable and unhelpful. When I was unsure whether something counted as a problem, the right move was always to ask, and teams expect those calls.

Complications by procedure

Complication rates vary by procedure, so it helps to know the honest picture for yours. Quoting rates as procedure-specific ranges, rather than one headline figure for all surgery, is the accurate way to think about it:

• Phalloplasty: the highest complication rate of common gender-affirming surgeries; urethral complications (strictures and fistulae) are the most frequent and often need further surgery. It is staged, with the total process commonly 12 to 18 months.
• Vaginoplasty: generally good outcomes; recognised issues include stenosis (loss of depth), delayed wound healing, granulation tissue, and (uncommonly) fistula.
• Metoidioplasty: a lower complication rate than phalloplasty, though urethral issues are possible if urethral lengthening is done.
• Chest or top surgery: generally low; possible haematoma, infection, scarring, and changes in nipple sensation.

For vaginoplasty specifically, the most important prevention is keeping up dilation, covered in long-term care after vaginoplasty.

Getting help and who to contact

Start with your surgical team, because they know your history and your procedure. On the NHS, follow-up runs through your surgical provider after referral from a Gender Dysphoria Clinic, and your GP can help you access urgent care². Keep your operation records to share with any clinician, which matters most if you had surgery away from home. If you had surgery abroad, follow-up is your responsibility to arrange, so identify in advance who manages complications at home; see gender-affirming surgery abroad for planning that continuity.

How revision surgery works

Revision surgery is further surgery to correct, improve, or complete a result, and it is a normal part of the field. For some procedures it is expected rather than a setback: phalloplasty is staged, built over multiple operations, so additional surgery is planned from the start. For others, revision addresses a specific issue, such as repairing a urethral stricture or fistula, or refining an aesthetic or functional result. The WPATH Standards of Care, Version 8 (2022), supports individualised, ongoing care, which includes revision where it is needed³.

Needing revision does not mean the first surgery failed. Reframing it that way helped me: it is part of how good results are achieved, not evidence that something went wrong.

Finding a surgeon for revision

Where possible, start with your original surgical team, then apply careful vetting if you need someone new. If you change surgeon, look for recognised specialist registration, the equivalent of the UK’s General Medical Council register⁴, an accredited facility, and specific experience with revision of your procedure. The same standards that guided your first choice apply again; see choosing a gender-affirmation surgeon.

A complication is not regret

Finally, hold on to the distinction between a complication and regret, because they are not the same thing. Regret across gender-affirming surgery is low, about 1 in 100 in a 2021 pooled estimate of around 7,900 patients¹, and most people who experience a complication still value their surgery once it is resolved. Treating a problem and feeling about the decision are separate. If a complication arises, it is a medical issue to be managed, and the evidence is that the large majority of people come through and report improved wellbeing on the other side. For that long view, see life after gender-affirming surgery.