Massage Therapy Journal Summer 2025

Summer 2025 • 65

feminizing vaginoplasty (creating a vagina), masculinizing metoidioplasty (uses the clitoris to form a micro-penis of less than about 2.57 inches long), phalloplasty (uses a flap of skin from another part of the body to form an average-sized penis of about 5 to 6 inches), and scrotoplasty (reshapes part of the labia majora [outer lips of the vulva] into a scrotum and may include implants). This is not an exhaustive list. The number of surgical gender affirming procedures has increased significantly in the United States. Among gender affirming procedures, chest surgery was the most common performed overall (over 50%). Genital reconstructive procedures were more common among older individuals. 55 The terms major surgery and minor surgery are relative, with differences noted when we compare them with each other. • Minor surgery involves removing superficial tissue such as skin or mucosae under local anesthesia and is minimally invasive. Minor surgery is also called day surgery or outpatient surgery. • Major surgery occurs when a person undergoes an operation. It involves general anesthesia and respiratory assistance and is invasive because the procedure requires exposing or entering a body cavity. Major surgeries are usually performed by a team of surgeons and require a hospital stay. Major surgery is also called inpatient surgery. Most gender-affirming surgeries are major surgeries. For major surgery, massage can begin once the client is medically stable. Medical stability occurs when vital signs, such as pulse, temperature and blood pressure, are within normal limits; the client is conscious and comfortable; and the prognosis is good to excellent. Communicate with the patient care coordinator if the client is still under medical supervision, and follow their directives. Position the client for comfort. A side Surgery and Massage: General Considerations

lying position may be needed to avoid pressure on areas containing incisions, drain tubes or medical devices, such as catheters or pacemakers. The incision, or cut, produced by surgical instruments during the operation and areas near the incision are avoided until sutures or staples are removed and the incision is dry, not moist or open, and into the remodeling (maturation) phase. This may take up to eight weeks after surgery. In addition, the area around the incision should not be manipulated in a way that places stress on it while it is healing. Avoid vigorous massage techniques on the lower extremities (thighs and legs) for 12 weeks after surgery because of increased risk of blood clots or venous thromboembolism. 56,57,58 For minor surgery, the same general guidelines apply, with one exception. If it appears that blood clot risk after minor surgery is low and brief, reduced pressure on the lower extremities may not be warranted. Instead, screen for blood clots by looking for signs and symptoms, such as unilateral leg swelling, heat, redness or noticeable discoloration, pain and tenderness. If signs and symptoms of DVT are present, avoid massage to the affected lower extremity.

GoodStudio / Shutterstock.com

amtamassage.org/mtj