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Some surgeons prefer to do most of the crafting of the outer vulva as a second surgery, when other tissues, blood and nerve supplies have recovered from the first surgery. Van Trostenburg stresses the need to maintain dilation and hygiene for the newly created vagina and tissues left vulnerable to infections that may result from surgery. Breast augmentation is the enlargement of the breasts. In extreme cases of shortage of skin, or when a vaginoplasty has failed, a vaginal lining can be created from skin grafts from the thighs or hips, or a section of colon may be grafted in colovaginoplasty. In , Seargent Sylvia Durand became the first serving member of the Canadian Forces to transition from male to female, and became the first member of any military worldwide to transition openly while serving under the Flag.

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Saige. Age: 32.
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Van Trostenburg stresses the need to maintain dilation and hygiene for the newly created vagina and tissues left vulnerable to infections that may result from surgery.

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Cali. Age: 23.
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In , Seargent Sylvia Durand became the first serving member of the Canadian Forces to transition from male to female, and became the first member of any military worldwide to transition openly while serving under the Flag. Surgeon's requirements, procedures, and recommendations vary enormously in the days before and after, and the months following these procedures. Some MTF individuals may elect to have voice surgery, which alters an individual's vocal range or pitch.

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