Complications

By Nick Peplow·Gender-affirming surgery coordinator

Last reviewed 12 October 2026· How this site is researched

Most recoveries go to plan. When one does not, what makes the difference is catching the problem early, and that mostly means knowing what it looks like. Below are the complications to know by name after MTF surgery, how you would notice each one and what usually happens next. Knowing them is not a reason to fear them: it is what lets you relax through the normal soreness and act fast on the rare thing that matters. This is information, not medical advice. If something worries you, ring your surgeon.

Emergencies

Some signs need an ambulance or an emergency department, not a callback:

• Chest pain or sudden shortness of breath, which can be a clot in the lung
• One calf swollen, hot and painful, which can be a clot in the leg
• Noisy breathing or difficulty breathing after neck or voice surgery
• Heavy bleeding that does not stop with firm pressure
• High fever with confusion, or feeling very unwell very quickly

Clots are the reason surgeons get you walking early, and the reason many ask you to pause oestrogen around bigger operations. Follow their plan for both.

After any operation

Haematoma. A collection of blood under the skin. It shows up as one side swelling more than the other, getting harder, tighter and more painful, usually in the first day or two. It is the main early risk after breast and facial surgery, and it is the one where hours matter. Small ones settle on their own. Larger ones go back to theatre to be drained, which is a short procedure and usually protects the result.

Infection. Redness that spreads, heat, swelling that gets worse after the first few days, pus, a bad smell or a fever. Most infections are caught in the first two weeks and treated with antibiotics. Infection around an implant is more serious and sometimes means the implant has to come out for a while.

Wound healing problems. Small areas where the edges separate or heal slowly are common, especially where skin is under tension. They usually heal with dressings and time. Smoking makes all of these more likely, which is why surgeons are strict about nicotine.

After vaginoplasty

Granulation tissue. Raw, red, overgrown healing tissue that bleeds easily and causes discharge. It shows up in a large share of people in the first months and is treated in clinic, usually with silver nitrate. It is a nuisance rather than a danger. The glossary entry has more.

Loss of depth or narrowing. The canal feels tighter, or the dilator stops going as far as it did. Swelling explains some of this early on, but a narrowing that persists needs attention, because a canal left to narrow can close. A steady dilation routine is the best protection, and the first thing your surgeon will ask about.

Urinary problems. A spraying stream is common at first and usually settles as swelling goes down. A stream that becomes slow, thin or hard to start weeks later can be a narrowing of the urethra, and it is usually fixable. Being unable to pee at all is urgent.

Rectovaginal fistula. A rare connection between the canal and the rectum. The signs are stool or gas coming from the vagina, or a foul discharge. It needs to be seen promptly and often needs further surgery, which is exactly why surgeons take it so seriously.

Graft loss and wound breakdown. Patches of the lining that do not take, or areas that open up, usually at the back of the canal. Most heal with time and careful dilation. Larger areas can cost depth.

After breast augmentation

Capsular contracture. Scar tissue around an implant tightening, so the breast feels firm, looks higher or rounder, and sometimes aches. It can appear months or years later. Mild cases are watched. Firmer ones are treated with surgery to release or remove the capsule. The glossary entry explains the grades.

Implant position. Implants that sit too high, too far apart or drop too low. Some of this settles as the implants drop over the first months, so surgeons judge position at three to six months.

Rupture. Uncommon with modern implants and often silent. Your surgeon will tell you how they want it checked over the years.

After facial feminisation

Nerve changes. Numbness of the scalp after forehead work and of the lower lip and chin after jaw work is expected and usually improves over months. Weakness in moving part of the face, such as raising an eyebrow or smiling evenly, is less common and usually recovers too, but tell your surgeon early.

Asymmetry and contour. Swelling is often uneven for weeks, so most of what looks lopsided early on settles. What remains at six months to a year is what a surgeon would consider revising.

After voice surgery

A voice that stays rough or weak. A breathy, hoarse or weak voice is normal early on. One that is not improving over the first few months needs a scope, not patience, because some causes, such as a granuloma at the front of the folds, are treatable.

Pitch drifting down. Some of the rise can relax over the first year, especially after cricothyroid approximation. It is judged at six to twelve months, and a revision or a second procedure is planned from there if needed.

Revisions

A revision is a second, usually smaller operation to improve or fix a result. Surgeons generally wait until swelling has fully settled, often six months to a year, before planning one. Labiaplasty after vaginoplasty, implant exchange and facial touch-ups are the common ones. Ask before your first operation what your surgeon's revision policy is and what it costs, because it varies a great deal. Bottom surgery revision and breast revision go into those two in depth.