Complications

By Nick Peplow·Gender-affirming surgery coordinator

Last reviewed 27 September 2026· How this site is researched

Surgeons list the complications in a consent form you skim once, in a room where you're already nervous. These five pages go through the ones that come up most, one at a time: what each looks like early, what normal healing looks like next to it, and whether it means a phone call today or an emergency department now.

Two belong mainly to chest surgery. A hematoma is blood collecting under the skin, usually in the first day or two. Published top surgery series put it at roughly one patient in twenty to one in eight, and it is the one where hours matter. The same page covers bleeds after face, neck and genital surgery, where the signs differ. Nipple necrosis is the opposite problem, a slow one. The hardest part is that a graft healing well looks frightening at a week, so that page spends as much space on normal as on failure.

Two belong to bottom surgery with urethral lengthening, and they are linked. A urethral fistula is urine leaking from somewhere other than the tip; a urethral stricture is a narrowing that makes it hard to pee. Fistulas tend to appear within weeks of the catheter coming out and strictures over months, and a stricture can force a fistula open upstream of it, which is why the two pages cross-reference each other. Both are common and usually fixable, but either can mean another operation and months added to the process. I would rather you knew that going in than found out at month four.

Infection can follow any of it, so it sits last and covers every procedure. That page is mostly about telling infection apart from ordinary healing, because ordinary healing is red, warm and sore too, and about implants, where an infection is harder to clear.

Emergency after any operation

Some signs mean your local emergency number or the nearest emergency department, not a message to the clinic:

• feeling faint, clammy or confused, or a racing heart, in the first days
• difficulty breathing or swallowing, especially after neck or jaw surgery
• chest pain, or sudden breathlessness, or one calf swollen and painful, which can be a blood clot
• being unable to pass urine at all, with a swelling, painful lower belly
• a phalloplasty flap going pale, dusky, blue or dark, or cold to the touch
• high fever with shaking, confusion or a fast heart rate

Everything else on these pages is a call to your surgical team, and the earlier the better. Every surgeon I've worked with would rather see a photo on day two than a problem on day nine. Before surgery, get the out-of-hours number and save it in your phone. If you're travelling for surgery, find out where the nearest emergency department is to where you're staying.

I'm not a clinician. These pages describe what the complications are and what I've watched people go through, so you can recognise something early and ask a better question. Diagnosing and treating them is your surgical team's job.