MEET the Irish plastic surgeon who’s changing the lives of US transgender patients.

When Louth woman Dr Sidhbh Gallagher graduated from UCD, she never imagined that she would wind up running a gender affirmation surgery programme in the conservative US state of Indiana.

6 Dr Gallagher explains how no two surgical procedures are ever the same

But with dozens of patients coming through her clinic every month seeking to match their bodies with their gender identities, she describes it as “the most meaningful work I’ve ever done”.

Dr Gallagher, 37, was always interested in the transformative effects of surgery, explaining: “The first time I saw plastics, I thought ‘this stuff is like Frankenstein, taking bits of tissue off the body, making noses’. I did art in school and I always fancied doing something creative, and there really is a creative aspect to plastic surgery because you want to make things look good.

“It didn’t disappoint me, you’d never be bored. Yesterday I was working on a nose, then genitalia, then a hand, and no two surgeries are the same.”

Having spent time working in Dublin’s Mater Hospital, Dr Gallagher continued her surgical training in Philadelphia before completing a fellowship in plastic surgery with the Indiana School of Medicine.

6 The surgery can be difficult

She then decided to focus her attentions on gender affirmation surgery.

However, getting specialist training was difficult, and she explained: “This is a very new area, and I did find it really tough to get training as I had to go to Australia, Belgium, California and Miami. A lot of the things you do in other types of reconstructive surgery, you do in gender affirmation surgery. It’s really exciting and techniques are improving all the time.”

After returning to Indiana, she set up the Indiana University Gender Affirmation Surgery Programme in 2015.

The programme’s title is significant. She explained: “In the US we use two terms — gender confirmation or gender affirmation. I think it’s the most respectful thing. It was originally sex change or gender reassignment, but a patient’s identity is the most important thing.

6 Dr Gallagher with her patient Laura

“In the past, it was believed these people were psychiatrically unwell and needed treatment to be convinced of their gender. But now we understand we change the body to fit the patient.

“The biological sex and all of that is none of your business, it’s how the patient identifies that’s important and we’re aligning the outside to what’s on the inside.”

While Dr Gallagher’s practice offers general plastic surgery, the vast majority of their patients are seeking gender affirmation procedures.

It’s one of the few programmes in the mid-west to offer genital surgery for transgender men and women, and its reputation is growing, with up to 90 referrals a month.

6 Sidhbh pictured with Thomas

The most commonly requested treatment is masculoplasty — removing breasts in female to male patients and creating a chest.

This area is particularly exciting as Dr Gallagher has developed a new and efficient technique which reduces discomfort for patients.

And she’ll shortly be publicising this element of her work in a medical journal.

She said: “With masculoplasty, you take off the breasts and traditionally there’s a space left behind so you put in plastic tubes called drains.

“But they are uncomfortable for patients, so we developed a way of doing it without drains. We’ve done over 300 of them, and there are fewer complications.”

Breast construction in male to female patients is also a popular procedure, as well as male to female genital surgery. But not all procedures are straightforward.

She revealed: “We don’t do much female to male genital surgery as it’s much more complicated. The plumbing is really difficult, trying to lengthen where you pee and for getting an erection.

6 An example of a mascaloplasty

“The techniques are improving and there are places doing it, but I would say that not many of our guys sign up for it.

“I’m very frank with patients, and by the time I tell them the possible complications, a lot decide not to do it. They’ll have their breasts removed, and have a hysterectomy, but they might leave it at that.”

Surgery for transgender patients is still a small area, but as knowledge and expertise increases, it’s gradually becoming more popular.

It’s not currently available in Ireland, although the HSE has funded the cost of operations abroad for 60 patients since 2012.

In addition, 40 Irish teenagers who have questioned their gender identity are undergoing treatment in the UK. In the US, the nearest equivalent to the HSE — Medicaid — covers transgender procedures in some states, but not in Indiana.

This meant when it came to setting up her practice, insurance was the trickiest issue for Dr Gallagher.

Encouragingly, while Indiana certainly isn’t regarded as the most liberal of American states, the gender affirmation programme has been widely accepted.

She explained: “Maybe I’m naive but I’ve never had any direct opposition to my work here.

6 Sidhbh in surgery in Indiana

“I tread carefully when I’m talking about my job because you don’t want to alienate people. I just say I’m a plastic surgeon and if they want to hear more I’ll tell them.”

With the opportunity to make such a difference to the lives of her patients, she recognises her work is a privilege, saying: “It felt very right from the beginning. ­When I was getting into the field, I didn’t know anybody personally who was transgender.

“People’s stories really resonated with me. I think it’s such bravery to come out. I can’t imagine, if you’re born and raised somewhere like rural Indiana, what it’s like when you have to come out to yourself and family and community. It’s very scary to have to say this is who I am and that’s a characteristic I see in my patients I really admire.

“When you have this diagnosis of gender dysphoria, the suicide attempt rate in people who aren’t treated can be up to 46 per cent.

“Our patients are so grateful for their surgery and I’ve a great bond with them. In a way I hate to see them go.

“This time of year is lovely, you have men who are going out sunbathing, and for the first time they’re able to take their tops off, and they tag me on Instagram. After a long day on the programme when you get home and you’re exhausted, it’s just lovely to see.”

Understandably, her unique area of work attracts plenty of questions, but she has been very heartened by the positive response from family and friends back home. She said: “I was home to Louth in February and my parents had a party so they invited neighbours and relatives.

“I was amazed at how much people knew about the subject. They were very well informed and using the right terminology.”

Dr Gallagher makes a keen effort to help improve public awareness of gender affirmation surgery, regularly posting photographs and videos on social media and on her own YouTube channel.

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And while Indiana is home for the foreseeable future, she’s also keen to help improve education in Ireland.

She said: “I’ve always had it in the back of my head. I’ve been very well educated in Ireland and I left really early, and I feel I should give something back.”

TO find out more about Dr Gallagher’s work visit the website universitygenderaffirmationsurgery.com.