Gender Identity disorder is now a well established psychiatric condition. In this genotype sex ( chromosomal sex ) and phenotype( body ) sexual characteristics are of one sex type either male or female but mentally and psychologically of opposite sex. So the person feels as if entrapped or caged in a wrong body.
Being a psychiatric disorder it has to be diagnosed and certified by two psychiatrists of repute at two different times. Once gender identity disorder has been established the person is started on hormonal therapy and encouraged to cross dress. After a period of one year if the patient is still found to be motivated for the surgery, it is undertaken. Also the patient has to take a legal undertaking giving the surgeon permission to operate upon him.
Male to Female (MTF)
Stage 1- bilateral removal of testes ( orchidectomy), removal of penis with preserving the urethra and part of glans with neuro-sensory supply intact). Reconstruction of neo-vagina (wet look and feel), labia majora, and clitoris.
Stage 2- breast augmentation with breast implants. Some ladies may require breast tissue expansion before placement of silicon implants
Stage 3 and further- laser hair removal, refinements of genitals, face modification and other body parts.
Female to Male (FTM)
Stage 1- hysterectomy ( uterus removal ), oopherectomy ( ovaries removal ) and vaginectomy plus top surgery which include bilateral mastectomy with free nipple graft.
Stage 2- phallus/penis reconstruction with forearm or thigh skin
Stage 3- scortum reconstruction with testicular implants
Stage 4- face and body modification like beard and moustache hair transplant
You may have a detailed discussion about this during your personal consultation. Some of the possible complications include - anaesthesia related complications, swelling, bleeding, infection, thickened scar etc