Sex Reassignment as an Artform

A rock-star-turned-doctor is one of Canada’s only sex-reassignment specialists, and a leader in the fight to get funding for people trapped in the wrong bodies

At age three, Cadence Matthews knew that he should have been a girl. He told his parents. “You’re a boy,” they responded. Matthews tried again to convince them at age five, seven, nine, and 13-“then I gave up.” But Matthews did live as a girl, wearing makeup and girls’ clothes, enduring classmates’ derision and parental anger. Worse, all she saw when she looked in the mirror was “ugly. I would walk down side streets and back alleys to avoid being on main streets where people would look at me.”The Internet opened the door to understanding her gender dysphoria. And then Matthews discovered Dr. Cameron Bowman, a plastic surgeon who specializes in sex reassignment. Nearly a year ago, Cadence Matthews-now a slender, long-haired, 23-year-old actor and singer-underwent an operation called facial feminization surgery, or FFS. By then, her parents had accepted her as female, and generously paid the $25,000 cost.It took Bowman more than nine hours to perform a string of procedures that included rhinoplasty and silicon cheek implants. “The week I had the surgery done I was swollen like a balloon and looked totally hideous. But I felt so much more confident than I ever had and instantly went back to walking on crowded streets,” says Matthews, who’s planning more procedures. “Now I feel that I’m pretty-in the right way, the way I want to be.”Such is Bowman’s profound effect on his patients. As one of only three physicians in Canada trained in sex reassignment surgery (SRS), he turns corporeal men into women and vice versa-or he would, if the provincial government let him. As things stand, phalloplasties and vaginoplasties (constructive surgeries that cost $20,000 and $9,300 respectively) are not performed in B.C. Phalloplasties, which are still termed “experimental” though thousands have been performed since the 1940s, are not funded here at all. Vaginoplasties are funded, but patients must fly to Montreal for the procedure. In B.C., Bowman is only permitted to perform less dramatic surgeries-he squares chests into male forms, smooths them into female forms. In a single day, he can do three chest surgeries, either constructing breasts for a transfemale or removing the breasts and sculpting a male chest for a transmale. ***At age 47, Bowman looks like a paragon of the establishment-member of a yacht club, in pressed white shirt and khakis and blue silk tie-but his path to medicine, and this rare specialization, was an unlikely one. When he was barely in grade school, he declared to his bemused parents that he planned to become a member of the Beatles. He taught himself to play piano and write songs, and eventually endured four semesters at SFU before quitting to join Barney Bentall and the Legendary Hearts as keyboardist. The group had a hit single, “Something to Live For,” won a Juno Award, produced albums, made videos, and lived the rock-star life. Fans likened Bowman, with his flop of blond bangs, to David Bowie.The rock ‘n’ roll journey lasted 10 years. When Bowman finally entered medical school at UBC he was 31, a geezer in comparison to most of his classmates. The restless muse that made him quit university, then return, was probably inherited from his father. Trained as an architect, Charlie Bowman shrugged off the rigours of that discipline to stoke his own creative fires, becoming an industrial designer and a trombonist, a fixture on Vancouver’s music scene. He died at age 44 when he crashed his ultra-light plane. His most memorable axiom, says Bowman: “‘If you’re not enjoying life, you have to change something.’ “Change” would become Bowman’s calling card.In 1995, the B.C. government accepted that sex reassignment surgery was appropriate treatment for transgenders. Victoria authorized the recruitment of surgeons and determined funding for various procedures, says Ryan Jabs, spokesperson for Ministry of Health Services. The Medical Services Plan couldn’t find a surgeon in B.C. skilled in SRS, though. So patients approved for delicate vaginoplasty surgery, which creates a vagina from penile tissue, had to travel to Centre Métropolitain de Chirurgie Plastique, a private hospital in Montreal where the country’s two other sex reassignment surgeons are based.By 2004, Bowman had finished a five-year plastic surgery residency at UBC medical school, where he became especially adept at breast reconstruction for breast cancer survivors. “I really liked plastic surgery, its creativity and artistry. Unlike other specialists, who just do bowels or the heart, you’re dealing with bones, nerves, vessels, and skin.”Fresh off his residency, Bowman was asked to consider further training in the subspecialty of SRS. The health ministry gave him $10,000 to help cover a fellowship in the medieval city of Ghent, Belgium, a centre for SRS. Bowman paid $15,000 out of his own pocket to cover expenses during a six-month stay at University Hospital Ghent, where he learned the art of creating neo-penises and neo-vaginas from the patient’s own genitalia. He marvelled at how every bit of tissue was repurposed, how nothing went to waste.When he returned to B.C., however, he encountered a web of bureaucracy. He submitted a business plan to the health ministry for a sex reassignment program that included a cost-benefit analysis showing how much money would be saved by doing surgeries in B.C. rather than Quebec. Approval for the program stalled, and the number of B.C. transgender patients awaiting surgery grew to 150. Then, in 2008, Bowman, who kept busy with cosmetic surgeries and rebuilding the bodies and faces of cancer, burn, car, and industrial accident victims, learned from a newspaper article that his proposal to expand the SRS program had been denied. George Abbott, B.C.’s health minister at the time, legitimized the move by saying that the province wouldn’t support a single-surgeon program. Bowman calls that rationale “ridiculous.”Patients continued to fly to Montreal. B.C. MSP would pay for vaginoplasties (but not phalloplasties) and the five-day hospital stay. Patients footed the bill for plane tickets and after-care at Centre Métropolitain’s recovery hospice. The return flight to Vancouver was arduous, says Emily, who flew to Montreal for a vaginoplasty in 2010, returning 10 days after the surgery with her catheter still in. “It’s not safe and it’s not prudent to have people go through major surgery and then come home on a plane.”Thus began Bowman’s battle against the Goliaths who control access to SRS. With no operating-room time, clinic time, or support staff, he laid down his scalpel for the sword of politicking. At times it seemed he was tilting at windmills. Patients whom he should have operated on were returning from Montreal with such complications as the inability to urinate. Occasionally, post-op patients were lucky enough to get Bowman, if he was on call. The situation was untenable. Bowman, fuelled by moral indignation, hunkered down for a protracted fight. “I’m drawn to controversy,” he admits. “And I didn’t train to be the follow-up guy.” For five years, Bowman has championed the right for British Columbia’s transgenders to increase their access to taxpayer-funded surgeries. Last May, his lobbying paid off. He was given clinic time and the support of a nurse to give transgenders post-op care following their Montreal procedures. Vaginoplasties are still being sent to Montreal, and the ministry refuses to add phalloplasties to its list of funded services. Refusing to fund phalloplasties is a “human rights abuse,” says Bowman, as it denies transmen equal access to health-care services. MSP will pay for phalloplasties for patients who are intersex, a congenital defect that causes ambiguous genitalia. “So why can we do a phalloplasty for someone who is intersex, whose genitalia doesn’t match who they are, but we can’t do it for people whose genitalia is opposite to what they identify with-what’s the difference?”Last October, his lobbying bore more fruit when B.C.’s Ministry of Health Services awarded him 15 days of operating time. Now, he’s whittling away at his waiting list at Vancouver General and UBC hospitals (“top” surgeries only). Still, he believes, there’s much to be done to raise his patients-long considered “crazy and a waste of resources”-from the bottom of the medical heap, where they have languished. “No one was helping these people,” he says. “They just couldn’t get on with their lives.”***Bowman’s Fairview Plastic Surgery & Skin Care office is decorated in a tasteful palette of greys and charcoals. Bowman unlatches an old-fashioned black leather doctor’s bag he bought in Florence-the kind once used for making house calls-and extracts an Apple laptop. The computer shows the physician’s equivalent of a family album: videos and photos of surgeries. Rock music can be heard on Bowman’s surgery videos; he carves and stitches to a soundtrack of U2, Prince, Van Morrison, and Steely Dan.Onscreen, he’s shaping the living clay of skin, nerves, arteries, fat, and muscle. Many of his transgender male patients post “after” photos on the Internet, displaying new, wide, flat pectorals where once they had womanly breasts. Bowman is especially proud of a phalloplasty he performed several years ago. Pulling a roughly drawn, blue transparency from his bag, Bowman fits it around his arm, demonstrating how it acts as a blueprint for a new penis. Assisted by a urologist, he takes a flap of flesh from the delicate skin of a patient’s arm, then rolls it up with the urethra, nerves, and blood vessels inside. The nerves of the clitoris are attached on the top to create a sensitive tip; a scrotum is created from the closed vagina. The result of the 10-hour operation is breathtaking. “I love this picture,” Bowman says, critically eyeing what appears to be the normal phallus of a young man.Bowman’s glad to have gained ground in the fight for transgender health-care rights. Changing his patients’ lives, helping them go happily forward, is his focus now. There is that moment, he says, when a transgender patient wakes up after surgery and looks in the mirror to see a body that is startlingly new and yet somehow familiar. “That’s my favourite part,” he says. “That first reaction. Sometimes they cry-that makes me cry sometimes. They hug you and say, ‘Thank you.’ That’s why I do this.”