After a lifetime of being "trapped in a man's body," Mr. Garrison visits Dr. Biber of the Trinidad Medical Center. There, he undergoes a cutting edge sex change operation (called a "vaginoplasty"), and with a few cuts and tucks, he is declared a full-bodied woman.
Meanwhile, Kyle fails to make the All-State basketball team and is told by his coach that "Jews can't play basketball." He leaves the court feeling depressed and cheated -- even though he feels like a basketball player on the inside, he's limited by his outward appearance.
After the boys meet the radically reconstructed "Ms. Garrison" on the street, Kyle asks his parents to explain a sex change operation. His mother says it helps people whose self-image is at odds with their physical appearance.
This strikes a chord with Kyle, who admits he's always thought he should be tall and black. He and Stan visit the Trinidad Medical Center where Doctor Biber tells Kyle that he could perform a "negroplasty" with relative ease, a process that would essentially make him tall and black.
Kyle's parents are furious when he asks permission to get the surgery. His father confronts Dr. Biber -- who quickly learns of Gerald's affinity for dolphins and offers to turn him into one. Kyle's dad opts for the "dolphinoplasty" operation and is soon hobbling around on a walker, with a dorsal fin and a blowhole on his neck.
Rejuvenated from the surgery, Kyle's dad has a change of heart. He can no longer deny his son the right to not be tall and black, so he lets Kyle get the negroplasty.
Things aren't going well for the newly minted "Ms. Garrison." Her boyfriend, Mr. Slave, leaves her. She then learns that even though she looks like a woman, she'll never have a period or be able to have children. Furious, she demands to be changed back -- only to learn that her testicles were implanted in Kyle's new knees and that her scrotum was used to fabricate Kyle's father's dorsal fin.
The Negro-fied Kyle made the All-State basketball team and will play in a game that night. But Dr. Biber says Kyle only looks black, and that if he actually takes the court, the strain on his new knees will squash Garrison's former balls.
Garrison, Biber, Cartman, Stan, and Kenny rush to the basketball arena, but it's too late. After he makes a spectacular slam dunk, Kyle's testicle-enhanced knees explode when he lands on the court, blasting off his lower legs.
Dr. Biber apologizes for the inconvenience to Kyle and his father. He admits that, unlike Garrison's surgery, their changes were only cosmetic. He then agrees to turn them back into their former selves for a nominal fee. There's no going back for Garrison however -- he decides to accept his new appearance and go on living as a woman.
"Even though I'm not truly a woman I think I still like the new me. I'd rather be a woman who can't have periods than a fag."
Ms. Garrison. After vaginoplasty surgery and some fake titty implants, Mr. Garrison is no more.
Dr. Biber is the plastic surgeon who turns Garrison into a woman.
The breezy, ethereal "Swim With The Dolphins" plays over Gerald's visions of becoming one with the dolphins.
The writing staff started the season with only a handful of half-developed ideas, including Mr. Garrison getting a sex change operation. The story about Kyle's frustration over not having the right body for sports is based on Trey's unrealized dream to play for the Denver Broncos.
After the sex change, Garrison flashes her breasts during what appears to be a Girls Gone Wild-like taping. But while the other women's boobs are obscured, Garrison's are displayed in all their tiny, pointy, disfigured glory.
Kyle admits to have always felt black: he listens to hip-hop, loves playing basketball, and watches UPN (a now-defunct cable network that catered largely to the African American demographic). He also admits that he's always wanted to play ball for the Denver Nuggets.
The idea of Kyle becoming black may have also been a nod to his similarities to Dr. Quinn from the Adult Swim show, Sealab 2021. What both characters have in common is that they are both very smart and very neurotic. They are also each picked on by each show's main jerk character, Kyle is picked on by Eric Cartman was Quinn was always picked on by Captain Murphy. Cartman and Murphy also share a lot of similar traits and personalities.
Michael Jackson, whom Dr. Biber offhandedly mentions as someone who'd had a "caucasioplasty" -- a conversion from black to white.
Scenes from a real-life sex change operation are used at the beginning of the episode. Originally there was almost a minute of bloody footage, but it got massively trimmed after an advance screening for Comedy Central.
In Kyle's family dining room, there's a picture of the Broflovski family fully decked-out in ski clothes. This picture is from the episode "Asspen".
We learn a lot of medical terms here: When a woman wants to become a man, the procedure is called a "Peenieplasty"; a man to a woman is a "Vaginoplasty"; a white person to an African American is a "Negroplasty"; an African American to a white person is a "Caucasioplasty"; and lastly, a human to a dolphin is a "Dolphinoplasty." All can be achieved with relative ease if you have about three thousand dollars.
This episode marks the beginning of the end of the gay-tastic relationship between Mr. Slave and Mr. Garrison. It will eventually come to a head later this season in "Follow That Egg" , when Mr. Slave and Big Gay Al get married.