What is Gender Affirming Surgery?

Gender Affirming Surgery is a body of elective plastic surgery procedures that transgender patients may choose to undergo to more closely align physical body with gender identity. Presently, only the minority of transgender people undergo genital surgery due to complexity and cost.

Below are a variety of surgeries for transition to male and transition to female, including “top” (chest) procedures, “bottom” (genitalia / sex organs) procedures, and facial procedures.

Types of Gender Affirming Surgery

Male-to-Female Surgeries

Facial Feminization Surgery

The goal of facial feminization surgery is to transform the masculine features of the face to features of feminine appearance using surgical manipulation of the bone and soft tissues. Depending on the number of procedures and the extent of the changes, this can be done in a single operation, or in multiple. Procedures chosen and decisions made about each procedure are very individual.

Transfeminine Top Surgery (single stage procedure)

The goal of transfeminine top surgery is to enhance the size and alter the shape of the breasts, creating a feminine chest contour. Many techniques used to perform top surgery — one should be chosen based on:

  • What is the desired size of the new breasts?
  • What type of implant will be used?
  • Where will the incisions be placed?

Transfeminine Bottom Surgery (single stage procedure)

The goal of transfeminine bottom surgery is to transform the male genitals into a functional vagina that allows for normal urination and sexual sensation, resulting in minimal scarring.  The most common of many transfeminine bottom surgical techniques is called a penile inversion vaginoplasty, often performed as a one-stage procedure, which involves Orchiectomy, Labiaplasty, Clitoroplasty, partial Penectomy, penile dissection and the creation of a vaginal cavity.

Female-to-Male Surgeries

Facial Masculinization Surgery

The goal of facial masculinization surgery is to transform the face’s bone and soft tissue for a more masculine appearance. Procedures involving the jaw, forehead, nose, and other aspects can be elected individually or in combination. Depending on the number of procedures and the extent of the changes, this can be done in a single operation, or in multiple. Procedures chosen and decisions made about each procedure are very individual.

Transmasculine Top Surgery (single stage procedure)

The goal of transmasculine top surgery is to perform a mastectomy to remove the breast tissue from both breasts changing the shape of the chest to a more masculine shape. Factors that might dictate which of many techniques for mastectomy is employed include:

  • The amount of breast tissue to remove
  • The amount of excess skin present
  • The patient’s desire for sensation in the nipples

Transmasculine Bottom Surgery (multiple stage procedure)

The goal of transmasculine bottom surgery is to reconstruct the female genitalia into that of a male. This surgery usually requires multiple operations, taking place in a hospital, and often involves a hospital stay of up to a week. Many techniques and approaches exist — the technique selected should be decided individually by each patient based on recommendations from their surgeon.

Types of Facial Procedures

Facial Feminization or Masculinization may include these procedures:

  • Brow: Enhancing or reducing the prominence of the brow
  • Adam’s Apple: Thyroid cartilage surgery, which reducesor increases the prominence of the Adam’s Apple.
  • Jaw: Jaw recontouring, or, adjusting the jawline. To masculinize, this involves increasing the width of the jaw and creating a more defined jaw angle.
  • Rhinoplasty: A “nose job” makes the appearance of the nose more masculine or feminine
  • Face shape: Skeletal augmentation to alter the shape of the face
  • Cheeks: Cheek augmentation uses dermal fillers or prosthetic implants to augment the volume and appearance of the cheeks.
  • Chin: Chin augmentation increases the height and projection of the chin.
  • Forehead: The forehead can be shortened or lengthened, augmenting or altering the projection of the forehead above the brows.