Feminizing surgery refers to a group of gender-affirming surgical procedures that alter your body’s appearance, shifting from masculine features to a look that is more feminine. Some patients choose these surgical procedures, in addition to hormone therapy, as part of the transition journey and to treat gender dysphoria.

Each person has unique needs, and there are many options to consider: facial feminization surgery, body contouring procedures, top surgeries to insert breast implants, and bottom surgeries to alter or remove the genital and reproductive organs.

Which Feminization Procedures Are Available?

Facial Feminization Surgery (FFS)

Surgeons can re-shape different parts of your face to look more traditionally female, focusing on creating smaller and less angular features. Many procedures exist, and you can discuss the options with your surgeon to achieve the appearance that fits your needs.

  • Cheek augmentation
  • Rhinoplasty (“nose job”)
  • Chin re-shaping/re-sizing
  • Jaw re-shaping/re-sizing

Tracheal Shave/Tracheal Chondroplasty

Reducing the prominence of the “Adam’s Apple” is a common feminization surgery. The term refers to the thyroid cartilage that protrudes from the throat area, often appearing more prominently in males. To feminize the appearance of the throat, surgeons shave the thyroid cartilage to produce a smaller, smoother surface. Special care is given to avoid the vocal cords which are located below the thyroid cartilage.

Chest Feminizing Surgery

Chest feminization is a common type of surgery for patients who are seeking a more feminine overall appearance. The process includes using implants, or fat that is relocated from another area of the body, to create feminine-looking breasts.

Depending on your specific needs, the surgeon will choose either implants or fat transfer to perform your chest feminization surgery. Implants are made from either silicone or saline, and are appropriate for a full range of desired breast sizes.

Fat transfer uses liposuction to remove fatty tissue from another area of the body, and then uses that tissue to create new breasts. Fat is usually removed from the abdomen, back, arms or thighs. This process is appropriate for patients seeking smaller-sized breasts.

Body Contouring

Many patients choose body contouring to achieve feminine curves. This can involve liposuction to remove fat and create curves in areas of the abdomen, legs and buttocks. Fat transfer may also be used to relocate fat from certain areas of the body to other areas that will produce a feminine look. Body contouring is an effective procedure for patients who are at or near their ideal body weight, and are looking to re-shape areas to appear more feminine.

Orchiectomy

As part of the feminizing process, many patients choose orchiectomy to remove their testicles. The procedure involves making an incision in the scrotum, and removing the testicles and spermatic cords. If the patient wishes to create a vagina or labia as part of their transition, the scrotal skin can be preserved to use for a vaginoplasty or vulvoplasty procedure.

Vaginoplasty

A vaginoplasty is a surgical procedure where the penis is removed and a vagina is created. If an orchiectomy (testicle removal) was not already performed, the testicles can be removed during the vaginoplasty procedure.

The surgeon uses skin from the penis and scrotum to create a vagina, vaginal canal and labia. If there is not sufficient skin available from the male genitals, the surgeon may recommend a skin graft to obtain additional tissue from other areas of the body. During the procedure, the urethra is shortened and re-positioned for urinary function.

Which vaginoplasty techniques are available?

Your physician will recommend a specific type of vaginoplasty surgery based on individual factors. Each technique has its own benefits and risks. A thorough discussion with your surgeon is essential to determining which technique is right for you.

  • Penile inversion: Skin from the penile shaft is inverted (turned inside out) to create the vaginal lining, clitoris and labia. If there is not sufficient skin available from the penile shaft, the surgeon may recommend using skin grafts from other areas of the body.
  • Penile non-inversion: Skin from the penile shaft is used to create the clitoris and labia, while the vaginal canal is lined with tissue taken from elsewhere in the body (skin graft). A penile non-inversion procedure does not use penile skin to create the neo-vagina, leaving more penile skin available to create the labia minora.
  • Vulvoplasty/Zero-Depth: Skin from the penile shaft and scrotum are used to create the external portions of female genitalia. Zero-depth vulvoplasty creates the labia majora (outer lips), labia minora (inner lips), and in some cases may create part of the vaginal opening.
  • Colon interposition: A section of the colon is used to create the vaginal lining. An incision is made in the abdomen, and a portion of the colon is removed. After the segment is removed, the remaining colon is reconnected to restore function.
  • Peritoneal pull-through (PPT): Peritoneal (abdominal) tissue is used to create the vaginal lining. An incision is made in the abdomen, and peritoneal flaps can be pulled through into the newly created vaginal cavity.

What Are the Risks Involved With Feminizing Surgical Procedures?

Like all surgeries, feminizing surgical procedures have risks. Complications may occur, including bleeding, infection, swelling for an extended period of time, and inadequate healing of incisions. With procedures to create a vagina (vaginoplasty), there are additional risks with urinary function.

It is possible that you may not achieve the full result you want. Each person’s result will be different, depending upon a number of factors. Speak with your surgeon to better understand how your personal health status may impact your surgical outcome.

How Do I Prepare for Surgery?

Preparation for feminizing surgery is different for each type of procedure. Usually, before having male to-female affirmation procedures, patients have spent months or years seeking psychological counseling, hormone therapy and living in their preferred gender identity.

Prior to some surgeries, your surgeon may recommend imaging, such as X-Ray, magnetic resonance imaging (MRI) or CT scan. Hair removal is another common preparation for surgery.

It is important to speak with your physician to discuss the complete preparation process that is necessary for your specific procedure(s).

Am I a Candidate for Surgery?

We follow the World Professional Association for Transgender Health (WPATH) standards of care to determine who is a candidate for feminizing surgery. A successful candidate will meet each of these criteria:

  1. Persistent, well-documented gender dysphoria
  2. Capacity to make a fully informed decision and to consent for treatment
  3. Age of majority (age 18 in the United States)
  4. If significant medical or mental health concerns are present, they must be reasonably well controlled.

In addition, patients seeking orchiectomy or vaginoplasty must also meet fifth criterion:

  1. Twelve continuous months of hormone therapy as appropriate to the patient’s gender goals (unless the patient has a medical contraindication or is otherwise unable or unwilling to take hormones).

What Can I Expect After Surgery?

Each surgical procedure has its own unique recovery timeline. You will need to discuss your specific procedure with your surgeon to fully understand the challenges you may face as you recover, and when you can expect to resume normal activities.

As with most surgeries, you should expect some degree of pain, swelling and bruising after having feminization procedures. Some surgeries are performed as outpatient procedures, and you may go home the same day. Other, more complex procedures require a multi-day hospital stay followed by a lengthy recovery.

With many feminization procedures, you will need support from family or caregivers during your post-operative time period. In addition, some surgeries require a long-term follow up plan which may include continuing to see an urologist.

Contact Us

For more information on our Gender-Affirmation Surgical Program or to schedule an appointment, please fill out the form below or call (832) 325-7181.

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