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Author: Babak Moein, MD FACSBoard-certified,
Fellowship trained in Cosmetic Surgery

Female to Male Surgery

Introduction to Female to Male Surgery

Female-to-male surgery is predicated on transforming the physical state of a transgender male from her female birth appearance to one that is more masculine. Transgender surgical procedures have been developed by modifying conventional surgeries. At SurgiSculpt, we strive to help our transexual male patients achieve their dreams. Transgender patients consulted at SurgiSculpt have typically completed mental health professional assessments and been under the care of endocrinologists. Although hormone therapy helps transsexual males masculinize their features, gender reassignment surgery is often essential to completing their female to male transformation. A combination of procedures is needed to achieve the postoperative outcomes desired by our transsexual patients. Surgical techniques have been adopted from conventional surgeries to create gender-affirming surgeries. Sex reassignment surgeries have focused on transforming the breasts, abdomen, back, and buttocks. Genital surgeries are not performed at our center, but referrals can be provided upon request. Transgender males who undergo surgical procedures intended to provide gender confirmation surgeries will be well educated on the specifics of their surgery, the risk of complications, and a realistic appreciation of the expected outcomes.

Table of Contents

Female to male surgery of the breasts

Female to male breast surgery involves transforming a female-appearing breast into a more masculine shape. A fuller, rounder breast mound characterizes the female breast. Transformation of a female breast requires multiple features, including a flat mound, linear borders, and repositioning and reduction of the areola. These prerequisites can only be achieved by eliminating breast soft tissue fullness and skin redundancy. This can only be achieved with a wedge mastectomy and nipple and areola transposition or grafting. Next, the perimeter of the breast must be converted from a rounded appearance to a linear border that is bold and armor plate in appearance. A combination of liposuction technique and fat transfer is employed to accomplish bold and linear breast borders.

Female to male surgery of the abdomen

Female to male surgery of the abdomen requires the transformation of a lean and curvy torso to a square and bold torso. This transformation requires filling out the waistline and eliminating lateral hip fullness while being able to chisel out the abdominal muscles. Utilizing high definition liposuction principles is critical to achieving female to male surgical outcomes. High definition liposuction outcomes are predicated on being able to achieve the following:

  • 360-degree body contouring
  • Unveiling of muscle highlights
  • Honoring masculine aesthetic guidelines
  • Female to male surgery of the back
Female to male surgery of the back is predicated on converting a lean upper, middle, and lower back and flanks to a fuller upper and middle back juxtaposed with a reduced lower back and flank region. The female to male surgery of the back is focused on transforming a lean back to a "V" shaped back. The masculine back must portray strong latissimus muscles over the upper and middle back. This fullness is contrasted on a trim lower back and flank by eliminating the prominence of the love handles so that a shelf is created around the trim lower back and flank and prominent upper lateral buttock.

Female to male surgery of the buttock

Female to male surgery of the buttocks transformation is reserved for transexual males who desire a more masculine buttock. Their desires require transforming a rounder and fuller buttock with prominent hips to a square-appearing buttock. The masculine square buttock is shaped like a butterfly, described by strong upper lateral prominence of the gluteus medius muscle and lower lateral buttock separated by a well-defined lateral gluteal concavity. The male buttock should appear firm but appear leaner and void of mid-buttock fullness. A combination of liposuction techniques and simultaneous fat grafting are employed to achieve this gender confirmation surgery. Patient outcomes are predicated on honoring gender aesthetic guidelines.

Female to male Surgery Procedure

Gender confirmation surgery is focused on transforming the breasts, abdomen, back, and buttocks. Transgender males desire to appear more masculine from all viewed angles. This desire can only be achieved by utilizing circular techniques employed in high definition body contouring principles.

Breast confirmation surgery has become a mainstay of gender reassignment surgery and is often the initial gender change surgery. Breast gender confirmation surgery refers to changing the appearance of the patient's breasts to align with their gender preference. The length of testosterone therapy and any breast changes resulting from being on hormones and your desired reassignment, female to male conversion,  will determine your ultimate surgical design.

Patients seeking a transformation from a female to a male are typically treated with a modified mastectomy. This procedure is done by truncating the female breast mound with a wedge excision. The wedge excision is performed with specific with a strategic straight-line excision pattern so that the remaining skin and soft tissues create linear borders that are bold and pentagonal. Frequently, tapered debulking of the central breast tissue is also performed to ensure that the chest is flat and masculinized.

Abdominal masculinization is the second most frequent request of our transgender patients. To achieve this transformation, the abdominal muscles must be etched to unveil the six-pack abs. In addition, the waistline must be made stronger with linear contour outlines.

Back masculinization is a continuum of abdominal conversion surgery and requires transforming a sleek, lean upper, middle, and lower back into a "V" shaped back. The "V" shaped masculine back is predicated on a fuller upper and middle back, conveying a strong latissimus muscle that tapers into a truncated lower back and flank region. The lower back and flanks are reduced by eliminating prominent love handles so that a strong upper lateral buttock creates a shelf appearance.

Buttock masculinization is predicated on creating a square-shaped buttock that is firm and bold but lean in appearance. Liposuction and fat grafting are employed to create a butterfly-shaped buttock that is best appreciated by viewing bodybuilder bums.

Female to male surgery Length

Female-to-male surgery may last between 1 to 5 hours, depending on the scope of surgery.

Female to male surgery Anesthesia

Female to Male surgery requires general anesthesia.

Female to male surgery Place of Treatment

Female to male surgery must be performed in an outpatient surgical suite or hospital operating room.Your gender abdominal confirmation surgery will be performed while under general anesthesia. General anesthesia is recommended since abdominal surgery involves VASER liposuction and infrequently excisional or tucking procedure involving surgical incisions.

Female to male surgery Side Effects

Contour irregularities. Due to the drastic change in contour required to alter a patient's gender appearance, minimal contour irregularities are more frequent than routine contouring surgeries. In the female to male gender breast confirmation surgery, all attempts are made to create straight-line contour chest borders. However, as incisions heal, they tend to "round out," which may compromise ideal straight-line borders. In abdominal etching, detailed etching is undertaken to create muscle highlights that might require additional procedures, especially if patients experience weight fluctuation.

Female to male surgery Risks

Skin compromise following gender breast confirmation surgery may occur since a combination of excisional surgery and debulking liposuction may be required to alter the female to male gender breast appearance. When a combination of excisional and lipectomy procedures is used, the risk of vascular compromise is heightened. This similar concern exists in the abdomen, where aggressive liposuction of the abdomen is necessary to unveil muscle highlights. Patients who have a history of smoking are at higher risk of skin compromise, especially even if they quit smoking months before surgery.

Female to male surgery Recovery

The recovery from gender breast confirmation surgery is approximately 2 to 4 weeks before returning to routine daily activities. Generally, gender breast confirmation surgery patients may return to full physical activity with no limitation by one month following surgery. However, due to the need for excision lines, a longer healing duration is typically required for incision lines to fade before considering going shirtless at the pool. Abdominal confirmation surgery requires 7 to 10 days of rigorous lymphatic messages performed every other day. Infrequently, if excisional surgery is required to eliminate skin redundancy, longer healing times of 4 to 6 weeks may be required.

Female to male Duration of Results

Patients are universally pleased with gender breast confirmation surgery results as the breast contouring transformations are dramatic and permanent. Patient outcomes are quite dramatic especially over the breast region resulting in our transgender patients enjoying more fruitful lifestyles.

FEMALE TO MALE FREQUENTLY ASKED QUESTIONS

Gender breast confirmation surgery involves a customized surgical plan to convert your gender breast appearance to your preference. The female to male breast transformation may be achieved using a modified wedge excision mastectomy procedure to create a flatter and more straight-line bordered pentagonal-shaped breast appearance. The female to male abdominal transformation similarly requires conversion of curvy outlines to more linear and square contours in addition to unveiling muscle highlights such as the six-pack abs.

Any patients who desire gender reidentification may be excellent candidates for gender breast confirmation surgery. Most patients seeking gender alteration surgery have typically undergone counseling and are typically on hormone replacement therapy before any gender reassignment surgery. If patients have been on prolonged hormone replacement therapy, they will typically require less surgical intervention to alter breast gender appearance.

Gender confirmation surgery requires a commitment to postoperative recovery. Since general anesthesia is required, 1 to 2 days of assistance is required by a responsible adult to ensure that the effects of anesthesia resolve. Patients should also get generalized help around the house if heavy lifting, pushing, or pulling is expected.

Whether you are undergoing male to female or female to male breast transformation, this is major surgery and requires optimization of your healing potential.  Patients are asked to maximize their daily protein intake by consuming 150grams of protein daily. Patients are also advised to avoid any blood thinners. Finally, ALL smoking must be stopped at least one month prior to surgery to optimize healing of skin incisions and minimize the risk of infection especially for a male to female transformations requiring placement of breast implants.

Gender breast confirmation surgery involves the creation of dramatic changes in contour that portray the change of a female to a male breast or male to the female breast. Female to male breast changes will demonstrate a transformation from a more feminized appearance of a fuller and rounder breast to a flat, yet bold armor plate chest appearance; in contrast, male to female breast changes will demonstrate a transformation of their flat chests to a more robust and rounded feminized breast appearance. 

Your gender confirmation surgery will be performed at one of our accredited surgery centers. Due to the invasive nature of the surgery, patients require general anesthesia.

Your gender breast confirmation surgery will be performed while under general anesthesia. General anesthesia is recommended to you since breast surgery involves surgical incisions and dissections through the chest region that has a high density of nerve fibers.

When you wake up from surgery, you will find your breasts wrapped with a compression dressing wrap. This wrap will prevent bruising and swelling but also minimize pain by virtue of activating pressure nerves that will overpower pain nerve transmission.

Patients who undergo gender breast confirmation surgery will require 1 week to return to routine daily activities. Patients are allowed to participate in below the waist workouts at 2 weeks but will have to wait a full month before being allowed to perform all physical activities without any limitations.

FEMALE TO MALE PATIENT-SPECIFIC QUESTIONS

When it comes to breast implant augmentation surgery, it is critical to appreciate two rules. The first, the implant must sit on the inframammary crease; in fact, it is the crease that supports the implant weight and prevents it from slipping down into the abdomen, termed bottoming out. The second, the implant must be centered on the nipple and areola complex; If you do some elementary geometry, you will recognize that the implant radius should equal the distance between the nipple and the inframammary crease. Since the nipple complex positioned lower on most males, this limits the size of the implant that can be used at the initial surgery.

The major difference between routine breast implant augmentation and one that is performed during gender breast confirmation surgery is the placement position of the implant. Breast implant augmentation generally requires placement of the breast implant in a subpectoral position. This placement minimizes the risk of thickened scar creation which may result in breast firmness, called capsular contracture. However, this placement is avoided in female patients who participate in physical fitness competitions since they have a more prominent pectoralis muscle. The reason for this is that when the pectoralis muscle has flexed a deformity, termed dynamic deformity, is created by virtue of these patients having thicker muscles. A similar situation occurs in males desiring gender reassignment breast surgery. Their muscles are often too prominent and they risk a dynamic deformity if the pectoralis muscle is released for a subpectoral pocket. As such, male to female breast transformations are performed with placement of the implant above the muscle, termed sub-glandular breast augmentation.

When performing traditional mastectomy, the breast soft tissues are removed using a transverse incision but all breast skin is preserved. When performing gender confirmation breast surgery, a strategic wedge excision of the lower breast tissues is performed with the purpose of eliminating both soft tissues and the overlying redundant skin in an attempt to masculinize the breast by creating a flat chest. The excision of the breast skin and soft tissues is designed to create linear borders in a pentagonal shape

HOW OUR PATIENTS FEEL ABOUT US:

Refresher

I came into SurgiSculpt office for botox and Juvederm with my best friend.The Dr was very knowledgeable and made me feel comfortable. Both procedures were pain free and the results were amazing and subtle. I have been getting lots of compliments about how refreshed I look. Will definitely be recommending him to all my friends!!

Breast Reconstruction Following Mastectomy

I've had several procedures with SurgiSculpt following my mastectomy. The entire staff is great, especially both massage therapists (Theresa and Polly) as well as James. I am going to do nipple tattooing with them as well and then I will finally be all done! I couldn't be happier to have found SurgiSculpt and close this chapter of my life.

Awesome experience

Awesome experience! SurgiSculpt knew exactly what I wanted and everything I asked for was perfect! Easy to work with, great results. With this type of procedure you need a good listener, SurgiSculpt was a great listener.

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