Male to Female Surgery

Who the operation is planned for

Transgender women who have finished a mental-health assessment and who are under the care of an endocrinologist come for surgery that changes the breasts, the abdomen, the back, and the buttocks. Hormone therapy helps feminize features. Surgery is often still needed to finish the change in shape. Genital surgery is not performed. A referral can be given on request. Before a date is set, the specifics of the operation, the risk of complications, and a realistic result are reviewed.

Male to female surgery adapts ordinary cosmetic operations. The combination of regions, not a single incision, is what produces the result. Breast surgery is often the first gender procedure. Abdominal feminization is the second most frequent request. The breast plan depends on how long hormones have been used, what breast changes those hormones have already made, and the size that is wanted.

Breast mound, nipple position, and implant plane

The male chest is flat. The goal is a fuller mound, a rounded perimeter, and enlarged areolas. Those three changes come from expanding the mound. Patients fall into two groups. One group wants a modest increase in size. The other wants a drastic enlargement.

A modest increase uses a conservative implant. The distance from the nipple to the inframammary crease has to match the radius of that implant so the nipple stays centered on the new mound. The implant goes over the muscle, not under it. The male pectoralis is bulkier than the female pectoralis. Lifting that muscle to make a subpectoral pocket can cause a dynamic deformity, which is why the over-the-muscle plane is the one used. The American Society of Plastic Surgeons describes breast augmentation as using an implant or fat transfer to increase size and roundness. The plane chosen here is the modification for a male chest. More of that breast plan is on the transgender breast surgery page.

One year after augmentation, the implant can be exchanged for a larger one once the skin between the nipple and the inframammary crease has lengthened. That wait is what makes a later, larger implant sit with the nipple still centered.

A drastic enlargement starts with a lower-profile expander. The expander stretches the lower-pole skin for three months. The expander is then removed and the final implant is placed. Stretching the lower pole increases the nipple-to-fold distance so it can hold the implant that was chosen. Patients who have been on hormones for a long time may already have grown some glandular tissue and lengthened the lower pole. That growth can avoid a staged procedure. A sizing consult decides whether a single stage is possible.

In male to female surgery, a modest breast increase is planned as one operation, and a much larger size is staged. Moderate fullness and roundness can be reached in a single surgery. A more notable increase in breast size needs the expander stage first.

Abdomen, waist, and feminine shadows

A lean, square torso is changed toward a curvy figure. The waist is narrowed aggressively, and prominence is added at the lateral hips. The abdomen itself is contoured so it looks feminine and less etched than a masculine abdomen. The shadows that are drawn are the semilunar lines and the linea alba, the lateral and central vertical gullies.

On the trunk, male to female surgery turns a square outline into a narrowed waist and a softer abdomen. High definition liposuction is how that contour is made. Three requirements are named for the result.

• 360-degree body contouring
• Unveiling of natural shadows
• Feminine aesthetic guidelines

The hourglass comes from narrowing the lateral waist, not from etching a six-pack into the abdomen. 360 liposuction is the circumferential pass, and waistline narrowing is the part of that pass that sets the waist. The American Society of Plastic Surgeons describes liposuction as removal of fat with a cannula to change contour. That description is the waist work. VASER is the ultrasound used so fat in the lower back, the flank, and the abdominal waist can be taken out thoroughly.

The back and the latissimus V

A masculine back is fuller through the upper and middle back and narrow through the lower back and flank. That V is the latissimus dorsi. A strong upper and middle back tapers into a truncated lower back and flank. Feminization removes the V and leaves a lean back from the upper back through the flanks.

Male to female surgery of the back continues the waist narrowing rather than treating the back as a separate debulk. The lower back and the flanks are contoured conservatively. They are the transition from a maximally narrowed waist to a fuller lateral hip and buttock. Taking too much fat there breaks the smooth line the hourglass needs. Smooth contour lines are the point of the back work.

Buttock width and projection

A square, firm, bold buttock is changed toward a rounder, fuller shape with prominent hips. The name bubble butt is used here for maximum width and maximum projection. A Brazilian butt lift, in this setting, is fat grafting through the buttock cheeks. The fuller buttock and the lateral hip are what finish the hourglass. The same idea is laid out on the feminized male BBL page.

Time, anesthesia, and where surgery is done

Male to female surgery lasts 1 to 5 hours, depending on how many regions are treated. General anesthesia is required. The operation is done in an outpatient surgical suite or a hospital operating room. Abdominal work is done at an accredited surgery center. General anesthesia is used because VASER liposuction and a possible tuck use incisions.

Preparing for the abdomen and the first month

Because general anesthesia is used, a responsible adult stays for 1 to 2 days until the anesthetic effects resolve. Help at home is needed if lifting, pushing, or pulling is expected. VASER also requires 10 days of daily lymphatic massage in the office.

Preparation is the same whether the abdomen is being feminized or masculinized. This is major surgery, and healing is planned before the day of surgery. Daily protein intake is raised to 150 grams. Blood thinners are stopped. All smoking is stopped at least one month before surgery so skin incisions can heal and the risk of infection stays lower.

On waking, the abdomen is in a customized compression garment lined with a foam inlay. The dressing is meant to limit swelling and bruising in the early days. After two weeks the garment may come off, and rebound swelling can follow. Activity is then used to counter that swelling.

Routine daily activity resumes at 1 week. Workouts below the waist are allowed at 2 weeks. Full activity without limits waits until 1 month. Heavy lifting, pushing, and pulling stay in the restricted group until that month is finished.