Published: January 27, 2021
Last updated: February 18, 2022
Content Reviewed by AEDIT Medical Advisory Board
Gender confirmation surgeries encompass a vast array of plastic surgery procedures that are used to assist those embracing their true gender in creating an embodied, genuine, and authentic physical representation of their identity. Plastic surgeons work with transgender candidates to refine and define their desired aesthetic in conjunction with medical or hormone therapies managed by the candidate’s health care provider.
For whole patient care and transgender health, male to female (MTF) and female to male (FTM) gender-affirming surgeries are important components in the care of gender dysphoria as are considerations for mental health. Advances in cosmetic and plastic surgery allow experienced, board-certified plastic surgeons to address a transgender patient's concerns from the top of their head to the tips of their toes.
What is male to female (MTF) gender confirmation surgery?
Male to female gender confirmation surgery refers to individuals identified as male at birth who are seeking to transition to their female gender identity. ‘Gender confirmation surgery’ is an umbrella term to capture a myriad of procedures addressing the head, neck, torso, and lower body. Individual transgender candidates may wish to pursue one or more procedures to achieve their desired aesthetic as part of their gender reassignment surgery. Expert and experienced plastic surgeons specializing in these types of procedures are able to consult with candidates to determine what is most appropriate based on medical history, current body type, and long term goals.
What are the main concerns related to MTF gender confirmation surgery?
The collection of plastic surgeries falling under the general term gender confirmation surgery can be organized into groupings of procedures specific to unique body areas. When considering the transition from a male to female gender identity, candidates can consider aesthetic changes to the head and neck, torso, and lower body that include:
- Facial Feminization: These procedures specifically address the hair, face, and neck. Facial feminization generally means softening lines, enhancing lashes and brows, creating a fuller scalp hair, and reducing bony prominences in the jaw and chin.
- Transfeminine Top Surgery: Top surgeries refer to the creation of characteristic female breasts, areola, and nipples.
- Transfeminine Bottom Surgery: Changes to the hips, buttocks, legs, and genitals are categorized as bottom surgeries. Hip and buttock implants can be used to create more volume, whereas a calf reduction can reduce musculature in the lower leg. A vaginoplasty for male to female transitions includes construction of the vagina, labia, and clitoris.
- Body Contouring: General alterations to body proportions through liposuction, skin tightening, and other contouring procedures that remodel soft fatty tissue to refine the shape of the body.
MTF gender confirmation surgery does not have to encompass all of the procedures listed above. Individuals, through consultation with their provider, can determine which areas of the body they wish to address.
Who may wish to pursue MTF gender confirmation surgery?
Individuals identified as male at birth who are now seeking to embrace their true female gender identity may wish to consider gender confirmation surgery as part of their transition. Medical and hormonal therapies are administered under the guidance of a healthcare provider, whereas cosmetic surgery procedures to further create an individual's desired aesthetic are performed by an expert plastic surgeon. Candidates should consider their overall health, expectations of the procedure, and willingness to commit to needed recovery time following their procedures when deciding to pursue a gender confirmation surgery.
Guidelines for the pediatric population seeking gender affirming surgeries recommend that transgender candidates do not seek genital reconstruction procedures such as phalloplasty (penile construction), scrotoplasty (scrotum construction), vaginoplasty (labia, clitoris, and vaginal construction), oophorectomy (ovary removal), or hysterectomy (uterus removal) until they are 18.
How is MTF gender confirmation surgery performed?
Now that we’ve covered the overview of gender confirmation surgery, let’s get a little more specific in what procedures exist to create the most authentic personal aesthetic. See our full guide to Male to Female (MTF) Gender Confirmation Surgery Solutions, or keep reading for a general overview of treatment options:
Facial feminization surgeries cover procedures from the scalp to the base of the neck. Hairline advancement, facial hair removal, eyelash/eyebrow augmentation, and forehead contouring can be used to address the upper third of the face. Rhinoplasty, cheek augmentation, and lip augmentation cover the middle third. Jaw reduction, chin surgery, and Adam’s apple reduction can be used to address the lower third of the face and the neck. Non-surgical alternatives include Botox, fillers, and thread lifts.
Transfeminine Top Surgery
Breast augmentation is the mainstay of transfeminine top surgery. Breast implants with synthetic materials or possibly via fat transfer are available, as are procedures to create a more feminine appearing nipple and areola.
Transfeminine Bottom Surgery
To refine the contour of the entire body, body contouring procedures like liposuction, Emsculpt®, CoolSculpting®, SculpSure®, and skin tightening can be used to further refine, define, and augment specific body parts to create a more femine aesthetic.
Gender confirmation surgery or gender reassignment surgery is a catch-all term encompassing a wide variety of plastic surgery procedures transgender people can use in conjunction with medical hormone therapies to further embody their gender identity.
The World Professional Association for Transgender Health (WPATH) works closely with the transgender community and medical professionals to define standards of care for sex reassignment surgery and gender affirmation surgeries. In the United States, USPATH is an American society offshoot of WPATH.
Expert board certified plastic surgeons specializing in these procedures can assist candidate’s in their transition and are available to help create a truly authentic aesthetic.
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- American Society of Plastic Surgeons Gender Confirmation Surgeries plasticsurgery.org
- Aglaja Valentina Stirn Body modifications and sexual health : Impact of tattoos, body piercing and esthetic genital plastic surgery on the sexual health of women and men PubMed.gov; 2017-09-06
- Marlene Rankin Resumption of sexual activity after plastic surgery: current practice and recommendations PubMed.gov; 2007-11-01
- Mayo Clinic Staff Breast Reconstruction with Implants mayoclinic.org
- Michael P Goodman A large multicenter outcome study of female genital plastic surgery PubMed.gov; 2009-11-12
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