FTM Body Masculinization Surgery Explained

What Is Body Masculinization Surgery?

Body Masculinization Surgery (BMS) is a group of procedures that masculinize body contours, particularly for trans men who feel they didn’t get enough masculinization from Testosterone and Top Surgery. Though less common than Top Surgery, these procedures are regularly performed, sometimes in tandem with Top Surgery.

While many trans men are satisfied with the body shape changes that are acquired through hormone therapy, others don’t achieve the level of masculinization desired, which can negatively affect body image, self-esteem and confidence. Body Masculinization Surgery provides a solution for masculinizing body shape when diet and exercise fall short.

The “Ideal” Male Physique

While there is no single type of body composition that describes the “ideal” body shape—which is highly subjective—the concept of the ideal male physique can still be helpful as a reference when considering the goals and benefits of Body Masculinization Surgery.

Traditionally, the ideal male physique is composed of a strong and well-defined chest, broad shoulders, a trim waist, and minimal fat distribution in the hips, buttocks, and thighs. This looks is sometimes referred to as the “classic V-shaped” figure.

Achieving the classic V-shape look can be challenging for some trans men. Hormone therapy and Top Surgery, combined with a smart diet and weight training, is often the best approach for developing a more masculine physique. Keeping weight down helps reduce curves overall while back and shoulder work outs broaden and define the upper body. Together, these help achieve the waist-to-chest ratio that describes the V-shape torso. Still, many trans men will find that some areas of fat are near-impossible to reduce without surgical intervention.

The sex hormone differences between men and women are to blame.

Generally, men carry less body fat than women, and when they do carry extra weight, it tends to be in the upper body, while women carry extra weight in the hips, buttocks and thighs.

As a consequence, many transgender men also carry extra weight in ways that can accentuate feminine-looking curves. It’s not surprising then that Body Masculinization Surgery is increasingly considered a necessary part of female to male gender reassignment surgery.

Areas That Can Be Treated to Achieve a More Masculine Body Shape

The goal of Body Masculinization Surgery is to broaden the appearance of the chest and shoulders while slimming the waist. This creates the V-shape torso look. The areas commonly treated to achieve this are:

• Upper body: Chest and back
• Abdomen (Abdominoplasty, aka “Tummy Tuck”)
• Flanks (“love handles”, “back bacon”)
• Hips
• Buttocks
• Inner and outer thighs (“saddlebags”)

Multiple areas can be treated in one surgery. For example, Abdominoplasty and liposuction of the hips and thighs are often combined. This approach allows the surgeon to visualize the body as a single aesthetic unit and tends to produce the best results.

Body Masculinization = Liposuction

Body Masculinization Surgery is performed using Liposuction, a safe procedure that suctions and removes fat from targeted areas. For example, Liposuction is used in Top Surgery to remove fat from under the arms and provide a masculine-looking contour to the pectoral muscles. In Body Masculinization Surgery, Liposuction is used to remove fat from the flanks, thighs and other areas to create contours that are slim and sleek—traits of the classical male physique.

Liposuction is performed on an outpatient basis, under general anesthesia or local anesthesia with twilight sedation. A 3.7-5mm diameter hollow tube (cannula) is inserted through small, strategically placed incisions and vacuum is applied to break up and suction out fat. (Liposuction is considered a nearly scar-less procedure because the incisions are so small.)

Surgery time depends on the number and size of areas being treated but is generally 1-2 hours in duration.

Ideal Candidates for Body Masculinization Surgery

Not all trans men are good candidates for Body Masculinization Surgery. It’s important to note that BMS is not intended to be a substitute for maintaining a good diet and getting regular exercise. Healthy transgender men who are close to their ideal body weight, have good muscle tone and no excess, sagging skin, but also have fat that has not responded to weight loss strategies are ideal candidates for Body Masculinization.

Post-Op and Recovery from Body Masculinization Surgery

After surgery, patients are fitted with a compression garment. Typically, the compression garment is worn 24/7, with a break for showering, for about 4 weeks. Depending on which areas were treated, patients may also have Jackson-Pratt drains, as is often the case with Top Surgery.