Feminizing surgery encompasses procedures that alter your appearance to promote the matching of your body with your gender identity (gender congruence). Feminizing surgery includes many options, such as “top” surgery to increase the size of your breasts (breast augmentation) and “bottom” surgery to remove your testicles (orchiectomy) and create a vagina (vaginoplasty). You might also consider facial procedures or body-contouring procedures to create a more feminine appearance.
Feminizing surgery, also called gender-affirming surgery, is often chosen as a step in the process of treating distress due to a difference between experienced or expressed gender and sex assigned at birth (gender dysphoria).
Feminizing surgery isn’t for all transgender women. These surgeries can be expensive, carry risks and complications, and involve follow-up medical care and procedures. Prior to some types of surgery, you might be required to obtain recommendations from mental health providers, live as a female and be on feminizing hormone therapy for a specific period of time. Certain surgeries will alter your fertility and your sexual sensations, in addition to how you feel about your body.
Feminizing surgeries are typically deferred until adulthood. Options include:
- A surgical procedure to increase your breast size (breast augmentation) through implants or the transplantation of fat from other parts of the body into the breast
- Plastic surgery techniques in which the jaw, chin, cheeks, forehead, nose, and areas surrounding the eyes, ears or lips are altered to create a more feminine appearance (facial feminization surgery)
- Body-contouring procedures, such as a tummy tuck (abdominoplasty), buttock lift (gluteal augmentation) and a surgical procedure that uses a suction technique to remove fat from specific areas of the body (liposuction)
- Surgery to raise the pitch of your voice (voice feminization)
- Surgery to minimize the thyroid cartilage or Adam’s apple (tracheal shave)
- A procedure to remove hair follicles from the back and side of the head and transplant them to balding areas (hair-transplant surgery)
- A procedure that uses a laser — an intense, pulsating beam of light — to remove unwanted hair (laser hair removal) or a procedure that involves inserting a tiny needle into each hair follicle, emitting a pulse of electric current to damage and eventually destroy the follicle (electrolysis)
- A procedure that uses a laser to improve the appearance of your skin or treat minor facial flaws by removing layers of skin (laser resurfacing)
- Silicone injections to enhance your hips, buttocks, breasts, lips, cheekbones and other body parts
- Genital surgery to remove your testicles (orchiectomy), create a vagina using penile or colon tissue (vaginoplasty), create a vulva (vulvoplasty), create a clitoris (clitoroplasty), and create labia (labiaplasty)
Feminizing surgery isn’t for all trans women. Your doctor might recommend against these surgeries if you have:
- Unmanaged mental health conditions
- Significant health conditions, such as heart or kidney disease, a bleeding disorder, or a history of blood clots in a deep vein (deep vein thrombosis) or in a lung (venous thromboembolism)
- Any condition that limits your ability to give your informed consent
Like any other type of major surgery, many types of feminizing surgery pose a risk of bleeding, infection and an adverse reaction to anesthesia. Other complications might include:
- Poor wound healing, such as along an incision line
- Fluid accumulation beneath the skin (seroma)
- A solid swelling of clotted blood within your tissues (hematoma)
- Changes in skin sensation such as persistent pain, tingling, reduced sensation or numbness
- Damaged or dead body tissue (tissue necrosis) in the vagina and labia
- A blood clot in a deep vein (deep vein thrombosis) or a blood clot in a lung (pulmonary embolism)
- An abnormal connection between two body parts (fistula), such as between the bladder or bowel into the vagina
- Dissatisfaction with appearance after surgery
- Loss of sexual pleasure and functioning, including the persistent inability to achieve orgasm despite responding to sexual stimulation (anorgasmia)
Certain types of feminizing surgery can harm or end your fertility. If you want to have biological children and you’re having surgery that involves your reproductive organs, talk to your doctor about freezing your sperm (sperm cryopreservation) before moving forward.