Transgender individuals feel that the sex they were assigned at birth, such as male or female, does not match the gender with which they identify. For example, a baby assigned “male” at birth may grow up with a sense of feeling they are female.
As a result of feeling that they were born in the wrong gender, some transgender individuals experience psychological distress known as “gender dysphoria” and take various actions to better align their gender identification with their external appearance. For some individuals, the transition process from one gender to another may include medical treatments, such as hormone therapy and gender confirmation surgery.
Usually the first step in the gender transition process, hormone therapy is intended to suppress the assigned sex characteristics, promote the desired characteristics, or both. For example, men who identify as women may take anti-androgens to block production of the male hormone testosterone, as well as estrogen to appear more feminine. Similarly, women who identify as men may take testosterone to develop more masculine features, such as facial hair.
If hormone therapy does not have the desired effectiveness, gender confirmation surgery may be an option. Also called gender reassignment surgery, the goal of this procedure is to create the outward physical appearance of the gender with which the person identifies. “Top surgery” refers to surgery above the waist, while “bottom surgery” refers to surgery below the waist.
Transgender surgery is major surgery and generally not considered reversible, so many healthcare providers require transgender individuals to complete several steps before they will proceed with surgery. These may include requiring a formal diagnosis of gender dysphoria and having counseling to determine their psychological readiness for surgery.
“Gender confirmation surgery involves both physical and psychological aspects,” says Manish Champaneria, MD, a plastic surgeon at Scripps Clinic. “Scripps follows the recommendations of the World Professional Association for Transgender Health (WPATH) regarding preparation for surgery, including having a referral from a mental health provider. Patients undergoing surgery are urged to live as the gender they identify as for at least 12 months before having the procedure.”
Scripps offers surgery procedures for both male-to-female (MTF) or transwomen patients, and female-to-male (FTM) or transmen patients.
Performed on the chest, top surgery is intended to create a more gender-confirming physique. Top surgery procedures include mastectomies for transmen and breast augmentation for transwomen. In most cases, top surgeries are completed in a single procedure.
MTF top surgery to augment the breasts may involve fat transfer or breast implants. In a fat transfer procedure, the surgeon removes fat from other parts of the body and injects it into the breasts. Fat transfer may be recommended for patients who wish to increase breast size without breast implants.
Patients who seek larger breasts may choose to have breast implants, which are surgically placed under the chest muscles to enhance breast size and shape. The surgeon and patient together determine the most appropriate size and type of implants.
In FTM top surgery, the surgeon removes breast tissue and manipulates the remaining tissue to create a more masculine appearance.
During MTF facial feminization surgery, the surgeon restructures masculine facial features to achieve a more feminine look. This involves reshaping bones and soft tissues and may be performed as a single procedure or in several stages.
Using various procedures, body contouring reshapes the body to create a more masculine or feminine physique. Specific procedures depend on the patient’s original body shape and desired outcomes. For example, fat transfer may be used to reduce curves in some areas and create them in others.
“We understand that gender confirmation surgery is a life-changing procedure that requires multidisciplinary medical expertise and experience, and we work very closely with our transgender patients every step of the way,” says Dr. Champaneria. “We urge anyone considering this surgery to start by talking with a trusted and physician who is experienced in transgender procedures.”