Gender affirming surgeries (GAS) can help a person feel more comfortable and live as their most authentic self. They involve using surgical procedures to change a person’s appearance.

Everyone has a sense of their own gender identity, which may lie anywhere along a broad spectrum, and each person may choose to express their identity in different ways.

For people whose gender identity does not align with their sex assigned at birth, such as people within the transgender or gender-diverse community, being able to express their gender is important for their ability to feel safe, valid, and comfortable.

This article looks at different types of GAS, the preparation and recovery times for these procedures, and questions to ask a doctor.

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Some people may feel that surgery would not help them in expressing their gender identity, while others may choose to undergo a combination of procedures.

GAS can focus on many different areas of the body, including the:

  • face and hair
  • genitals
  • chest

Healthcare professionals may talk about these surgeries in terms of masculinizing and feminizing. While some people may identify with these terms, a person can have any mix of procedures regardless of their gender.

People may refer to GAS that focuses on the chest area as “top surgery,” and surgeries that focus on the genitals as “bottom surgery.”

Top surgeries

Top surgeries aim to reshape the chest in a way that affirms a person’s gender.

Top surgery procedures that aim to remove tissue and flatten the chest, sometimes known as masculinizing top surgeries, include:

  • Double incision: This involves removing tissue from two incisions under the chest area.
  • Periareolar: This involves making a circular incision around the areola, the skin circling the nipple, and working under the skin to remove tissue. Surgeons also make another incision to remove excess skin and reshape the areola. This procedure is best suited for smaller chests.
  • Keyhole: To perform this procedure, surgeons use one small half-moon incision around the areola to remove tissue. Keyhole surgery does not include removing excess tissue or reshaping the areola. The procedure is best for small chests.
  • Inverted-T: This procedure is similar to a double incision but keeps the nipple and areola attached to the nerves. This involves creating an extra incision from the nipples down to the horizontal double incisions, creating an upside-down “T” shape.

Top surgeries that aim to give the chest a fuller, rounder appearance typically involve breast augmentation using either saline or silicone implants.

Bottom surgeries

Bottom surgeries aim to make changes to the genitals to affirm a person’s gender.

Transfeminine bottom surgery

Transfeminine bottom surgery, also known as vaginal construction or vaginoplasty, refers to a procedure that reconstructs tissue from the penis and scrotum into a vaginal canal, clitoris, and labia.

A 2021 paper found transfeminine bottom surgeries have:

  • a low rate of serious complications
  • a high level of functionality
  • high levels of satisfaction with the results

Transmasculine bottom surgeries

Transmasculine bottom surgeries, or penile construction surgeries, involve removal of the vagina and reconstruction of a penis and urethra.

The surgeon does this either using vaginal tissue and creating the penis around the clitoris (metoidioplasty) or using tissue from other parts of the body, such as the thigh or forearm (phalloplasty).

Some people may also have surgeries to remove the following:

Other GAS procedures include:

  • Facial feminizing surgeries: Facial feminizing surgeries aim to create feminine facial features and can involve surgery on the nose, brow, chin, and jaw. Some people may also undergo hairline restoration and Adam’s apple reduction surgery.
  • Facial masculinizing surgery: Facial masculinizing surgeries aim to create masculine facial features involving changes to the nose, forehead, chin, and jawline.
  • Body contouring: Body contouring procedures aim to create a body shape that more closely aligns with a person’s gender. Procedures may involve either liposuction or fat crafting around the hips, abdomen, and buttocks to minimize or accentuate body curves.

GAS can be an emotionally charged experience.

A person may feel excited but overwhelmed by the thought of undergoing such procedures. People may benefit from having an understanding support system around them to help them through this process and their recovery.

Although everyone’s journey is different, a person may find talking with others who have undergone similar surgeries helpful. They can also speak with a doctor about what to expect and any concerns they may have.

The National Center for Trans Equality offers a list of healthcare and mental health resources that can provide individuals with extra support during their gender affirming process.

As for physical preparation, some specialists may recommend that a person be on hormone therapy for a certain period before surgery.

When working with a person to see if they would be a good candidate for GAS, many specialists follow the World Professional Association for Transgender Health (WPATH) guidelines.

WPATH suggests that it is best for a person undergoing GAS to meet the following criteria:

  • They experience ongoing gender dysphoria.
  • They have the ability to give informed consent for their treatment.
  • They are considered an adult according to the laws in their country.
  • Any existing mental health or medical problems they experience are well-managed.

Recovery from GAS can vary depending on which procedures are involved. For example, healing from a vaginoplasty can take several weeks. A person will need to wait around 4 weeks before having penetrative sex.

The recovery period after facial feminizing surgery can also last several weeks. Individuals will need to follow all postoperative instructions from their surgeon.

It is best for people to speak with their surgeon about their recovery plan for the specific procedures they are having. Where possible, a person may wish to make arrangements for a friend or loved one to provide them with support and care at home for the first few days after surgery.

During a consultation about GAS, a person may wish to ask their surgeon the following questions:

  • Is the surgeon a member of WPATH?
  • Can they show before and after pictures that give a reasonable expectation of results?
  • How long is the recovery process, and what support is available?
  • What are the risks and complications of the procedure?
  • What are the steps for managing complications?
  • What are the options if a person is dissatisfied with their results?

A person can find surgeons who are members of WPATH and trained in transgender medical care on the WPATH website.

Gender affirming surgery describes a range of procedures that aim to match a person’s outward appearance more closely with their gender identity.

GAS is an important part of healthcare for transgender and gender-diverse individuals. These life changing procedures can help a person feel physically aligned with their identity and allow them to live comfortably and happily as themselves.

There is no one right way to present gender. People may undergo different combinations of procedures, or they may not wish to have any surgeries.