Masculinizing surgery refers to a group of gender-affirming surgical procedures that alter your body’s appearance, shifting from feminine features to a look that is more masculine. Some patients choose these surgical procedures, in addition to hormone therapy, as part of the transition journey and to treat gender dysphoria.

Each person has unique needs, and there are many options to consider: facial masculinization surgery, top surgeries to remove breasts and masculinize the chest, and bottom surgeries to alter or remove the genital and reproductive organs.

Which Masculinization Procedures Are Available?

Facial Masculinization Surgery

Surgeons can re-shape different parts of your face to look more traditionally male, focusing on creating larger and more angular features. Many procedures exist, and you can discuss the options with your surgeon to achieve the appearance that fits your needs.

  • Cheek augmentation
  • Rhinoplasty (“nose job”)
  • Chin augmentation/contouring
  • Jaw augmentation/contouring

Tracheal Augmentation (Creation of an “Adam’s Apple”)

The creation of an “Adam’s Apple” is a common masculinization surgery. The term refers to the thyroid cartilage that protrudes from the throat area, often appearing more prominently in males. To create or enhance the thyroid cartilage, surgeons retrieve existing cartilage from other parts of your body to construct an implant.

Chest Masculinization Surgery

Chest masculinization is a common type of surgery for patients who are seeking a more masculine appearance. The process includes removing the breast tissue (mastectomy) and surrounding fatty areas to create a flatter, masculine-looking chest. There are several options for this type of surgery, including both traditional incision processes and minimal-incision processes.

Your physician will surgically remove your breast tissue and possibly some of the surrounding skin. Then, the surgeon adjusts the remaining chest tissue and contours the flatter chest to have a more masculine appearance. The nipple and areola may be altered to be better proportioned with a masculine-looking chest.

Which chest masculinization techniques are available?

Your physician will recommend a specific type of chest-masculinization surgery based on individual factors, such as breast size. Each technique has its own benefits and risks. A thorough discussion with your surgeon is essential to determining which technique is right for you.

Minimal incision

  • Keyhole: This procedure may be appropriate for patients with smaller chests. Your surgeon will remove the breast tissue by making a small incision underneath the areola.
  • Peri-areolar: This procedure may be appropriate for patients with moderate-sized breasts. Your surgeon will remove the breast tissue by making a circular incision around the nipple and areola.

Incisional

  • Double incision with/without free nipple graft: This procedure may be appropriate for patients with larger breasts. Your surgeon will remove the breast tissue by making an incision across the bottom of the chest muscle. Sometimes the nipple will be removed and re-sized before re-attaching.
  • Inverted –T: This procedure may be appropriate for patients with larger breasts. Your surgeon will remove the breast tissue by making an incision from the nipple to the lower portion of the breast, and another incision across the bottom of the breast. In this procedure, the nipple is not removed.

Hysterectomy

During this procedure, female reproductive organs (uterus, ovaries and cervix) are removed, which will end your ability to become pregnant. The procedure is performed by a gynecologic surgeon. Depending on your specific health needs, your physician may recommend an abdominal hysterectomy (incision in the lower abdomen), vaginal hysterectomy (incision in the vagina) or a minimally invasive laparoscopic technique.

Oophorectomy

With an oophorectomy procedure, one or both of the ovaries are removed. The surgery is performed by a gynecologic surgeon. Depending on your specific health needs, your physician may recommend a laparotomy (incision in your lower abdomen) or a minimally invasive laparoscopic technique.

Metoidioplasty

In a metoidioplasty procedure, your surgeon creates a penis using tissue from the clitoris or vagina. Before having surgery, at least one year of testosterone therapy to enlarge the clitoris may be recommended.

Which metoidioplasty techniques are available?

Your physician will recommend a specific type of metoidioplasty surgery based on individual factors. Each technique has its own benefits and risks. A thorough discussion with your surgeon is essential to determining which technique is right for you.

  • Simple release: The surgeon makes an incision that separates the clitoris from the pubic bone. The clitoral skin is then used to construct a penis.
  • Ring: The surgeon releases the clitoris from the pubic bone, removes the vagina and closes the vaginal opening, and uses tissue from other parts of the body to create a penis. Patients will be able to urinate while standing after this procedure.
  • Centurion: The surgeon releases the ligaments attached to the labia and repositions them to add volume to the new penis.

Additional procedures

Other procedures are usually done in conjunction with metoidioplasty. Surgeries to close the vagina (vaginectomy) and create a scrotum (scrotoplasty) are often done at the same time.

Several months to a year after having metoidioplasty, vaginectomy and scrotoplasty, it may be possible to insert penile implants for sexual function.

Phalloplasty

A phalloplasty procedure creates a penis using skin and tissue from other parts of the body. Phalloplasty is a more complicated procedure than metoidioplasty, requiring a longer hospital stay and a longer recovery time.

Which phalloplasty techniques are available?

Your physician will recommend a specific type of phalloplasty surgery based on individual factors. Each technique has its own benefits and risks. A thorough discussion with your surgeon is essential to determining which technique is right for you. Options include taking tissue from your arm, thigh, back, abdomen, groin or lower leg.

  • Radial forearm flap (RFF)
  • Anterolateral thigh flap (ALT)
  • Musculocutaneous Latissimus Dorsi (MLD)
  • Abdominal
  • Groin flat
  • Fibular flap

Additional procedures

Other procedures are usually done in conjunction with phalloplasty. Surgeries to close the vagina (vaginectomy), create a scrotum (scrotoplasty) and lengthen and re-route the urethra (urethroplasty) are often done at the same time.

Several months to a year after having phalloplasty, vaginectomy, scrotoplasty and urethroplasty, it may be possible to insert penile implants for sexual function.

What Are the Risks Involved With Masculinizing Surgical Procedures?

Like all surgeries, masculinizing surgical procedures have risks. Complications may occur, including bleeding, infection, swelling for an extended period of time, and inadequate healing of incisions. With procedures to create a penis (metoidioplasty and phalloplasty), there are additional risks with urinary function.

It is possible that you may not achieve the full result you want. Each person’s result will be different, depending upon a number of factors. Speak with your surgeon to better understand how your personal health status may impact your surgical outcome.

How Do I Prepare for Surgery?

Preparation for masculinizing surgery is different for each type of procedure. Usually, before having female-to-male affirmation procedures, patients have spent months or years seeking psychological counseling, hormone therapy and living in their preferred gender identity.

Prior to some surgeries, your surgeon may recommend imaging, such as X-Ray, magnetic resonance imaging (MRI) or CT scan. Hair removal is another common preparation for surgery.

It is important to speak with your physician to discuss the complete preparation process that is necessary for your specific procedure(s).

Am I a Candidate for Surgery?

We follow the World Professional Association for Transgender Health (WPATH) standards of care to determine who is a candidate for masculinizing surgery. A successful candidate will meet each of these criteria:

  1. Persistent, well-documented gender dysphoria
  2. Capacity to make a fully informed decision and to consent for treatment
  3. Age of majority (age 18 in the United States)
  4. If significant medical or mental health concerns are present, they must be reasonably well controlled.

In addition, patients seeking metoidioplasty or phalloplasty must also meet fifth criterion:

  1. Twelve continuous months of hormone therapy as appropriate to the patient’s gender goals (unless the patient has a medical contraindication or is otherwise unable or unwilling to take hormones).

What Can I Expect After Surgery?

Each surgical procedure has its own unique recovery timeline. You will need to discuss your specific procedure with your surgeon to fully understand the challenges you may face as you recover, and when you can expect to resume normal activities.

As with most surgeries, you should expect some degree of pain, swelling and bruising after having masculinization procedures. Some surgeries are performed as outpatient procedures, and you may go home the same day. Other, more complex procedures require a multi-day hospital stay followed by a lengthy recovery.

With many masculinization procedures, you will need support from family or caregivers during your post-operative time period. In addition, some surgeries require a long-term follow up plan which may include continuing to see a gynecologist or urologist.

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For more information on our Gender-Affirmation Surgical Program or to schedule an appointment, please fill out the form below or call (832) 325-7181.

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