Everything You Need to Know About Transgender Body Contouring

Transgender Body Contouring is a set of surgical procedures that can help trans, non-binary and gender non-conforming individuals feel greater gender congruence with the frame or shape of their body. In more concrete terms, body contouring or body sculpting surgery involves a patient choosing between targeted liposuction, fat grafting and/or skin excision procedures. These procedures are sometimes performed at the same time as top surgery: chest reconstruction or breast augmentation. 

In this article, you can learn more about procedures like gender-affirming liposuction, Brazilian Butt Lift (BBL) and hip dip fat transfers: what techniques they involve, how much they cost, their risks, how to prepare for and recover from them.

For many of our patients, transgender body contouring is often a significant step in relieving the psychological distress caused by gender dysphoria. For example, many peer reviewed studies (referenced on page S167) note that while procedures like top surgery and body contouring may adversely affect erogenous sensation, patients’ overall satisfaction with their sex lives and sexual function improves thanks to gender affirmation. 

To experience the benefits of gender-affirming body contouring, it is essential that patients have realistic expectations for surgery. Liposuction, fat grafting and skin excision are not effective weight loss strategies for patients who wish to lose significant amounts of body fat. Rather, ideal candidates for liposuction and fat grafting are those who have a BMI under 32 since patients with a higher BMI are likely to not yield noticeable results. While being on hormone therapy is not a prerequisite for body contouring, we recommend that patients who are taking full doses of testosterone or estrogen wait until at least a year has gone by to see how much fat is redistributed.

In order to experience the benefits of gender-affirming body contouring without serious health risks, it is important that patients receive quality care. The following guidelines will help you find a surgeon that you can trust to provide care with integrity that helps you meet your goals:

1. Board Certification: Ensure that the surgeon is board-certified by the American Board of Plastic Surgery or another reputable organization, indicating their extensive training and expertise in plastic and reconstructive surgery.
2. Experience with Gender-Affirming Surgeries: Look for surgeons who specialize in gender-affirming procedures, particularly body masculinization and feminization surgeries, and have a proven track record of successful outcomes. According to the World Professional Association of Transgender Health (WPATH), surgeons should be knowledgeable about diverse gender identities and expressions, pursue continuing education in the field of gender-affirming surgery and have an active practice in gender-affirming surgical procedures.
3. Hospital Privileges: Choose a surgeon who has operating privileges at accredited hospitals or surgical centers, ensuring access to quality facilities and support staff.
4. Before and After Photos: Review the surgeon’s portfolio of before and after photos to assess their aesthetic skills and the quality of their work.
5. Patient Reviews: Read reviews and testimonials from past patients to gain insight into the surgeon’s bedside manner, communication skills, and overall patient satisfaction.
6. Consultation Experience: Attend a consultation to assess the surgeon’s bedside manner, attention to detail, and ability to understand your specific goals and concerns. You can schedule a free virtual or in-person consultation with the GCC here. Please note that most surgeons charge patients for a consultation.

You can learn more about our dedicated team of board-certified surgeons at the Gender Confirmation Center here.

Body Masculinization Surgery:

Body Masculinization Surgery Before & After 1

Body Masculinization Surgery Before and After 2

Body Masculinization Surgery Before and After 3

Body Masculinization Surgery Before and After 4

Body Feminization Surgery:

Body Feminization Surgery Before and After 1

Body Feminization Surgery Before and After 2

Body Feminization Surgery Before and After 3

Body Feminization Surgery Before and After 4

At the GCC, our surgeons take the time to get to know our patients one-on-one to make unique, surgical plans designed to meet your goals. It is important to be as transparent as possible about your medical history so that our clinical team can do everything in our power to prevent complications and ensure your safety throughout surgery. When it comes to designing a customized surgical plan for body contouring, patients usually find one of the two following approaches helpful:

The first approach involves having a patient identify which parts of their body are sources of persistent gender dysphoria and what changes to their body could bring them the greatest amount of gender euphoria. After years of hormone replacement therapy, consistent diet and exercise, there may be stubborn areas of fat that do not disappear. For example, some transmasculine patients may elect for gluteal, hip and thigh liposuction to treat their hip dysphoria. Conversely, some transfeminine individuals may elect for a Brazilian Butt Lift (BBL) to augment the volume of the hips and buttocks to treat their hip dysphoria. Similarly, skin excision procedures like an abdominoplasty or “tummy tuck” can eliminate unwanted skin overhang.

The second approach involves revising the common effects of a first testosterone-dominant or estrogen-dominant puberty, and how body contouring surgery can help reverse their effects. On one hand, a first, estrogenic puberty tends to create fuller gluteal forms, a wider pelvis and greater fat deposition in the buttocks and hips. This tends to create a waist-to-hip ratio (WHR) in the ratio of 0.65 to 0.80, which is a common goal for transfeminine patients who pursue body contouring. Non-binary patients who want a more androgynous frame will often request liposuction and/or fat grafting to give them a WHR of 0.70 to 0.85. Transmasculine patients, on the other hand, often seek out lower-body liposuction and/or skin excision to lift the appearance of the waistline and give them a WHR in the 0.85-0.95 range. Likewise, upper body liposuction and top surgery can give a patient’s torso a more rectangular shape. This can significantly alter the appearance of clothing on patients. 

We can review some of these procedures in detail so you can see which ones you would like to discuss with your surgeon.

Liposuction for Transgender Patients

Liposuction is a body contouring procedure that can be used to eliminate undesired fat from various regions of the body. Liposuction can be used to diminish or accentuate the curvature of the hips or give the body an overall more rectangular or curved form, depending on the areas targeted. Stubborn fat deposits in these areas are often the result of or at least reminiscent of an estrogenic puberty or androgenic puberty, which can cause body dysphoria in some people. In the Body map below, you’ll find areas most commonly targeted using liposuction. You can consult the following links to read more about feminizing trunk liposuction, common trends in liposuction for masculinization and liposuction for non-binary patients.

After liposuction, patients will experience moderate pain, bruising and inflammation through the first three weeks after surgery. Most patients can return to work two weeks after liposuction, although you should wait at least six weeks before resuming strenuous exercise and weight lifting.

Fat Grafting and Body Sculpting

Fat grafting is another surgical procedure that may be used to sculpt the body to augment the hips and/or buttocks, providing a greater curvature. These techniques are referred to as a “Brazilian Butt Lift (BBL)” and “hip dip fat transfers.” This procedure harvests fat from one area of the body, such as the abdomen, flanks or underarms, purifies it and transfers it into the area a patient desires to augment. Since this procedure uses the patient’s own fat as opposed to foreign bodies, such as silicone implants, the risk of rejection is almost non-existent. We recommend patients consult our guidelines on weight gain and weight loss to understand how they can best prepare for surgery to ensure permanent results.

Recovery from a fat grafting procedure is more complex than body liposuction. This is because patients will not be able to put pressure on their buttocks for three weeks after surgery. That said, most patients will return to work around 2 weeks after their operation. Strenuous exercise and weight lifting should be avoided for the first 6 weeks of recovery. 

Chest Contouring Through Top Surgery

Generally speaking, many patients choose to combine their body contouring procedure with top surgery. In other words, they elect to simultaneously undergo procedures like body liposuction, skin excision and/or fat transfer alongside a chest reconstruction or breast augmentation surgery. Please note that while the GCC does not have BMI requirements for top surgery, we generally recommend that patients who wish to undergo liposuction and/or fat grafting have a BMI under 32. This has less to do with medical necessity to qualify for surgery and more to do with accomplishing realistic goals as patients with BMIs over 32 tend to have limited results.

On some occasions, top surgery procedures may be accompanied with chest liposuction or breast fat grafting. In chest reconstruction top surgery, it is relatively common for surgeons to liposuction the middle chest, under the underarms and the upper abdomen. Removing fat from these three zones can help with chest tightening for patients who would like to achieve very flat results. Likewise, liposuctioning under the armpits can help prevent dog ears. Generally speaking, patients who undergo upper body liposuction can expect to have surgical drains for about the first week of recovery to prevent seroma formation.

On the other hand, fat grafting is a much less common procedure for breast augmentations. Fat injections to augment breasts have a low success rate when a large amount of volume is needed and the skin is particularly tight. This is why, for most transfeminine and non-binary patients assigned male at birth, surgeons opt for silicone or saline breast implants. Fat grafting can be used in addition to implants, for example, to increase cleavage.

Consultation and Personalized Surgical Plan

An initial consultation allows you and your surgeon to explore the possible paths you can take to achieve your aesthetic goals. Dr. Ley (she/her/they), Dr. Facque (he/him) and Dr. Mosser (he/him) are our highly trained and experienced board-certified surgeons who offer gender-affirming body contouring. Unlike most surgical practices, the GCC offers free virtual and in-person consultations. If you are interested in meeting with a surgeon to design your unique, surgical plan, you can request a free consultation today. Beforehand, we encourage you to think about the following questions:

• What areas of your body would you like to address through surgery? Is there skin overhang or are there fat deposits that are the cause of persistent gender dysphoria for you?
• What changes to your body frame would bring you feelings of gender euphoria? What body shape do you aspire towards having?
• Are there any other gender-affirming surgeries you would like to undergo?

Surgical Procedure and Recovery

Body contouring at the GCC is always conducted under general anesthesia, meaning that patients are completely unconscious and feel nothing during the procedure. Body contouring surgery can last anywhere from 2-6 hours depending on the number and type of procedures you undergo. Most body sculpting surgeries are out-pateint procedures, meaning you will need someone to come to the hospital or surgical center to pick you up after your operation. 

Patients can consult our website for specific recovery instructions for liposuction and fat grafting. To prepare for your surgical recovery, we recommend that you consider the following factors:

• Request time-off: Make sure to request time-off from work at least six weeks in advance of your procedure when possible. This will give you ample time to prepare for surgery and set up your recovery plan. 
• Preoperative medical obligations: Make sure to follow pre-operative medical obligations such as refraining from the usage of alcohol one week before surgery, and refraining from smoking tobacco or marijuana at least three weeks beforehand. 
• Your care team: Coordinate your care team for physical and emotional recovery after your procedure. Patients will need a support person around the clock for the first 24 hours after surgery. From there, you will likely still need friends and/or family to be with you every day for the first week or two after surgery to help with household tasks.
• Your recovery space: We recommend that you prepare your recovery space two days before surgery. We outline a checklist of suggestions for how you might organize this space. For example, you might purchase ice-packs and a cooler to manage swelling and inflammation and keep emergency numbers handy or by bed. Likewise, patients that undergo lower-body liposuction should elevate their legs while sleeping.

Recovery Table:

Understanding the Risks

With any surgical procedure there are potential risks. Each of the transgender body contouring procedures we described come with risks associated. These risks may include scarring, infection, asymmetry after the procedure and temporary emotional distress during the recovery period. We encourage our patients to discuss any risks or concerns they may have about the procedure in their surgical consultation. Prior to your operation, our clinical team will review the risks associated with your procedures during the informed consent process.

Costs are one of the greatest barriers to trans, non-binary and gender non-conforming individuals accessing medically necessary, gender-affirming care. At the GCC, we strive to mitigate economic barriers to surgery with our top-class insurance concierge service and philanthropic efforts. You can read more about these efforts below. We encourage patients in need of financial assistance to refer to our guide on grants and financing resources for gender-affirming surgery.

Understanding the Costs Involved

Transgender body contouring can cost between $8,500-$19,500. The following table includes the price ranges for cash-pay patients, meaning patients that will not use insurance to help pay for their gender-affirming procedure. During the pre-surgical consultation, you and your surgeon will discuss and decide the surgery techniques and accommodations that will be necessary to achieve your goals. This will be reflected in the final procedure cost. Therefore, the costs outlined below are general estimates only.

If you would like an exact quote for the cost of your surgery, you can request a free surgical consultation today. 

Insurance Coverage

Insurance coverage can be a complex and difficult process to approach. At the GCC, our insurance concierge team has a 90% success rate of navigating these changing rules and securing full or partial coverage for interested patients, which can significantly reduce the costs of medically necessary, gender-affirming care. ​​

That said, as of May 2023, there are new insurance restrictions around body contouring procedures:

If you have insurance coverage and we are a contracted provider, we are unable to offer you an out-of-pocket price for your medically necessary body contouring (liposuction and/or fat grafting) procedure). This is due to the service being reimbursed at a drastically reduced amount, limiting our ability to provide this service at a reasonable reimbursable rate.

In the past, GCC billed for multiple units, each representing different areas on the body, and the procedure was reimbursed based on the number of units. However, insurance companies are now reimbursing for only one (1) unit, regardless of the number billed.

Please note that managed Medi-Cal plans, such as San Francisco Health Plan (SFHP), coverage has not changed for Liposuction, ensuring flexibility in Liposuction units.

For information about prices and financing options, we invite you to consult this page.

Masculinizing Liposuction Before & After

Mossser FTM Top Surgery Before and After 1

Mosser FTM Top Surgery Before and After 2

Mosser FTM Top Surgery Before and After 3

Mosser FTM Top Surgery Before and After 4

Feminizing Liposuction & Fat Grafting Before & After

Mossser FTM Top Surgery Before and After 1

Mosser FTM Top Surgery Before and After 2

Mosser FTM Top Surgery Before and After 3

Mosser FTM Top Surgery Before and After 4

• What is the recovery time for transgender body contouring?

• Generally speaking, patients can expect to return to work 2 weeks after surgery. That said, patients should avoid heavy lifting and strenuous physical activity for at least the first 6 weeks post-op.

• Are the results of body contouring permanent?

• The results that hold about 6 months after surgery are considered to be permanent. That said, drastic weight fluctuations can alter the amount and distribution of fat cells in the body and therefore undo the effects of surgery.

• How do I know if transgender body contouring is right for me?

• There is no simple way to know if transgender body contouring is right for our patients. Through a careful and trusting process, an initial consultation with a surgeon can create an open conversation around gender dysphoria and the possibilities to relieve these sensations, your personal goals, and whether or not surgery is the best way to achieve them. We encourage you to request a free consultation to know if transgender body contouring is right for you.

• Can body contouring be combined with other gender-affirming surgeries?

• Because our patients create personalized and customizable plans to realize their bodily goals, body contouring and top surgery can sometimes be incorporated into the same surgical plan. However, some surgeries may be difficult to undergo simultaneously due to recovery periods or other medical constraints. A surgical consultation is the best time to get a concrete answer to this question.

• Is transgender body contouring covered by insurance?

• At least in California, transgender body contouring may be covered by insurance. At the GCC, our insurance concierge team will ask for the required documents to secure full or partial coverage for your medically necessary gender-affirming care. Please note that since May of 2023, most insurance companies are reimbursing less to patients for body contouring procedures. Given the changing rules and policies around certain medically necessary gender-affirming care, we ask that you work with us to secure full or partial coverage for your care. You can learn more about our efforts to secure affordable care for our patients here.