A Comprehensive Guide to Gender-Affirming Surgery

Medically reviewed by Paul Gonzales on April 15, 2024.

Gender-affirming surgery is an umbrella term for a series of surgical procedures that help transgender, non-binary and gender non-confirming individuals alleviate their gender dysphoria and promote a sense of congruence between their physical body and gender identity. Below we outline the different types of gender-affirming surgeries that are documented in the World Professional Association for Transgender Health’s (WPATH) Standards of Care 8 (SOC8) alongside important cost, insurance, and recovery information often solicited by patients.

At the Gender Confirmation Center (GCC), we believe that medically necessary gender-affirming surgical care should be made available to patients of diverse gender identities and body types with differing BMIs. If you are interested in making an individualized surgical plan to meet your unique needs, you can schedule a virtual or in-person consultation with one of our board-certified surgeons today.

Types of Gender-Affirming Surgeries

There are several types of gender-affirming surgeries available, each designed to help patients feel more congruence between their body and their gender identity. We highly recommend that patients seek out board-certified surgeons with hospital privileges and extensive experience in gender-affirming surgical care.

Top Surgery

Top surgery refers to procedures that modify the chest area. In our practice, top surgery usually refers to chest reconstructions or breast reductions, both involving the removal of breast tissue. Patients can also modify the nipples through a free nipple graft to adjust the size, shape and placement of their nipples or remove the nipple completely. In addition, nerve preservation techniques can also be performed to prevent the loss of heightened, erotic sensation in the nipples.

Another type of top surgery procedure is a breast augmentation. In general, implants yield better results than fat transfers when a large increase in volume is desired and existing skin is relatively tight. Patients can choose between silicone and saline breast implants, their size and placement, as well as the location of their breast implant scars.

Bottom Surgery

Bottom surgeries are gender-affirming procedures performed to reconstruct external genitalia or remove internal reproductive organs. Bottom surgery can involve the construction of structures that do not currently exist on the patient’s body (like a vaginal canal, vulva or penis).

Fertility planning considerations and/or preoperative hair removal may be required for some procedures.

• Vaginoplasty and vulvoplasty: This procedure involves the creation of a vaginal canal using tissue from the penis, scrotum or parts of the intestine. Patients who undergo a vaginoplasty will need to dilate for the rest of their lives to maintain the patency of the vaginal canal and preserve sexual function. Patients will need to undergo laser hair removal of their scrotum and/or penis prior to undergoing a vaginoplasty.
  • Zero-depth vaginoplasty or vulvoplasty: This involves the creation of a vulva and clitoris without the creation of a vaginal canal for penetrative sex.
  • Penile-preserving vaginoplasty: This involves the creation of a vulva, clitoris, and vaginal canal by reconstructing penile and scrotal tissues.
  • Labiaplasty and revisions: Dr. Ley is well-renowned for her expertise in bottom surgery revisions. These procedures allow for corrections to the size, shape and/or symmetry of their labia minora, labia majora and/or clitoral hood.

• Orchiectomy: This procedure involves the removal of the testicles. Patients interested in a vaginoplasty or vulvoplasty should have their scrotal tissue preserved for the construction of the labia. An orchiectomy can take place up to 8 weeks before their vaginoplasty or vulvoplasty procedure.