The Complete Guide to Gender-Affirming Surgeries

Medically reviewed by Jennifer Richman on February 20, 2025.

What is Gender Affirmation Surgery?

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. Not everyone needs surgery to affirm their gender. Below we outline the different types of gender affirmation surgeries that are documented in the World Professional Association for Transgender Health’s (WPATH) Standards of Care 8 (SOC8). You can request a free, surgical consultation to have your questions answered about the procedures below and/or create a unique surgical plan tailored to you.

Bottom Surgery (Pelvic Surgery or Genital Reconstruction Procedures)

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

• Hysterectomy, oophorectomy and vaginectomy: Patients can have their vaginal canal, uterus, and/or one or both of their ovaries removed.
• Metoidioplasty: A metoidioplasty involves releasing erectile tissue (clitoris), from restraining structures, allowing it to move into a more forward and elevated position. Patients can opt for a urethral lengthening procedure if they would like to be able to urinate while standing up.
• Phalloplasty: This surgery involves the creation of a penis using a tissue flap from the patient’s groin, outer thigh, or forearm.
• Orchiectomy: This procedure involves the removal of the testicles.
• Vaginoplasty and vulvoplasty: This procedure involves the removal of the penis (penectomy) and the creation of a vulva with or without a functional vaginal canal.
• Labiaplasty: Dr. Ley (she/her/they) 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.

Top Surgery (Chest and Breast Surgery)

• Chest reconstruction top surgery: This surgery involves removing the chest (breast) tissue to create a chest as flat as the patient would like. The nipple-areola complex can be resized and repositioned through free nipple grafting, spared (i.e., preserved in their original form), or removed altogether.

• A nerve preservation technique can also be performed to prevent the loss of erogenous or heightened sensitivity in the nipples.

• (Aggressive) breast reduction top surgery: This procedure involves significantly reducing the size of breast tissue, leaving behind a small tear-drop shape.

• Breast augmentation top surgery: Silicone and saline breast implants of varying sizes can be placed to augment the size of the breasts. In general, implants yield better results than fat transfers when a large increase in volume is desired and existing skin is relatively tight.

Facial Surgery

• Facial feminization surgery (FFS): FFS describes a menu of procedures that patients can choose from to soften different facial features. Common procedures include: tracheal shave (Adam’s Apple reduction), jaw contouring, lip lift, cheek augmentation, rhinoplasty (nose reshaping), brow bone contouring, brow lift, hairline advancement, and more.

• Facial masculinization surgery (FMS): FMS encompasses a variety of procedures patients can choose from to alter the neck and bottom-third of their face (like jawline augmentation), the middle-third of the face (like rhinoplasty or nose reshaping) and upper-third of the face (like eyelid surgery). FMS is typically aimed at creating more prominent, angular facial contours that mimic the effects of testosterone on bone and cartilage development in adolescence.
• Gender-affirming facial surgery (GAFS): GAFS is the umbrella term for all facial surgery procedures that either augment (i.e., making more prominent and angular) or soften facial features. Non-binary patients can choose from any procedures to align their facial and neck appearance with their gender identity.

Body Contouring

• Liposuction: Liposuction is not a weight-loss strategy, but rather a means of targeting stubborn fat deposits that do not disappear through lifestyle changes. Patients can undergo feminizing trunk liposuction to achieve a more contoured waistline or in any of the following areas (for masculinizing or other desired effects): flanks (the space between the ribs and the hip), waist/hips, abdomen, inner thighs, outer thighs (saddlebag area) upper body (chest and back) and/or buttocks.

• Fat transfer: Fat transfer involves taking fat from other parts of the body, purifying it, and injecting it into parts of the body that the patient would like to be augmented, such as the buttocks and hip fat transfer augmentation (aka. Brazilian Butt Lift or “BBL”)

• Skin excision: Patients can remove undesired skin overhang through skin excision and skin tightening procedures. For example, an abdominoplasty can help transmasculine patients tighten their abdomen after pregnancy (rectus diastasis) and achieve a more rectangular or top-heavy body frame.

Vocal Surgery

• Vocal feminization surgery (VFS) and vocal masculinization surgery (VMS): Voice modification surgery, also known as voice feminization surgery or voice masculinization surgery, alters the vocal cords and other structures in the throat to help individuals achieve a voice that aligns with their gender identity. Vocal therapy is often needed before and after surgery. You can learn more about gender-affirming vocal therapy and surgical treatments from trusted providers like San Francisco Voice and Swallow.

Frequently Asked Questions about Gender Affirmation Surgeries

Will insurance cover my gender affirmation surgery?

Many insurance plans cover gender-affirming surgeries. However, coverage and requirements vary by plan and state. It’s essential to check with your insurance provider for specific details on coverage, pre-authorization requirements, and any exclusions or limitations. Some procedures like phalloplasty are only performed on patients who have insurance coverage.

At the Gender Confirmation Center (GCC), our insurance advocacy team provides free support and guidance for our prospective patients. They have a 90% success rate in securing coverage for interested patients. For more information, click here.

What is the recovery process like for gender-affirming surgeries?

The recovery process differs depending on the specific procedure(s) performed. Generally, it involves some downtime, pain management, and follow-up appointments. Your surgeon will provide detailed recovery instructions and timelines. It’s important to follow these instructions carefully to ensure proper healing and minimize the risk of complications.

You can find more specific recovery guidelines in the following articles:

• Recovering from top surgery (chest reconstruction or breast reduction)
• Recovering from breast augmentation
• Recovering from facial surgery
• Recovering from liposuction
• Recovering from fat grafting (BBL)
• Recovering from vaginoplasty, vulvoplasty, and/or labiaplasty
• Recovery from metoidioplasty
• Recovery from phalloplasty

Are there any risks associated with gender-affirming surgeries?

As with any surgical procedure, there are potential risks and complications associated with gender-affirming surgeries. These can include bleeding, infection, scarring, and adverse reactions to anesthesia. Your surgeon can discuss specific risks or complications, as well as steps to minimize these and ensure the best possible outcome. For more information on how you can minimize surgical risks, click here.

How long does it take to recover from a vaginoplasty?

The recovery process for a vaginoplasty can take at least 3 months, which is when patients can begin to have penetrative sex. Initial healing typically takes 4-6 weeks, during which time you may experience discomfort, swelling, bruising, and the need for dilation to maintain the vaginal depth and width. Dilation is a life-long commitment to maintain the vaginal canal opening after surgery. However, it can take 6 months to a year for swelling to resolve so that final results are visible. For more in-depth information on vaginoplasty recovery, click here.

Can gender-affirming surgeries be reversed?

Depending on the surgery, some procedures can be reversed. For example, implants can be removed after a breast augmentation. However, attempting to reverse the outcomes of any surgery can be complex and may not restore function pre-operatively (i.e. inability to chest feed after mastectomy). Additionally, procedures that alter reproductive organs like an orchiectomy (removal of the testicles), hysterectomy (removal of the uterus) or oophorectomy (removal of one or more ovaries) are irreversible. For this reason, we recommend that our patients look into their fertility preservation options prior to undergoing said procedures.

How much does gender-affirming surgery cost?

The costs of gender-affirming procedures can vary depending on the unique, surgical plan you and your surgeon come up with. Not to mention, your surgeon’s level of experience and geographical factors may also impact cost. Many insurance companies recognize these kinds of surgeries as medically necessary and therefore provide full or partial coverage for them. For more information on financing and costs, click here.