Feminizing Surgery

Overview

Feminizing surgeries are medical procedures that change certain features of the body to match a person’s gender identity. Common procedures include breast augmentation to increase breast size, as well as bottom surgery, which may remove the testicles or both the penis and testicles, and may create a vagina, labia, and clitoris.

Some individuals also choose facial or body-contouring surgeries for a more typically feminine appearance. Each of these procedures can have different outcomes for fertility and sexual sensation, depending on the type selected. A summary table of common feminizing surgery types:

Surgery Type	Main Goal
Breast Augmentation	Increase breast size
Genital Surgery	Reshape or create female genitalia
Facial Procedures	Adjust facial features for femininity
Body Contouring	Refine overall body shape

Not everyone chooses these surgeries, as they can lead to risks, costs, and require medical care before and after surgery.

Reasons for Feminizing Procedures

Some transgender women and others who want their bodies to align more closely with their gender identity choose feminizing surgery. This type of care, often called gender-affirming care, supports people experiencing gender dysphoria.

Gender dysphoria is the discomfort or stress that can occur when someone’s gender identity does not match the sex they were assigned at birth. For many, these procedures offer relief from distress and help them feel more at ease in daily life.

Surgery is a deeply personal decision—some people may feel it is essential for their well-being, while others may not pursue any surgical changes at all. Care should remain flexible and based on each person’s unique needs and goals.

Types of Feminizing Surgery and Procedures

Procedure	Main Purpose
Orchiectomy	Removal of the testicles
Vaginoplasty	Creation of a vagina and other genital changes
Breast Augmentation	Increasing breast size (top surgery)
Facial Feminization	Making facial features appear more feminine
Body Contouring	Creating a more traditionally feminine figure
Voice Surgery/Therapy	Raising voice pitch
Tracheal Shave	Reducing the Adam’s apple
Scalp Hair Transplant	Treating baldness and shaping the hairline
Hair Removal	Removing facial and body hair

People may choose one or several of these options. WPATH guidelines (World Professional Association for Transgender Health) suggest that access to gender-affirming care, including surgery, helps improve a person’s mental health and quality of life.

Some surgeries, such as breast augmentation, may be chosen if hormone therapy does not create the desired results. Others, like facial feminization, help align someone’s appearance with how they see themselves.

Possible Complications

Feminizing surgery can influence a person’s ability to have biological children. Procedures involving the reproductive organs often lead to permanent infertility. This is important for anyone who may want children in the future.

Key Considerations

• Surgery affecting reproductive organs usually makes it impossible to produce sperm afterward.
• Options such as sperm cryopreservation allow individuals to store sperm ahead of time.

Option	Details
Sperm Freezing	Preserves future fertility
No Preservation	Permanent loss of biological fertility

Surgery can also create urology concerns, such as urinary incontinence, pelvic floor troubles, or changes in urination. Tobacco and cannabis use may increase surgical risks, including poor wound healing or greater chances of chronic pain.

Getting Ready

Giving Your Approval

Before any surgery, patients must make an informed choice. They need to clearly understand the risks and benefits of the procedure. This includes learning about possible side effects, costs, choices other than surgery, and how the operation may affect things like fertility and sexual function. The surgeon will review all of these points and answer any questions.

Informed consent means saying yes to surgery after all topics have been discussed. It is important to think about how permanent some of these changes will be and how surgery fits with personal goals. A table below can help organize the main topics for consent discussions:

Topic	Example Questions to Ask
Risks and Benefits	What could go wrong? What are the upsides?
Alternatives	Are there non-surgical options for me?
Financial Cost	How much does this cost?
Sexual Function	Will surgery affect intimacy or fertility?
Goals & Outcome	What can I expect after surgery?

Surgical Assessment

Before any operation, health professionals review the patient’s personal and family medical history to look for anything that might affect surgery. They often require blood tests, a physical check, and a review of hormone treatments and vaccines.

Lab work helps ensure the patient is ready for the procedure. The surgeon or healthcare team may also discuss stopping certain medicines, tobacco, or supplements before the date of surgery. People taking hormone therapy will have this reviewed as well.

A mental health professional may participate, especially if referral letters are needed or to check on issues related to gender dysphoria, overall mental health, or substance use. The professional may also discuss social supports, work or school challenges, and any sexual health concerns.

Checklist for Surgical Assessment

• Medical and family history review
• Physical exam
• Lab tests (blood, screening)
• Review of hormone use
• Vaccination record
• Screening for infections and substance use
• Mental health assessment
• Letters of referral if required

What You Can Expect

Changing Facial Appearance with Surgery

Surgeons use several options to make facial features appear more feminine. Common choices include moving the hairline to make the forehead look smaller, adding implants to the cheeks and lips to give them more shape, and reshaping the jaw and chin. Sometimes, surgeons tighten the skin after these changes to give the face a smooth, natural look.

They may also reshape the nose (rhinoplasty), lift the brow, remove extra skin from eyelids (blepharoplasty), or advance the scalp to change the hairline position. Most facial surgeries are outpatient, so patients can go home the same day. General anesthesia keeps the person asleep and free from pain during the operation. Recovery from these surgeries generally takes several weeks, but jaw procedures may require a longer healing time.

Patients may need hair removal with laser treatment before surgery, especially if skin from the face or scalp will be repositioned. Full recovery and final results can take a few months. Individuals may have swelling and bruising that fades over time, with most people able to return to daily routines after a few weeks. Regular follow-up visits with the surgical team help ensure proper healing.

Common Facial Procedures

Procedure	Purpose
Hairline correction	Lowers or reshapes forehead
Cheek/lip augmentation	Increases volume and softens appearance
Jaw/chin contouring	Reduces size, rounds angles
Nose reshaping (rhinoplasty)	Refines nose shape
Brow lift	Raises eyebrows for a feminine curve
Tracheal shave	Reduces Adam’s apple size
Skin-tightening	Improves smoothness after bone surgery

Reducing the Appearance of the Adam’s Apple

Surgeons make the Adam’s apple less noticeable by reducing thyroid cartilage. They make a small cut just below the chin or in a natural crease in the neck to keep any scarring hidden. Then they carefully shave down the cartilage for a smoother neck profile.

They usually perform this procedure with the person awake but using a local anesthetic to numb the neck area, though sometimes they use general anesthesia. Patients can often go home the same day. Swelling and mild discomfort are common for a few days after surgery.

Benefits

• Makes the profile of the neck smoother
• Reduces or eliminates the bump from the Adam’s apple

Things to Consider

• A faint scar may remain, but is often hard to see.
• Risks include infection, bleeding, and changes in voice if the voice box is injured, though this is rare.

Post-Surgery Care

• Keep the incision site clean and dry.
• Follow the doctor’s advice for when to return to normal activities.
• Watch for signs of infection, such as redness or swelling.

Breast Enhancement Surgery

Those wanting a larger chest may choose breast enhancement, which uses surgical methods to increase breast size and improve shape. Even with hormone therapy, many people find their breast growth is less than they want. Surgeons can use silicone or saline implants, or sometimes fat and tissue from other body parts.

Surgical Steps

1. The surgeon makes an incision—this can be around the areola, under the breast, or near the armpit.
2. The surgeon positions an implant, filled with silicone gel or saline, under the breast tissue. Alternatively, fat can be transferred from elsewhere on the body to the chest.
3. The incision is closed, and the area is bandaged.

If the chest skin does not have enough stretch, the surgeon may place tissue expanders under the skin first. These are slowly filled over weeks to widen the area, then replaced with implants in a follow-up surgery.

Recovery

• Most people go home the same day.
• Swelling, bruising, and discomfort last a week or two.
• Lifting and exercise are limited for several weeks.
• Scarring fades over time but may be permanent.

Breast Augmentation Options

Method	Benefits	Considerations
Implants	Predictable size & shape	May need replaced
Fat grafting	Uses its own tissue, softer feel	May resorb over time
Tissue expanders	For small nipples/skin capacity	Two-step surgery

A plastic and reconstructive surgeon with experience in transgender surgeries usually performs breast augmentation. Side effects can include scarring, loss of feeling, or, rarely, implant leakage. Regular follow-ups ensure healing goes as planned. A clear plan for pain control and activity limits supports recovery.

Surgery to Change Genital Appearance

Surgery to help the genitals look and function in a more feminine way can include several different options, depending on a person’s needs and goals. The main types are testicle removal, creating a vagina (vaginoplasty), and creating external female genitals (labiaplasty and clitoroplasty).

Testicle Removal (Orchiectomy)

Surgeons remove the testicles to lower testosterone levels and prevent sperm production. This procedure can reduce the need for hormone blockers and may lower the amount of estrogen needed for other changes. The operation is often quick, and doctors can perform it as an outpatient procedure.

• Surgeons use local or general anesthesia.
• They make a small cut in the scrotum to remove the testicles.
• Usually, patients do not need to stay overnight in the hospital.
• Healing normally takes a week or two.

Creating a Vagina (Vaginoplasty)

Vaginoplasty is one of the most common genital affirming surgeries for transgender women. The surgical team uses skin from the penis and scrotum to form a vaginal canal and the outside parts, including the labia and clitoris. Several techniques exist:

• Penile Inversion: Surgeons turn skin from the penis and scrotum inside out to make the vaginal canal.
• Labiaplasty: Surgeons use skin to create the labia. Labiaplasty can be done with or without creating a vaginal canal.
• Zero-Depth Vaginoplasty: Only the external appearance changes; a vaginal canal is not created.
• Clitoroplasty: Surgeons use the tip of the penis, with its nerves, to create a sensitive clitoris.

Some people may need tissue from other body parts (like the colon) to make the vagina. Surgeons often require the hair in the surgical field (penis and scrotum) to be removed using laser treatments before surgery. This process can take several months but is important to prevent hair growth inside the vagina.

After Surgery

• Doctors leave a catheter in the bladder to drain urine for several days.
• Pain, swelling, and bruising are normal and slowly get better.
• Most patients stay in the hospital for a week or less.
• Full recovery can take two months or longer.

Post-Surgery Care

• Keep the area clean and dry
• Avoid heavy activity for at least six weeks
• Report any pain, swelling, or fever to the healthcare team

Maintaining the New Vagina (Vaginal Dilation)

Vaginal dilation is a necessary, lifelong step after vaginoplasty. Patients use dilators (tube-shaped tools of increasing size) to keep the vaginal canal open and prevent it from closing up or shrinking.

• Patients perform dilation multiple times a day for the first year after surgery
• After that, the frequency drops—sometimes as little as once a week
• Skipping dilation can cause the vaginal canal to narrow or close, which may need extra surgery to fix

Tips for Dilation

1. Prepare a private, comfortable place
2. Wash hands and use clean, water-based lubricant (never petroleum jelly)
3. Use a mirror at first for accuracy
4. Start with the smallest dilator, relax the muscles, and use gentle pressure
5. Move to larger sizes as advised by the doctor

Many people find dilation painful at first, but relaxation and pain medicine help. Learning the right position and method can make the process easier over time.

Important reminders:

• Dilation is lifelong to keep the canal open.
• Time and privacy are needed for each session.
• Follow the doctor’s plan for how often and how long to dilate.

Health Care After Surgery

Even after surgery, the prostate gland remains. People need routine health checks—such as screening for prostate cancer—as they age. Some may notice changes in urination because of the prostate, and ongoing medical care helps manage these changes.

Other Genital Options

• Metoidioplasty: Surgeons may use this technique as part of female-to-male surgery or in some gender-affirming surgeries.
• Vaginectomy/hysterectomy/oophorectomy are not typically part of feminizing genital surgery, but are relevant for those seeking surgery in the opposite direction.

People considering these operations benefit from talking with a team experienced in transgender care. Every surgical choice is planned based on the individual’s anatomy, health, and wishes.

Planning and Recovery Tips

• Meet with a surgeon for a full evaluation and a discussion of options.
• Arrange for help at home during the first weeks after surgery.
• Follow the aftercare instructions carefully to avoid complications.
• Attend all follow-up appointments for checkups and possible adjustments.

Summary Table – Feminization Surgery Options

Surgery	Purpose	Setting	Recovery Time	Lifelong Care
Face reshaping	More feminine appearance	Outpatient	Weeks to months	Occasional touch-ups
Adam’s apple reduction	Smoother neck shape	Outpatient	Few days – week	Scar care
Breast enhancement	Fuller, more feminine chest	Outpatient	1–4 weeks	Implant monitoring
Genital surgery	Creation of vagina and labia	Inpatient/Outpt	4–8 weeks+	Lifelong dilation
Testicle removal	Lower testosterone	Outpatient	1–2 weeks	Hormone adjustments

Each option has its own set of preparation steps, aftercare needs, and risks, and all should be discussed with a surgeon skilled in gender-affirming procedures.

Outcomes

Gender-affirming surgery often leads to better mental and physical well-being. Many patients report improved sexual function and quality of life. Ongoing care such as pelvic floor physical therapy and voice therapy can help maintain these results.

Support Type	Role in Recovery
Pelvic Floor Physical Therapy	Aids in physical healing
Voice Therapy	Enhances vocal satisfaction
Postsurgical Care	Prevents complications
Follow-up Visits	Monitors long-term progress