Gender affirmation surgery for transmasculine & non-binary people

Gender affirmation surgery can be an important step in aligning an individual’s physical appearance with their gender identity.

For transmasculine and non-binary individuals these procedures can have life-changing effects, improving both mental and physical well-being. They also help them navigate the world more easily, in accordance with their core self.

This article will provide an overview of gender-affirming surgical options, what to expect during the process, and key considerations for those exploring this journey.

What is gender affirmation surgery?

Gender affirmation surgery refers to a range of procedures that help individuals align their physical characteristics with their gender identity.

For transmasculine and non-binary people, this can include top surgery, body contouring, sometimes genital surgery, and others. The choice of procedures varies depending on personal goals, medical considerations, and desired outcomes. It also depends on what is available in different countries (due to legislative restrictions).

These surgeries are highly personalised and are carried out with the aim of improving comfort and confidence in one's own body.

People have a wide range of expectations and goals when seeking top surgery, and these are, most of the time, related to aspects of life that cis individuals take for granted.

Top surgery, or for some, chest masculinisation

One of the most commonly sought procedures among transmasculine and non-binary individuals is FTM top surgery.

This involves removing breast tissue and reshaping the chest for a more masculine or non-binary appearance.

There are different surgical techniques available, including:

Double incision mastectomy: best suited for those with larger chests, this method involves making incisions across the chest, removing breast tissue, and reconstructing the chest wall using free nipple grafts, pedicled dermal flaps, or non-nipple reconstruction to achieve the desired outcome.
Periareolar (keyhole) surgery: ideal for individuals with smaller chests, this technique involves a circular incision around the areola to remove breast tissue while preserving nipple sensation.

The choice of the surgical technique depends on someone’s chest size, expectations, overall health status, presence of previous surgery and others, all of which are part of a detailed consultation.

Additional masculinisation surgeries

Beyond top surgery, some individuals may choose additional procedures to further align their body with their gender identity. These can include:

Body contouring: liposuction or fat redistribution to create a more traditionally masculine silhouette. These are best not performed together with a major procedure like top surgery, as they significantly increase the risk of perioperative complications.
Hysterectomy and oophorectomy: removal of the uterus and ovaries, which some individuals choose as part of their medical transition. These are preferably performed by inclusive gynecologists or general surgeons.
Bottom Surgery (Genital Reconstruction Surgery): procedures that involve constructing or reshaping the genitalia to better align with a masculine anatomy. Common options include metoidioplasty and phalloplasty. These are performed by highly specialised plastic surgeons or urologists.

Preparing for gender affirmation surgery

Preparation for surgery is key to a successful outcome. This includes:

Online research of not only your preferred surgeon but also the available surgical options. The more in-depth this research, the more meaningful your consultation will be.
Consultation with a specialist surgeon to discuss goals and options.
Medical and mental health evaluation, ensuring overall well-being and suitability for surgery. Different surgeons and countries require different approaches. A specialised referral may or may not be necessary.
Hormone therapy is not a prerequisite for someone seeking top surgery.
Stopping smoking is important, as it can hinder the healing process and increase surgical risks, but other adjustments may also be required, such as losing weight or discontinuing certain medications.

Recovery and aftercare

Recovery times vary depending on the procedure, but generally, patients can expect some swelling, bruising, and discomfort in the initial weeks.

It is important to follow all post-surgical instructions, which may include:

Wearing compression garments to minimise swelling.
Avoiding heavy lifting and strenuous activity for several weeks.

Gender affirmation surgery can be a life-changing step for many transgender and non-binary individuals.

While it requires careful consideration and preparation, the benefits for mental health and overall well-being can be profound.

If you are considering surgery, consulting a qualified gender-affirming surgeon is the first step to start your transition journey.