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Transgender procedures are also known as gender-affirming procedures. They are meant for individual patients who identify with the gender that is opposite to the gender assigned to them at birth. Both transgender male patients (or “trans men”) and transgender female patients (or “trans women”) are able to make physical changes to their faces and bodies through gender affirming surgeries. It is up to the individual patient to determine which surgical changes they would like to make in order for their physical appearance to be in harmony with how they wish to be perceived and present themselves to others.
For trans men and trans women, “top” surgery refers to procedures performed of the breasts to make them appear consistent with their identity as men or as women. In the case of trans men, mastectomy with free nipple-areola grafting is the procedure that surgically removes the majority of the breast tissues and repositions a much smaller nipple-areola graft consistent with a male breast and chest. The surgical incisions typically follow a curving path on each side of the chest along the lower border of the new male-shaped breasts and pectoral muscles. The recovery takes 1-2 weeks for the majority of the bruising and swelling to resolve. At 2-3 weeks patient start using scar fading products and external radiofrequency treatments (called NuEra) to speed up the recovery from swelling and stiffness in the area of surgery. By 4-6 weeks patients typically return to unrestricted activity, and by six weeks compression garment use is no longer necessary.
For trans women, top surgery usually means breast augmentation surgery with breast implants to make the breasts the desired size. Many trans women will have been on exogenous estrogen to begin the growth, development, and feminization of the breast tissues prior to moving forward with breast augmentation surgery. Like in cis women, breast augmentation in trans women is performed through small incisions in the inframammary folds. The implants can be placed in a pocket above or below the pectoral muscles. Silicone gel or saline implants of the desired size are used. Drain tubes are rarely used. The size, type and positioning of the implants is discussed with the patients and individualized to their needs. The recovery typically is 1 week to return to driving, 3-4 weeks to return to light exercise, and 6-8 weeks to unrestricted activities. In the first six weeks sports bras are used, after which regular bras are worn.
Contouring of the body to achieve a more feminine or masculine shape is usually done through liposculpting/liposuction and through fat grafting techniques. A more feminine body shape means accentuating an hourglass, curvy shape with narrow waistline and fuller hips and buttocks. A more masculine body shape means accentuating the upper body and reducing the lower body so that the hips and thighs are more slender, the buttocks are narrower, taller, and slightly depressed along their outer border and the chest and shoulders are broader relative to the lower body.
Transgender procedures, like many procedures performed in aesthetic plastic surgery, can be very transformative and life enhancing when performed properly and in a well-considered and timed manner. These procedures should be incorporated at a pace that is a natural evolution of how the transgender person has lived and continues living unequivocally as a self-identified man or woman. They are a means to create a more harmonious coexistence between that person’s inner world and the exterior that they present to themselves and to the rest of the world.
Place your trust in deserving hands. Explore state-of-the-art options and design your personalized treatment plan with renowned plastic surgeon Dr. Paul Fortes. Your best results are within reach.