Transition-Related Procedures

People who are undergoing the process of transition each have their own unique goals and expectations. The process of transitioning will be different for each patient and may involve care provided from a variety of health care professionals. Plastic surgeons have the ability to assist in many of these areas including surgical and non-surgical facial procedures, breast and chest surgery as well as bottom reassignment surgery.

Top Surgery – Masculine Chest Contouring

Individuals who feel that feminine breasts do not suit their perception of themselves may request chest masculinization. The goals of this top surgery are to remove the breasts and to create a male chest contour.

The type of surgery offered will depend on the size of the breasts, the position of the nipple and the quality and amount of excess skin. Every effort is made to perform the surgery with as few visible scars as possible. The most common approaches include the “Keyhole” or “Periareola” procedure that involves a small incision made around the border of the pigmented areola skin, or the “Double Incision” procedure that involves removal of the excess breast tissue and skin along with repositioning and resizing of the nipple and areola. This approach leaves a scar in the crease at the lower border of the pectoral muscle and a second scar around the border of the new areola. In larger breasts a small vertical scar may also be recommended.

Adjunctive procedures including liposuction and the use of internal shaping sutures may also be indicated to optimize the appearance of the chest.

Top surgery is performed under general anesthesia and you will be able to go home the same day. Drains are rarely used and you will be asked to wear a thin compression garment for several weeks to assist with your recovery.

Following surgery, patients often state that they have an improved level of confidence and feel that their body better reflects the way in which they personally see themselves.

Top Surgery – Feminine Chest Contouring

The creation of a female chest contour means different things to different people. Most commonly, this involves augmenting the size of the breast to create a breast shape that is in better proportion with the rest of the body. This is typically performed with the use of breast implants, although in some patients, the breasts can be augmented with the use of transferred fat.

Most patients will have had a trial of hormone therapy to try to stimulate breast growth. Often, this growth is inadequate to meet the desires of the patient. It is important to recognize that breast augmentation performed for MTF transition has unique differences from a breast augmentation performed in a cis female. Not only is the underlying muscle anatomy different but there will be other aspects of feminization to address including appropriate size of the nipple and areola complex as well as the removal of unwanted hair and chest wall fat.

Click here for more information on breast augmentation.

Facial Procedures

Patients will often consider a variety of facial procedures as part of the process of transition. These procedures may be either surgical or non-surgical. The specific treatment plan will be tailored to the individual’s goals and needs. Examples of  common procedures include:

  • Alteration of scalp and facial hair patterns
  • Adjustment of the facial structure through surgery on the facial skeleton or the use of facial implants
  • Injectable fillers for facial contouring
  • Laser therapy for hair removal, skin pigmentation, or improvement in skin texture
  • Skin care program for skin health and appearance

Bottom Surgery

Gender reassignment through bottom surgery is an involved procedure requiring the participation of several health care professionals. It is important that this be performed in a center with experience managing patients undergoing transition. This option is now available in the Province of Ontario at Women’s College Hospital in Toronto. For more information, please click here.