Masculinizing Gender Confirmation Surgery

“In my practice, I’ve found that facial and top surgery tend to be the most common procedures,” says Dr. Aditya Sood, a board-certified plastic surgeon in Skokie, Illinois. “This may be due to various factors, but social media influence and the visibility of these areas are likely the main reasons.”

While many surgeons perform transgender procedures, it’s important to find a board-certified plastic surgeon or facial plastic surgeon who specializes in surgical techniques for the specific procedures you’re seeking. Some surgeons focus primarily on facial plastic surgery, while others routinely perform top surgery (aka transgender mastectomy) and/or bottom surgery (phalloplasty). 

These are the most popular transgender surgery options for men.

	Rhinoplasty surgical	Chin Implant surgical	Masculinizing Top Surgery surgical	Transgender Phalloplasty surgical
Worth It Rating	90%	88%	98%	88%
Average Cost	$11170	$7601	$8318	Not yet available
Downtime	Up to 2 weeks of downtime	Up to 1 week of downtime	2 weeks of downtime	4–6 weeks of downtime
Anesthesia	General anesthesia or local anesthesia with sedation	Local anesthesia with IV sedation	General anesthesia	General anesthesia

Facial procedures

• Facial masculinization surgery “Masculinization depends on what the patient already has in their facial features,” says board-certified Beverly Hills facial plastic surgeon Dr. Toby Mayer in a RealSelf Q&A. “Making the chin and nose larger as well as dropping high brows and making the cheeks larger will do this.” Depending on your anatomy, you may opt for: 
• Forehead lengthening and augmentation, to achieve a more dominant forehead with lower-set eyebrows
• Cheek, chin, and jaw augmentation, to create a square jaw and more chiseled overall aesthetic
• Rhinoplasty, to balance your nose with larger facial features
• Adam’s apple enhancement, to create a more masculine-looking neck
Dr. Justine Lee, a board-certified facial plastic surgeon in Los Angeles, reports receiving far fewer requests for masculinization procedures than for facial feminization surgery, but the transmasculine patients she does treat commonly desire more angularity in the lower face—something she achieves with sturdy 3D-printed implants for the chin and the mandibular angles of the jawline.  Recovery time will vary by the number and extent of procedures performed, but most patients can get back to work and social engagements within a month. Your surgeon will provide thorough post-op care instructions and prescribe pain medication in order to help you manage post-op swelling and discomfort.

Body procedures

• Top surgery, or chest masculinization surgery, removes breast tissue via a bilateral mastectomy or, “occasionally, breast reduction, to create a male mound of the chest, with nipple repositioning,” Dr. Sood says. “There are several nuances and methods to surgery, but the goal is to keep any surgical scars in the shadows of the native pectoralis muscle, create a more masculine-shaped and -sized nipple/areola, and create a good overall contour from all views.”  As board-certified Newport Beach, California, plastic surgeon Dr. Jed Horowitz explains in a RealSelf Q&A, “The chest can also be made more masculine with fat grafting or pec implants, to provide a more muscular and sculpted appearance.” When deciding which procedure to perform, surgeons consider the patient’s current breast size and ptosis (degree of droopiness), along with the size and positioning of the nipple-areolar complex. “All these factors help us decide which masculinizing techniques will best fit our patient,” says Dr. Sood.  Hormone replacement therapy (HRT) is not required for top surgery, adds Dr. Horowitz, unless you're seeking insurance coverage. (In that case, companies often require patients to be on HRT for one year prior to surgery.) “The benefits of HRT include heavier chest muscles and more chest hair, which can cover some incisions while you are healing,” he explains. Dr. Sood notes that “recovery tends to be much easier than most patients envision.” Many rely on narcotics for only a day or two. “Drains and negative pressure incisional therapy will remain for seven days, and a binder and nipple wound care generally last for three weeks post surgery,” he says. To decrease stress on the surgical scars, he restricts patients’ arm movement to 90 degrees for three weeks post-op.  Find doctors who perform top surgery
• There are two primary options for FTM bottom surgery: phalloplasty and metoidioplasty. Both procedures create a functional penis for a transgender man. A phalloplasty may be done in stages. The process usually starts with a vaginectomy, to remove the vaginal walls and close the opening, as well as a urethroplasty, which lengthens the urethra in order to give you the ability to pee standing up. Other complementary procedures that may be performed early on include a hysterectomy, to remove the uterus, and an oophorectomy, to remove the ovaries. Next, your surgeon creates the neo-penis. Tissue is removed from elsewhere on the body—often the forearm, thigh, abdomen, or upper back—and used to construct the penile shaft. Then a glansplasty is performed, using the clitoris to form the tip of the new penis and create some erectile function. Talk with your surgeon about penile implants or inflatable devices that help maintain a full erection. Some patients opt for a metoidioplasty, which uses only existing genital tissue. Once the clitoris has been enlarged by testosterone therapy, it forms the shaft of the new penis. Like phalloplasty, metoidioplasty procedures often involve a glansplasty and urethral lengthening.  Both procedures usually include a scrotoplasty, which creates a new scrotum using tissue from the labia majora that’s filled out with silicone testicle implants. Note that you can have a phalloplasty after a metoidioplasty, but not vice versa. Find doctors who offer phalloplasty

Related: I Got My Gender Confirmation Surgery at 54—and I Finally Feel Liberated