Individuals considering transgender surgery procedures, including female-to-male and male-to-female top and bottom surgery, choose UVA Plastic Surgery, one of the leading providers of gender-confirming procedures in the region. Dr. John Stranix is a trusted plastic surgeon who combines exceptional surgical talent with an inclusive and compassionate demeanor to make your transition go as smoothly as possible.
Dr. Stranix is carrying on the legacy of the late Dr. Milton Edgerton, who established UVA Plastic Surgery and was one of a handful of pioneers in the field of transgender surgery.
How Is Gender Confirmation Surgery Performed?
Transgender surgical procedures include top surgery, bottom surgery, and facial plastic surgery. Each procedure involves specific techniques designed to help patients feel more comfortable physically by creating results that more closely resemble their identified gender.
Keep in mind that each patient is unique and your results may vary.
Chest Masculinization: Circumareolar approach
Breast Augmentation with Fat Grafting
Chest masculinization, Grade II Ptosis: Double incision with free nipple grafting
Nonbinary chest flattening without nipple reconstruction
Chest masculinization, Grade I Ptosis: Double incision with free nipple grafting
Chest Masculinization, Grade III Ptosis: Double incision with free nipple grafting
Keep in mind that each patient is unique and your results may vary.
What Is Top Surgery?
Top surgery directly addresses the chest’s appearance. Dr. Stranix customizes these surgical procedures based on the patient’s goals.
Male to Female (MTF)
MTF procedures use implants to create larger, more feminine breasts. In some cases, fat grafting can also help enhance the look and feel of the results or may be used as the primary method of augmentation alone. As with all breast augmentation procedures, the MTF top surgery can be customized based on the patient’s preferences. Many patients choose implants filled with silicone gel because they look and feel more like natural breasts than saline implants. Saline implants are also more prone to visible rippling. Dr. Stranix also offers autologous breast reconstruction for gender confirmation using tissue from the patient’s lower abdomen in a procedure referred to as a DIEP free flap. It is a technique often used for breast reconstruction.
During your initial consultation, Dr. Stranix discusses the details of each procedure, including the surgical technique, your breast implant options, and what to expect during the recovery.
Female to Male (FTM)
Creating a flatter chest involves removing breast tissue and, in many cases, reducing the size of the areolas and changing their position so they appear more masculine. The size of the patient’s breasts and the amount of skin, along with the size and position of the areolas, influence the specific surgical technique used during FTM top surgery.
A less invasive periareolar approach may be appropriate for patients with smaller breasts. This technique uses liposuction to remove breast tissue from behind the nipple and is often combined with an incision around the areola to reduce the areolar size.
For most patients with moderate to large breast volumes, Dr. Stranix utilizes the “double incision” technique. This method involves incisions above and below the areola along the inferior (lower) pole of the breast. This is designed so that the final incision follows the inferior border of the pectoralis major muscle—the most defining characteristic of a male chest. The nipple/areola are removed and then replaced in the appropriate position and size as free grafts after removal of all glandular breast tissue and excess chest skin. Liposuction may also be used as an adjunct in some cases as needed to optimize the result.
In both MTF and FTM top procedures, as with breast augmentation and breast reduction surgeries, Dr. Stranix tailors the surgical approach to provide the desired results while minimizing the appearance of scars. He provides detailed post-operative instructions for both MTF and FTM top procedures.
What Is Bottom Surgery?
Male-to-female and female-to-male sex reassignment surgeries use specific techniques to reconstruct patients’ genitalia to match that of their gender identity.
MTF Bottom Surgery
The goal of MTF bottom surgery is to create the most aesthetically appealing and functional vagina possible. Multiple procedures may be needed to reach these goals, including surgery designed to provide vaginal and clitoral sensation. These operations require the expertise of a multidisciplinary team that includes plastic surgery, urology, and sometimes colorectal surgery. Surgical procedures that may be involved in MTF bottom surgery include:
- Penile skin inversion vaginoplasty with or without scrotal skin grafting
- Revision vaginoplasty using small bowel or the rectosigmoid colon
- Secondary genital reconstruction
During a one-on-one consultation, Dr. Stranix explains these procedures in detail and the benefits they offer.
FTM Bottom Surgery
Surgery to create male genitalia can be performed using different techniques and may or may not be combined with a hysterectomy. One technique, called phalloplasty, uses tissue from either the forearm or the thigh to create a phallus and a urethra for standing urination. These procedures are usually performed in 2 stages. Dr. Stranix also performs metoidioplasty, which elongates the existing genital tissue to create a more defined phallus in a single stage.
The details of the procedure, the course of recovery, the expected outcomes, and the possible complications are covered in detail during your surgical consultation.
Facial Plastic Surgery
Your face can quickly communicate your gender identity to others. Dr. Stranix performs aesthetic procedures to make facial features appear either more feminine or more masculine. Because no single feature makes a face appear feminine or masculine, a range of surgical and nonsurgical approaches can be used to achieve these goals.
A feminine face is typically softer and more rounded than a masculine face. Lower face and neck lifts can help create this appearance by repositioning tissue and muscle using incisions made where they will be almost imperceptible. These techniques can produce a thinner, more feminine jawline and an overall heart-shaped facial structure.
Other procedures used for facial feminization include:
- Hairline/scalp modification
- Face lifting
- Facial volume enhancement using fat grafting or filler
- Brow reshaping
- Upper/lower eyelid surgery (blepharoplasty)
- Laser skin resurfacing
- Lip enhancement
- Laser hair removal
Many MTF patients can also benefit from a procedure commonly called a tracheal shave, which reduces the size of the Adam’s apple.
A well-defined chin, chiseled jawline, and angular features define the masculine face. Dr. Stranix tailors his surgical plans based on the needs of each patient, but they usually involve a combination of procedures focused on sculpting the chin, jaw, and cheeks to appear more masculine.
Synthetic implants can be used to enhance the shape of the chin, jaw, and cheeks. These facial contouring procedures can be combined with nose reshaping (rhinoplasty) and increasing the size of the Adam’s apple using an implant.
Transgender Surgery FAQ
Is gender reassignment surgery safe?
While there are risks associated with all types of surgery, for optimal safety it’s important to choose a surgeon who specializes in gender confirmation surgery and has performed many of these procedures for a variety of patient needs. Dr. Stranix and his team perform a thorough evaluation to ensure each patient is a good candidate for surgery and minimize risks.
How common is gender reassignment surgery?
Gender reassignment (confirmation) surgery is more common in transgender men (42 to 54%) than transgender women (28%). Top (chest gender confirmation) surgery is performed approximately twice as often as bottom (genital) surgery. In studies that assessed transgender men and women as an aggregate, top surgery accounts for 8 to 25% and bottom surgery at 4 to 13%. Review study details.
How long does it take to transition to another gender?
Gender transitioning is a very personal and variable process that can take many months to many years, depending on the specific steps the individual chooses to take. The process can involve psychological assessment, hormone therapy, and gender reassignment surgery. For patients that decide to have surgery, some have only one surgery and others have a combination.
Can breasts grow back after top surgery?
Breast tissue does not grow back after it is removed. Dr. Stranix leaves some fat behind to create natural-looking chest contours. While this fat can enlarge like fat anywhere on the body, it likely will not take on a feminine appearance.
Are you ready to find out more?
Dr. Stranix sees transgender plastic surgery patients from throughout Virginia and as far as Tennessee, West Virginia, and North Carolina who travel to UVA Plastic Surgery for its track record of exceptional results. The experience is a deeply personal one, and our practice is thrilled to expand our services to provide even more opportunities for empowerment through plastic surgery.