Transgender, nonbinary, intersex and gender-nonconforming individuals may decide to have feminizing top or bottom surgery to help them embrace their gender identity. Feminizing gender-affirming surgery involves breast augmentation to achieve feminine proportions (chest feminization), removal of the testicles (orchiectomy) and creation of external genitalia (vaginoplasty and vulvoplasty).
We follow the World Professional Association for Transgender Health’s standards when performing feminizing top and bottom surgeries. These guidelines are set for safe, effective physical and mental health care for transgender and gender-nonconforming patients. Requirements for each procedure will vary.
Procedures offered:
Chest feminization
Our plastic surgeons use implants and contouring to achieve feminine proportions. Our specialists have extensive experience with chest reconstruction and work with you to find the best technique that meets their goals. Chest feminization options
- Type of implant (saline or silicone)
- Shape of implant
- Implant placement (above or below muscle)
- Incision site
Who’s eligible for chest feminization?
To be eligible for chest feminization, you must:
- Meet criteria set by WPATH guidelines
- Be nicotine-free at least six weeks prior to surgery
- Have other health conditions such as diabetes, weight and high blood pressure reasonably controlled
Post-surgery recovery for chest feminization
Most patients who undergo chest feminization go home the same day and return to normal activities within six weeks.
Prior to your surgery, your surgeon will discuss specific restrictions you may have during your recovery period.
Risks after surgery
- Scar tissue formation. This can become uncomfortable or change the shape of the breast.
- Implants that leak or rupture based on type. These have to be removed.
- Changes in how the nipple feels.
- Infection.
- A need to redo surgery. This may be needed if the breasts are lopsided or wrinkled.
Orchiectomy
Orchiectomy is surgical removal of one or both testicles. It can be done as a separate step for gender affirmation. Patients may choose this option to remove the body’s source of testosterone, as part of a vaginoplasty or vulvoplasty, to relieve dysphoria or to lower some estrogen therapy requirements.
We perform orchiectomy through a small incision in the scrotum, for most patients. We provide individualized care and take into consideration possible future reconstructive needs, as the scrotal skin can be used for vaginoplasty.
Who’s eligible for orchiectomy?
To be eligible for orchiectomy, you must:
- Meet criteria set by WPATH guidelines, including two letters from your mental health providers
- Be nicotine-free at least six weeks prior to surgery
- Have other health conditions such as diabetes, weight and high blood pressure reasonably controlled
Post-surgery recovery for orchiectomy
Most patients who undergo orchiectomy go home the same day and return to normal activities within two to three weeks.
Prior to your surgery, your surgeon will discuss specific restrictions you may have during your recovery period.
Risks after surgery
- Immediate risks include a small chance of bleeding and infection.
- Lowering testosterone increases the risk of bone loss and heart disease, so we recommend routine check-ups in the future.
- Without prior sperm-banking, you cannot have biological children. If you wish to have children, discuss this with your surgeon, as there are many options available to preserve fertility.
Vaginoplasty
Vaginoplasty is surgery that creates external genitalia that resembles and functions as close to cisgender female genitalia as possible. It addresses gender dysphoria and provides orgasmic sensation, penetrative intercourse, cosmetic appearance and urinary function consistent with an individual’s gender identity.
Nima Baradaran, MD, a reconstructive urologist, and Rajiv Chandawarkar, MBBS, a reconstructive plastic surgeon, collaboratively perform vaginoplasty.
Vaginoplasty options
- Penile inversion vaginoplasty uses different parts of the existing male genitalia to reconstruct female organs. This is the most common technique for vaginoplasty, and is what we offer to most individuals at the Ohio State Wexner Medical Center.
- Intestine vaginoplasty is a procedure that uses a piece of intestine to create the vaginal canal. This technique is used usually for major revision or if local tissue is unusable.
- Peritoneal flap vaginoplasty is a similar technique to penile inversion and can be considered in the setting of revision surgery or if there isn’t enough local tissue to reconstruct the vaginal canal. We usually perform this technique robotically, and it can be considered for certain individuals.
Who’s eligible for vaginoplasty?
To be eligible for vaginoplasty, you must:
- Meet criteria set by WPATH guidelines, including two letters from your mental health providers
- Be nicotine-free at least eight weeks prior to surgery
- Have other health conditions such as diabetes, weight and high blood pressure reasonably controlled
- Secure adequate resources for hair removal and recovery after surgery
Before vaginoplasty surgery
- We encourage you to read and learn as much as possible about vaginoplasty
- Talk to our patient care navigator who’ll help guide you through your transition journey
- Write down questions you have for your care team
- We encourage you to bring someone whom you trust to the appointment for support
- Plan to discuss hair removal and complete nicotine restrictions with your care team
Post-surgery recovery for vaginoplasty
This is a long and complex surgery. Most patients who undergo vaginoplasty spend three to five days in the hospital for monitoring. You’ll have a urinary catheter, surgical dressings/packing and surgical drains. Your surgeon will discuss these details with you prior to your surgery. Most patients require six to eight weeks of recovery at home, with reduced activity and restrictions.
Risks after vaginoplasty surgery
Major complications after vaginoplasty are uncommon. Minor complications include wound and urinary tract infection, wound healing issues and scar formation. Your surgeon will discuss more serious but rare complications with you prior to surgery.
Dilation and douching
Douching of the vaginal canal allows you to remove old skin secretions and avoid infections.
Since the new vagina is made of skin that lacks the elastic properties of cis female genitalia, dilation is crucial to maintain the depth of the new vagina. Our pelvic floor physical therapists teach patients how to relax pelvic floor muscles to assist with dilations and intercourse. You’ll see physical therapists prior to and after surgery until you’re comfortable with the dilation process.
You should expect to perform dilations three times a day for 30 minutes and gradually increase the dilator size up to your goal during the first six to 12 months after surgery and slowly decrease the frequency afterward. This is a lifelong process, and if you think this isn’t feasible, you should discuss it with your surgeon to find alternative solutions.
Vulvoplasty
Vulvoplasty or “zero-depth vaginoplasty” is a technique similar to regular penile inversion vaginoplasty but without creating a vaginal canal. The external genitalia, orgasmic function, sensation and urinary function are similar to cis gender females. Vulvoplasty can be considered in patients who aren’t interested in penetrative intercourse or have certain medical conditions such as conditions involving the rectum or previous prostate cancer treatments that make creation of a vaginal canal high risk. This procedure doesn’t require hair removal prior to surgery or dilation afterward. You can discuss this option with your surgeon in more detail.
Who’s eligible for vulvoplasty?
To be eligible for vulvoplasty, you must:
- Meet criteria set by WPATH guidelines, including two letters from your mental health providers
- Be nicotine-free at least eight weeks prior to surgery
- Have other health conditions such as diabetes, weight and high blood pressure reasonably controlled
- Secure adequate resources for recovery after surgery
Post-surgery recovery for vulvoplasty
Most patients who undergo vulvoplasty stay in the hospital for one to three days. Recovery is generally faster than classic vaginoplasty.