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Masculinization

In 2015, Dr. Deschamps-Braly performed the world’s first ever complete female-to-male (FTM) facial masculinization surgery, which included inventing and pioneering a new surgical technique for augmenting an Adam’s apple to give it a more masculine profile and appearance.

Typically, FTM facial confirmation surgery is performed solely by plastic surgeons. However, for this surgery to be optimal your surgeon should have a deeper understanding of not only of the aesthetic qualities of the male face but also the underlying craniofacial structures that define what it is to be ‘masculine’. For this reason, we recommend that your plastic surgeon is also a qualified craniofacial (maxillofacial) and jaw surgeon to achieve the most successful result.

Many techniques are available to masculinize the body and a surgeon who is well-trained in the nuances of gender confirmation in trans men is best suited to achieve aesthetic results that will match the individual’s vision for their body. Dr. Ginger Xu is a Board-certified plastic surgeon who has helped many trans men achieve greater self-confidence through masculinizing surgery.

The Deschamps-Braly clinic offers several procedures to create a more masculine appearance in both the face and body for transmen and transmasculine patients. These may include craniofacial procedures, soft tissue surgeries, and non-surgical procedures. Our team includes experts in cosmetic and gender affirming surgeries, Dr. Deschamps-Braly and Dr. Xu. As world leaders in gender affirming procedures, each of these surgeons understands the unique needs of trans patients as well as the smallest details that make up a truly masculine appearance.

FTM Facial Gender Confirmation: Masculinizing the Face

For some FTM transmen, testosterone therapy on its own may not be enough to masculinize the face. Depending on the existing proportions of your facial features, facial masculinization surgery may be an effective adjunct to hormonal therapy. Masculinization surgery is comprised of a set of aesthetic and reconstructive surgical procedures that work to reshape female facial features to be more masculine. There are two types of individuals for whom masculinization surgery may be an ideal solution:

  • Transgender individuals (transmen) undergoing female-to-male (FTM) transition
  • Cisgender males (male assigned male at birth) wanting to appear more masculine. For example, a male who is born with a “weak chin” and wants a more chiseled and defined chin and jawline

How Is Facial Gender Confirmation Surgery Performed?

When an individual is seeking to undertake facial gender confirmation there are several categories of procedures that may be recommended depending on existing facial structures and aesthetic goals. These procedures fall under the categories of either:

Typically, facial gender confirmation surgery is performed under general anesthetic as a long-format surgical operative session during which several procedures are performed either simultaneously or sequentially.

A range of procedures is available to help you reach your goals of having a masculine chest. The best way to learn about which approach can help you is to make an appointment with Dr. Xu. During the consultation, Dr. Xu will listen to your goals, examine your body and recommend an approach that best suits your needs.

The limitations and benefits of different techniques are described below:

FAQ’S ABOUT MASCULINIZATION SURGERY

What Is FTM Top Surgery?

Also known as masculinizing chest surgery or subcutaneous mastectomy, this type of surgery aims to remove the signs of a female-appearing chest to better align with gender identity and relieve dysphoria.

This involves removing breast tissue and skin to create a flat, masculine-looking chest. A range of procedures can be used to achieve this goal (see below), each with its own features around:

  • Location of incisions
  • Extent of scarring
  • Amount of skin and breast tissue removed
  • Ability to reshape the nipple and areola
  • Retention of nipple sensation
  • Recovery process
  • Need for additional procedures

A good surgeon who listens to your vision for your body and who has experience in all the techniques is best able to match their surgical approach with your goals and body type.

 

 

Am I A Good Candidate for FTM Top Surgery?

People who are good candidates for FTM top surgery:

  • Are in good physical health
  • Are in good emotional health
  • Have stable body weight – significant changes in body weight after surgery can affect the results
  • Are close to healthy body weight – although being overweight does not exclude you from surgery
  • Are non-smokers or have quit smoking at least six weeks before surgery
  • Understand why they want to have a masculine chest
  • Are able to provide a referral letter from a mental health professional

 

How Do I Work With My Plastic Surgeon to Decide Which Technique Is Best for Me?

Dr. Xu has extensive experience with all forms of top surgeries. Through her specialized training and vast experience working with transgender people, she has developed variations on the established techniques and continues to evolve and improve the existing procedures.

You and your surgeon must communicate and work together so you have a good understanding of the recommended process. Dr. Xu will arm you with the knowledge to understand the factors affecting your top surgery and recommend the best approach to suit your pre-existing anatomy, goals, and values.

It is important that you have a realistic understanding of:

  • How your chest will look after surgery
  • Where your nipples will be positioned
  • The limitations of the surgery
  • Any short- and long-term side effects such as scarring
  • Any possible complications
  • The potential need for more surgery

 

Is Liposuction Included in FTM Top Surgery?

Liposuction for FTM top surgery is a technique available to remove very small amounts of breast tissue, although it is rarely used alone. It is often used in combination with other approaches to fine-tune the results.

Liposuction can also be used as an adjunct to help better shape the chest, by removing unwanted fat deposits in areas such as:

  • The outer region of the chest – liposuction of “side rolls” for overall chest contouring
  • Axillary fullness – liposuction of armpit fullness or rolls

To create more masculine body contoursliposuction of the torso and lower body can be performed in addition to FTM top surgery. Areas that can be contoured include:

  • Back – liposuction of fat from back rolls
  • Abdomen – liposuction in this area can be done alone or as part of a tummy tuck
  • Hips and lower body – to help create a more masculine overall appearance

 

Can I Have Body Contouring at the Same Time As FTM Top Surgery?

Yes! Transgender body contouring gives a more masculine appearance to the whole body and can be performed at the same time as FTM top surgery.

 

What Is the Cost of FTM Top Surgery?

The cost of FTM top surgery depends on which techniques are most suitable for your situation. The best way to understand the costs of top surgery is to schedule a consultation with Dr. Xu, during which a customized plan will be developed and the surgical costs reviewed. Dr. Xu will advise you of a surgical plan as well as the related costs.

 

What Are the Possible Complications of FTM Top Surgery?

Your risk for complications will depend on the specific technique used and Dr. Xu will make you aware of these before you have surgery. The risk of some common complications (such as infection, bleeding, and wound separation) can be decreased by following your doctor’s post-surgery instructions.

Potential complications after FTM top surgery include:

  • Bleeding or hematoma (a collection of blood)
  • Seroma (fluid collection) requiring drainage procedures later
  • Wound separation or breakdown
  • Temporary or permanent loss of nipple sensation
  • Reduced or changed nipple sensation
  • Loss of a nipple graft
  • Unfavorable scarring
  • Infection
  • Chronic pain
  • Suture irritation or extrusion
  • Fat necrosis
  • Minor asymmetry

 

FTM body contouring for gender affirmation involves reshaping the body into a more masculine form to relieve gender dysphoria. In addition to facial masculinization surgery and masculinizing top surgery, the areas of the body that typically can be transformed and masculinized with body contouring include:

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