Gender Affirmation Procedures

At UChicago Medicine, we offer gender-affirming procedures on the chest and trunk that can create a more masculine-looking physique, including:

• Chest masculinization with nipple reduction and repositioning (“top surgery,” also known as subcutaneous mastectomy)
• Body contouring of the trunk (including liposuction, “tummy tucks” and fat transfers)

Bottom surgery, also known as genitourinary reconstruction surgery, describes a wide range of gender-affirming procedures performed on the genitals. Some of the masculinizing bottom surgeries available from our expert surgical team include:

• Phalloplasty, which uses skin and tissue from the thigh, forearm or other areas of the body to create a penis
• Metoidioplasty, which creates a penis with existing genital tissue that has been enlarged with testosterone
• Penile implants, which improve the ability to have erections (options include semirigid/malleable implants and inflatable implants)
• Urethroplasty, which lengthens the tube in which urine travels to the tip of the penis
• Urethral stricture and fistula repair after phalloplasty
• Scrotoplasty, which creates a scrotum with or without testicular implants
• Vaginectomy, which removes the vagina
• Colpocleisis, which closes the vagina
• Vaginal preservation after phalloplasty or metoidioplasty
• Hysterectomy, which removes the uterus
• Oophorectomy, which removes the ovaries

Our skilled plastic and reconstructive surgeons also offer many procedures to give your face a more masculine look, including:

• Cheek implants (cheek augmentation)
• Jaw contouring with or without implants (jaw augmentation, also known as mandibular contouring)
• Chin reshaping with or without implants (chin augmentation, also known as genioplasty)
• Nose surgery (“nose job,” also known as rhinoplasty)
• Surgery to create an Adam’s apple (tracheal augmentation)

To help you achieve a more feminine appearance on your chest and trunk, we offer:

• Breast augmentation with implants or fat transfers
• Body contouring of the trunk (including liposuction, “tummy tucks” and fat transfers)
• Hair removal

Some of the feminizing bottom surgeries, also known as genitourinary reconstruction procedures, offered by our experienced surgical team at UChicago Medicine include:

• Vaginoplasty, which creates a vagina (options include penile inversion, intestinal, peritoneal, revision and shallow-depth vaginoplasty)
• Vulvoplasty, which creates the clitoris and vaginal lips
• Clitoroplasty, which reconstructs the clitoris
• Orchiectomy, which removes one or both testicles
• Perineoplasty, which recreates the area between the genitals and anus

At UChicago Medicine, our plastic and reconstructive surgeons also offer a wide range of feminizing procedures to help you achieve your ideal appearance, including:

• Brow lifts
• Brow and forehead reduction (brow and frontal bone contouring)
• Cheek implants (cheek augmentation)
• Jaw reduction (mandibular contouring)
• Chin reshaping (genioplasty)
• Nose surgery (“nose job,” also known as rhinoplasty)
• Facial fat transfers (facial fat grafting)
• Adam’s apple reduction surgery (tracheal shave, also known as chondrolaryngoplasty)
• Hair removal

At UChicago Medicine, we offer voice feminization surgery and Adam’s apple reduction surgery through our Voice Services for transgender and gender-diverse individuals.

Gender affirmation surgery refers to a wide range of reconstructive procedures that treat gender dysphoria, the distress a person experiences when their assigned sex at birth does not match their gender identity.

“Top surgery” is often used to describe chest masculinization surgery. It involves removing the chest tissue and resizing and repositioning the nipples to create a more masculine appearance.

“Bottom surgery,” also known as genitourinary reconstruction surgery, describes a wide range of gender-affirming procedures performed on the genitals. Bottom surgeries can be feminizing or masculinizing.

Examples of masculinizing bottom surgeries include phalloplasty, metoidioplasty and scrotoplasty. Examples of feminizing bottom surgeries include vaginoplasty, vulvoplasty and clitoroplasty.

As recommended under the World Professional Association for Transgender Health (WPATH), patients seeking top surgery must have a referral from a mental health provider. Patients seeking bottom surgery must have referrals from two mental health providers.

It is also recommended that patients undergoing top or bottom surgery live full-time in their identified gender for at least 12 months beforehand.

However, you do not require a referral from a mental health provider to have facial feminization or masculinization surgery.

Many health plans provide some coverage of affirming surgeries with the proper documentation, but others may still deny coverage. We recommend reaching out to your health plan to understand the specific requirements.

It’s important to allow a few months to heal between certain gender affirmation surgeries, such as a phalloplasty and a hysterectomy. This can help ensure the success of your procedures.

When you work with the surgeons at UChicago Medicine, we will coordinate your care to ensure the appropriate timing of your operations to optimize your results.

Before you have a gender-affirming procedure, our reproductive endocrinology/fertility specialists can meet with you to discuss ways to preserve your fertility if you may want to become a parent in the future.

At UChicago Medicine, we have one of the most comprehensive teams of experts dedicated to affirming health care for transgender and gender-diverse people. Our surgeons are skilled in performing microsurgical procedures that can be used during gender-affirming surgery to maximize sensation and function. This includes abdominal flaps, groin flaps (SCIP flaps), vaginal flaps, radial forearm free flaps (RFFFs) and anterolateral thigh (ALT) flaps. We also routinely treat patients seeking revision surgery or those who were told they were not candidates for surgery because of comorbidities like obesity.

In addition, our team is fully committed to providing you with patient-centered care in an affirming, welcoming environment. We aim to treat you with courtesy and respect during each interaction with our surgical team.

• Mastectomy with removal of breasts
• Chest contouring to create a masculine appearance after a mastectomy

• Hysterectomy (removal of the uterus)
• Oophorectomy (removal of the ovaries)
• Metoidioplasty
• Complex Genitourinary reconstruction (congenital, traumatic and oncologic)
• Complex Urethroplasty
• Urethral Fistula repair after phalloplasty

Penile construction surgery, including:

• Abdominal flap
• Groin flap (also known as SCIP flap)
• Metoidioplasty, with and without urethral lengthening
• Phalloplasty, which involves removing the vagina (vaginectomy) and reconstructing the urethra and penis
• Radial forearm flap (RFAFF) and anterolateral thigh flap (ALT) microsurgical (procedures that maximize sensation and function)
• Orchiectomy (removal of one or both testicles)

Penile implants, including:

• Penile prosthesis implantation to improve erectile capability
• Semi-rigid/malleable implants
• Two- and three-piece inflatable implants
• Scrotoplasty and testicular implants

Vaginoplasty, including:

• Inversion vaginoplasty
• Intestinal vaginoplasty
• Peritoneal vaginoplasty
• Revision vaginoplasty
• Shallow depth Vaginoplasty
• Vulvoplasty

• Facial masculinization to give feminine faces a more masculine appearance
• Body contouring, including removing fat to create a masculine look

• Facial feminization, such as altering the chin, nose, cheeks, forehead, and other features to appear more feminine

• Breast augmentation with either fat grafting or implants

• Body contouring procedures, including fat transfers, to enhance a feminine shape