Gender Affirmation Procedures

Gender Affirmation Procedures

A large part of individual identity lies in our appearance. For transgender individuals, this means the ability to bring their physical appearance into alignment with their true sense of self. We are proud to offer gender affirmation procedures at Elite Transformations. These procedures include chest reconstructive surgery,  facial feminization, and body contouring.

For the chest, male to female breast augmentation and female to male top surgery techniques are offered. Facial feminization and body contouring by both surgical and non-surgical means are offered as well.

Dr. Fisher’s office in Palo Alto, California is conveniently located in the San Francisco Bay Area. We provide compassionate care to patients from nearby metropolitan areas including San Francisco and San Jose, as well as to those who travel from out of state and internationally to see us for gender affirmation procedures.

Female to Male Top Surgery 

FTM chest reconstruction, also called Top Surgery, is performed for transgender men and non-binary transmasculine individuals. This procedure involves removal of existing breast tissue by various techniques to create a masculine chest. Female to male top surgery may be further complemented by appropriate body contouring procedures for masculinization. These may include liposculpting of the axillary area, which is fullness that often extends from the side of the chest to the underarm region. Fat reduction of the “muffin top” or flank areas to create a more masculine hip line can also be performed.

FTM Top Surgery Techniques

There are a number of techniques that may be considered for female to male top surgery and the technique chosen depends on multiple factors. Dr. Fisher performs all state-of-the art techniques, and the surgery is tailored to the individual. The incision type and tissue removal procedures you may be candidate for are determined by factors such as the amount of existing breast tissue, current breast size, and breast shape. Different incision techniques, such as keyhole, periareolar, and double incision all lead to different scar patterns. Dr. Fisher will help you understand which technique is most appropriate for you.

Recovery from FTM Top Surgery

Patients will need care at home and supervision for a few days after surgery. Care is generally done by a family member, close friend, or intimate partner. A compression garment will be worn for several weeks after surgery. Comfort is initially managed with prescription pain medication and progresses to over-the-counter medication within the first week after surgery. The ability to shower after surgery depends on the technique used. In some cases, drain tubes are placed, and will stay in place for 1-2 weeks. While walking is encouraged after surgery, it is important to limit activities requiring upper body motion. In most cases, light physical activity can be resumed 1 week after surgery, and vigorous activity must be avoided for at least 1 month after surgery. Most people are excited to see that within 3 weeks after surgery, your result will start to be clear.

Male to Female Breast Augmentation

Top Surgery | Transgender Surgery San Francisco | Palo Alto CATransgender women and transfeminine gender non-conforming individuals on hormone therapy may not obtain their desired degree of breast development with hormones alone. MTF breast augmentation is surgical breast enhancement using saline or silicone gel breast implants. This procedure allows for both increase in size and fullness of the breasts to create a much more feminine contour.

There are multiple implant options, and the implant choice depends on multiple factors. Patients may choose between saline and silicone gel implants, each of which is made in varying projections, sizes. Silicone breast implants in general have a more natural feel and are preferred when there is little natural breast tissue to cover them. Saline implants allow for the most volume at their largest. Each one may have advantages and/or disadvantages for any given person. In your consultation with Dr. Fisher, the type of implant that will best suit your desired outcome will be selected.

Recovery from MTF Breast Augmentation

Swelling and bruising are normal side effects of breast augmentation surgery. Discomfort and swelling are managed with prescription medications and ice packs initially, and later, over-the-counter medications and proper wear of the recommended garment or bra.

Patients should have a personal care assistant during the first 48 hours after surgery, if not longer. Physical activity including lifting objects and strenuous exercise will need to be avoided for several weeks no matter how good you feel. Walking is resumed and encouraged immediately after surgery. It will take several months for your final outcome, oftentimes longer than that for cis women, and Dr. Fisher will prepare you for that progression.

Gender Affirming Body Sculpting

Body type is a combination of fat distribution, muscle mass, and bone structure. The shape of one’s body is therefore largely determined by genetics and body composition. Body sculpting procedures are performed to assist trans people to feel more confident in their physiques.

Trans men may move toward a more masculine body shape with liposuction to reduce the contour of the hips, flanks, thighs, back, and other bothersome areas.

Trans women may also turn to liposuction to accentuate curvature in the waist or other areas. Buttock augmentation may also be performed to add feminine contouring in appropriate candidates.

Non-surgical procedures such as Vanquish ME, a state-of-the-art radiofrequency technique, provides circumferential fat reduction without surgery.

Facial Feminization Procedures

Some patients seeking to have more feminine facial features will benefit from facial feminization procedures. Facial feminization surgery can be a pivotal step toward the expression of gender. There is no “one size fits all” protocol to achieve a desirable outcome. As with all procedures done by Dr. Fisher, facial feminization is tailored to the individual. Dr. Fisher spends a great deal of time with each patient in order to evaluate and understand the objective to be met. We understand that some patients may be interested in a dramatic change as quickly as possible, and others may want to take a more gradual approach to facial changes.Facial Feminization | Transgender Surgery San Francisco | Palo Alto CA

Common procedures performed in facial feminization include:

  • Forehead contouring
  • Browlift
  • Eyelid surgery (blepharoplasty)
  • Cheek augmentation
  • Rhinoplasty
  • Facelift/necklift
  • Lip augmentation
  • Chin and neck contouring
  • Trachea shaving
  • Hair transplantation
  • Permanent makeup
  • Injectable procedures (botox, fillers)

Candidates for Gender Affirmation Procedures

Gender affirmation procedures are appropriate for non-smoking individuals who have come to an informed decision about permanently altering their outward appearance. Patients who are prepared for this change, and who have realistic expectations of what is possible for them after comprehensive consultation, are the happiest with the outcome of their decision.


Transgender Surgery | Gender Affirmation San Francisco | Palo Alto CA
Schedule a Consultation

Dr. Fisher would be happy to speak with you about your personal goals for gender affirmation.

If you’re ready to learn about your options, we should talk! Call to schedule your appointment at our office in Palo Alto, CA at ‭650.321.2629‬.

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