Trans surgery, formally called gender-affirming surgery, is a set of surgical procedures that reshape the body to match a person’s gender identity. There is no single “trans surgery.” The term covers a wide range of operations, from chest reconstruction and genital surgery to facial reshaping and voice modification. Which procedures a person pursues depends on their goals, and many people choose only one or two rather than every available option.
Types of Gender-Affirming Surgery
Gender-affirming procedures fall into several broad categories: chest surgery, genital (or “bottom”) surgery, facial surgery, and voice surgery. Some people also pursue body contouring or hair removal, though these are less commonly discussed under the surgical umbrella. The most frequently referenced procedures are chest reconstruction and genital surgery, but facial feminization is increasingly common and can have a significant impact on how a person is perceived in daily life.
Chest Surgery (“Top Surgery”)
Masculinizing chest surgery removes breast tissue to create a flatter, more traditionally masculine chest contour. Several techniques exist, and the choice depends largely on breast size and skin elasticity. People with smaller chests and good skin elasticity may qualify for less invasive approaches, such as a semicircular or periareolar technique, which leave minimal scarring. Those with larger chests typically undergo a double-incision procedure, where the surgeon removes breast tissue and excess skin through two horizontal incisions, then repositions the nipples as free grafts.
The double-incision method offers the best contouring results but leaves visible horizontal scars across the chest. One known tradeoff of the free nipple graft approach is some loss of nipple sensation and possible changes in nipple color over time. Some surgeons use a pedicle technique that keeps the nipple attached to its blood supply to preserve sensation, though this can limit how precisely the chest can be sculpted.
For transfeminine individuals, breast augmentation with implants is an option, though many people find that hormone therapy alone produces enough breast development.
Feminizing Genital Surgery
The most common feminizing genital procedure is penile inversion vaginoplasty. The surgeon uses penile and scrotal skin to create both the external vulva and an internal vaginal canal. The skin is separated from underlying tissue, formed into a tube over a medical dilator, and then inverted into a space the surgeon opens between the bladder and rectum. The result is a vaginal canal typically wide enough to accommodate a 35-millimeter dilator.
When a person’s anatomy doesn’t provide enough skin for adequate depth, surgeons can supplement with peritoneal flaps, tissue borrowed from the membrane lining the abdomen. This robotically assisted technique adds depth to the canal without needing skin grafts from other parts of the body, which reduces additional scarring and donor-site complications. Other less common approaches use a segment of the colon, though this carries its own set of risks.
After vaginoplasty, regular dilation is essential. Patients use medical dilators multiple times a day in the early weeks, gradually tapering to a maintenance schedule over several months. Skipping dilation can lead to the canal narrowing or losing depth, so this ongoing commitment is one of the most important things to understand before choosing the procedure.
Masculinizing Genital Surgery
Transmasculine individuals have two main options for genital surgery: metoidioplasty and phalloplasty. The two differ significantly in size, complexity, recovery, and risk.
Metoidioplasty works with existing anatomy. Testosterone therapy enlarges the clitoris over time, and the surgeon releases it from surrounding tissue to increase its projection, creating a small penis. The procedure can include urethral lengthening so the person can urinate while standing, though this step is optional. Metoidioplasty preserves natural erectile function and sensation, involves fewer surgical stages, and has a lower complication rate. The main limitation is size: the result may not be large enough for standing urination or penetrative intercourse in every case.
Phalloplasty creates a larger penis using a skin flap, most commonly taken from the forearm or the front of the thigh. The forearm flap is popular because the tissue contains two nerves, which improves the chance of developing sensation in the new phallus over time. However, this leaves a visible scar on the arm. Thigh flaps produce a less conspicuous donor scar but may offer slightly different aesthetic results. Phalloplasty typically requires three or four staged surgeries and a longer overall recovery period. A penile prosthetic can be placed in a later stage to allow for erections.
The biggest distinction in risk is urethral complications. Phalloplasty carries a fistula rate (an unintended opening in the urinary channel) of roughly 28%, and urethral strictures, where the channel narrows and obstructs urine flow, occur in 20% to 44% of cases depending on the flap type. These often require additional corrective procedures. Metoidioplasty has substantially lower rates of both. For many people, the decision comes down to priorities: those who value sensation and fewer surgeries lean toward metoidioplasty, while those who prioritize size and the ability to urinate standing tend to choose phalloplasty.
Facial Feminization Surgery
Facial feminization surgery (FFS) is a collection of procedures that soften features commonly perceived as masculine. The specific combination varies by person, but the most common targets are the forehead, nose, jaw, and chin.
Forehead contouring reduces the bony ridge above the eyes. The surgeon may shave the bone down directly or, for more prominent ridges, cut out a section of bone and replace it with a reshaped graft that sits flush. Hairline advancement can be done at the same time to reduce a high or receding hairline. Rhinoplasty narrows the nose and refines the bridge and tip. Jaw contouring shaves or cuts the corners of the lower jaw to create a softer angle, while chin reduction reshapes the chin bone into a less prominent, more oval profile. A tracheal shave reduces the visibility of the Adam’s apple by trimming the cartilage of the larynx.
FFS is sometimes described as the procedure with the greatest impact on daily social interactions, since the face is the primary way people are identified by others.
Voice Surgery
Testosterone deepens the voice permanently, so most transmasculine individuals don’t need voice surgery. Transfeminine individuals, however, don’t experience voice changes from estrogen, making voice training or surgery the main options.
Surgical techniques raise vocal pitch by modifying the tension, mass, or length of the vocal folds. Simpler one-factor procedures address just one of these variables. More complex approaches combine two or three modifications. A two-factor technique combining laser thinning of the vocal folds with a tension-increasing procedure raised pitch by an average of 45 hertz in published data. A three-factor endoscopic approach produced a mean increase of about 77 hertz across transgender patients, though results were more modest in patients over 50. External three-factor approaches can push pitch up by as much as 320 hertz, but this sometimes produces a voice that sounds unnaturally high.
Requirements Before Surgery
Most surgeons follow the criteria outlined by the World Professional Association for Transgender Health (WPATH). The current standards require that a person has a sustained experience of gender incongruence, demonstrates the capacity to consent, and has had any mental or physical health conditions that could affect surgical outcomes properly assessed. For genital surgeries, at least six months of hormone therapy is typically recommended, unless hormones are medically contraindicated or not desired. Patients are also expected to have explored their options regarding fertility, since many of these procedures affect reproductive capacity.
Recovery Expectations
Recovery varies widely depending on the procedure. Chest surgery generally involves a few weeks of restricted activity, with most surgeons recommending limits on lifting (often 10 pounds or less) for four to six weeks. Genital surgeries require longer recovery windows. After vaginoplasty, the dilation schedule is the most demanding part of aftercare, requiring consistent daily attention for months. Phalloplasty, because it involves multiple staged procedures, can mean a recovery process stretching over a year or more when all stages are included.
For minimally invasive procedures like tracheal shaves, recovery can be as short as one to two weeks. Facial feminization surgery falls somewhere in between: significant swelling and bruising last a few weeks, but the final result may take several months to fully settle as bone and soft tissue heal.
Satisfaction and Regret Rates
A systematic review and meta-analysis covering nearly 8,000 patients found that the pooled regret rate after gender-affirming surgery was 1%. Regret was slightly more common after vaginoplasty (about 2%) and lowest after chest masculinization (less than 1%). Of the 77 patients across all studies who expressed regret, about half had what researchers classified as minor regret rather than a desire to reverse the procedure entirely. The same body of research documents significant improvements in quality of life, body satisfaction, and overall psychological well-being after surgery.