Feminizing Gender-Affirming Procedures
Many transgender women and transfeminine people seek gender-affirming surgery to help align their physical characteristics with their gender identity.
Feminizing procedures include breast augmentation (top surgery), vaginoplasty (bottom surgery), facial feminization surgery, or a combination of treatments.
There is no single “right” path. Your plan will be based on your goals, anatomy, medical history, and readiness.
At UVA Health, our surgical team provides comprehensive, respectful, and individualized care.
During your first visit, we'll go over:
- Your goals and expectations
- Available surgical options
- Benefits and limits of each procedure
- Risks and potential complications
- Recovery timelines
- Long-term outcomes
Our goal is to ensure you feel informed, supported, and confident in every decision.
Gender-Affirming Surgery at UVA Health
At UVA Health, our surgeons understand the importance of aligning your physical appearance with your gender identity. Plastic and reconstructive surgeon JT Stranix, MD, and urologist Sean Corbett, MD, discuss the commitment and care offered by our transgender surgery specialists.
Dr. JT Stranix: I can only imagine how distressing it is to have an external anatomic appearance that is not congruent with how you identify as an individual person in terms of where you fall on the gender spectrum. That, I'm sure, has an enormous impact on self-esteem, self-confidence, overall wellbeing. And so the primary goal of any patient encounter I have is to firmly establish what their needs are so that I can help them achieve those. From a masculinization standpoint, whether they need a double incision technique, or if we're able to get away with a minimally-invasive technique that leaves just scars around the nipples. From a feminization standpoint, there's a large range of different chest shapes and sizes. And I want to make sure that I know where they want to end up so that I can help them get there. Dr. Sean Corbett: I offer various gender confirmation procedures, specifically bottom surgery procedures. Most of what I've been offering from a surgical standpoint is gender-confirming surgery for the male to female transition, primarily orchiectomy, scrotal excision, some of the more straightforward procedures like that. But pairing up with Dr. JT Stranix and our plastic surgery department, our goal is to offer the full complement of bottom surgery procedures, including vaginoplasty, and phalloplasty, and metoidioplasty. Dr. JT Stranix: This program is really something special. We all, as providers, like each other, respect each other, and look forward to collaborating and working with each other. That dynamic has led to a really robust program that has a very positive trajectory. Dr. Sean Corbett: My experience thus far is when these patients come in after their procedures, in general, there is kind of like a weight lifted where they're so satisfied with what's been done.
Feminizing Procedures
We offer several types of feminizing gender-affirming procedures.
Top Surgery (Chest Feminization)
Top surgery enhances breast size and contour to create a more traditionally feminine chest.
Hormone therapy may help breast development, but many patients choose surgical augmentation for increased volume, symmetry, and projection.
We tailor breast augmentation to your preferences and body proportions. Implant choice affects appearance, feel, and long-term results. Options include:
- Silicone gel implants – Popular for their natural look and feel
- Fat grafting – Uses your own fat (harvested via liposuction) to enhance breast volume, either alone or combined with implants
Your surgical team will help you select implant type, size, and placement to achieve your desired outcome.
Chest Feminization Recovery
Most patients return to light activities within 2-4 weeks. Swelling and settling continue over several months.
Final results develop gradually as tissues heal.
Bottom Surgery (Vaginoplasty)
We offer several types of bottom surgery to create external female genitalia with both aesthetic appearance and functional capability.
Penile Inversion Vaginoplasty
We offer penile inversion vaginoplasty, one of the most established techniques for genital reconstruction. This procedure:
- Creates a vaginal canal
- Forms labia and clitoral structures
- Preserves erotic sensation when possible
- May use scrotal skin grafting if additional depth is needed
Post-operative dilation is needed to maintain vaginal depth.
After Penile Inversion Vaginoplasty
This procedure includes:
- A hospital stay
- Several weeks of limited activity
- Long-term dilation protocol
- Ongoing follow-up to monitor healing
Your surgical team will provide detailed guidance at every stage.
Zero-Depth (Shallow-Depth) Vaginoplasty
We offer zero-depth vaginoplasty (also called shallow-depth vaginoplasty or vulvoplasty), a gender-affirming genital surgery that creates natural-appearing external female genitalia without constructing a vaginal canal.
This option may be right for patients who desire feminine genital appearance but do not want penetrative vaginal depth.
This procedure:
- Creates labia majora and labia minora
- Constructs a clitoris with sensation using preserved nerve tissue (when anatomically possible)
- Repositions the urethral opening to a typical female location
- Removes erectile tissue and testes
- Does not create a vaginal canal
Because a canal is not created, skin grafting for depth is not needed.
After Zero-Depth Vaginoplasty
This is an outpatient surgery, meaning you can go home the same day.
You'll need to limit activity for several weeks. Swelling, bruising, and temporary discomfort are expected.
You'll need ongoing follow-up appointments to monitor healing and outcomes. Unlike full-depth vaginoplasty, long-term vaginal dilation is also not needed.
Most patients return to non-strenuous activities within a few weeks, with continued improvement in comfort and appearance over several months.
Your surgical team will provide detailed instructions to guide you through every stage of healing.
Facial Feminization Surgery
Facial feminization surgery reshapes masculine facial features to create softer, more traditionally feminine contours.
Because facial structure plays a significant role in gender perception, many patients find these procedures highly impactful. Procedures may include:
- Forehead contouring and brow lift
- Hairline advancement or scalp reshaping
- Rhinoplasty (nose reshaping)
- Jaw and chin contouring
- Blepharoplasty (eyelid surgery)
- Lip lift or lip augmentation
- Fat grafting or dermal fillers for facial volume
Questions? View our gender-affirming surgery FAQs.