Trans-feminine (Male to Female) Surgeries

Trans-feminine surgeries are for patients looking to acquire typically female characteristics. These procedures may be referred to as feminizing gender affirming surgeries (GAS). The Center for Transgender Medicine and Surgery (CTMS) offers services addressing the entire body. This encompasses everything from facial procedures to genital surgeries.

Feminizing Surgical Procedures

CTMS surgeons perform a variety of feminizing gender affirming surgeries at Mount Sinai facilities. Our team will work with you to learn your goals and to develop an individualized plan to meet your needs. We currently offer:

  • Breast augmentation
  • Facial feminization surgery
  • Orchiectomy
  • Tracheal Shave
  • Vaginoplasty
  • Voice feminization

Breast Augmentation

Breast augmentation is a common procedure for transgender patients. It involves a surgeon inserting breast implants into the chest with optional fat grafting. There is no hospital stay after surgery. We perform this procedure under general anesthesia.

CTMS surgeons use a variety of implants to help create your ideal chest. At the surgical consultation appointment, the surgeon reviews all options. We want to give you the best possible outcome.

Facial Feminization Surgery (FFS)

Facial feminization surgeries (FFS) include a variety of procedures. These include forehead and brow bone reshaping, jaw and chin contouring, nose reshaping (rhinoplasty), hairline advancement, and tracheal shave. Our plastic surgery team works with you to determine a plan for the best possible outcome.

We perform facial feminization surgery under general anesthesia. Most people spend one night in the hospital after the procedure. You should expect to recover within a few weeks.

Orchiectomy

Orchiectomy is the removal of testes. All other tissues and parts of the genitals remain. We can perform this procedure under general or local anesthesia. Orchiectomy is suitable for patients seeking elimination of testosterone production without undergoing full genital reconstruction.

This is an ambulatory procedure, meaning there is no hospital stay after surgery. Most people recover within a few weeks.

Tracheal Shave/Modification of the Adam’s Apple

The male larynx (voice box) has a more prominent Adam’s apple versus a woman’s larynx. This is called the laryngeal or thyroid prominence. Frequently, the thinner your neck, the more prominently this stands out.

At Mount Sinai, we perform a surgical procedure, the tracheal shave, which reduces the size of this area by carefully removing only that portion of the thyroid cartilage that is on the outside. This involves a small incision that is placed in a natural crease in your neck, and is minimally visible after healing.

Vaginoplasty

Gender affirming vaginoplasty involves creating a vagina, clitoris, labia majora, and labia minora using your existing genital tissue. Our surgeons typically use a penile inversion technique. This procedure is effective both for people who have and those who have not had orchiectomy in the past. Removal of the testes is required as a part of vaginoplasty.

We perform vaginoplasty under general anesthesia. Most people spend three full days in the hospital after surgery. Recovery from vaginoplasty can take up to three months, and requires intensive post-operative care. Most people spend the first seven to ten days after the procedure in bed, getting up only to go to the bathroom. It is important to have both someone who can help take care of you after surgery as well as the privacy you need to take care of yourself.

You will also need the privacy to dilate every day. Dilation involves inserting a medical dilator into the vagina to keep it from closing. The process can be painful and messy.

Creating a self-lubricating vagina has been a challenge. Our surgeons have pioneered an approach using the peritoneal lining. The peritoneal lining is hairless and pink. While the peritoneal vaginoplasty does provide moisture, it is not self-lubricating. Patients will still need to use water-based lubricant for intercourse and dilation. This approach can work even for patients who are not suited to a traditional penile inversion vaginoplasty.

Voice Feminization Surgery

Using a technique called the Wendler glottoplasty, CTMS surgeons can shorten the length of the vocal cords to change a voice to a higher pitch. The CTMS otolaryngology team accomplishes this by placing a webbing over a portion of the vocal cords to immobilize them. Vocal coaching with a speech and language pathologist is required prior to surgery.

Recovery from this procedure involves not speaking for one week after surgery, and gradually increasing the amount of talking that is possible over the course of a month. Glottoplasty is an ambulatory procedure, meaning there is no hospital stay after surgery.

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