Gender-Affirming Masculinization Procedures
For many transgender men and transmasculine individuals, gender-affirming surgery can be an important step in aligning physical characteristics with gender identity. Procedures may include chest (top) surgery, genital (bottom) surgery, facial masculinization procedures, or a combination of treatments.
There is no single "right" path. Your surgical plan is personal and based on your goals, anatomy, health history, and readiness.
Our team at UVA Health provides consultations, second opinions, and comprehensive surgical planning in a respectful, affirming environment.
During your first visit, we’ll go over:
- Your goals and expectations
- Available procedure options
- Surgical techniques and staging
- Recovery timelines
- Risks and potential complications
- Expected outcomes
Our goal is to make sure you feel informed, supported, and confident in your care decisions.
Charley's Gender-Affirming Surgery
From a young age, Charley Burton knew that his body did not match his gender identity — a struggle he kept inside for 50 years. With the help of family nurse practitioner Reagan Thompson, FNP, MSN, RN, and a whole team of caring providers, Charley found a safe place to become his true self.
CHARLEY BURTON: I'm Charley Burton. I'm a native of Charlottesville, Virginia. There's a picture of me as a little kid, and you can't tell that I wasn't a little boy.
I always knew. My body just didn't match my mind. And I pushed that in for the next 30, 40 years until I became 50 years of age and started my journey.
REAGAN THOMPSON: When I first met Charley, he was pretty frustrated. He had hit a lot of barriers getting appropriate transgender care and had given up on our system.
CHARLEY BURTON: And so when I go to the hospital, there's this level of anxiety that builds up in me every time. But I've been lucky because I've had a Reagan Thompson in my corner. She truly wants to know, what can she do as a medical professional to make my life better?
REAGAN THOMPSON: I think it's super important to listen to your patients and try to figure out what they're angry at.
CHARLEY BURTON: She has seen me at my lowest. And she now sees me where I'm at today.
[MUSIC PLAYING]
CHARLEY BURTON: Today's the day that I have my top surgery. Top surgery is the removal of the breasts. It's another stage in my transition. So I'm a little nervous today. Nervous and excited.
[MUSIC PLAYING]
JT STRANIX, MD: It's impossible not to like Charley when you meet him. We talk about what the goals are for surgery. His, in particular, were to have a chest that was congruent with his male identity.
SPEAKER 1: And can you tell me what Dr. Stranix is going to do? And Dr. Sopata?
CHARLEY BURTON: Yeah, we're doing a double mastectomy.
SPEAKER 1: OK.
CHARLEY BURTON: The top surgery.
SPEAKER 1: Yup.
CHARLEY BURTON: And total hysterectomy.
CARRIE SOPATA, MD: Trans patients should feel comfortable coming to any location in UVA and knowing that they're going to get the right care and the best care.
[MUSIC PLAYING]
CHARLEY BURTON: There was this one nurse. One night, she came in and she just wanted to know so the next person that comes on her floor that has had top surgery or is trans, what could she do better? And she asked some of the most beautiful, poignant questions. It was just total respect.
[MUSIC PLAYING]
JT STRANIX, MD: In my mind, a successful gender-affirming surgery is one that makes a patient feel more comfortable with their gender identity and really improves their overall well-being.
CHARLEY BURTON: The first day that I was able to take the ACE bandages off, I saw the chest that I've always wanted and it was-- I'm getting emotional now. It was just 10 times more than what I thought it would be.
REAGAN THOMPSON: And now Charley is a very happy person with very few complaints, and has a desire to fix a system that is driving him to be more involved in the transgender community.
[MUSIC PLAYING]
CHARLEY BURTON: I'm becoming the man that I want to be. I am confident in who I am, and I never thought I'd ever be there.
[MUSIC PLAYING]
Masculinization Procedures
We offer several types of procedures.
Top Surgery (Chest Masculinization)
Chest masculinization surgery creates a flatter, more traditionally masculine chest contour. This involves removing breast tissue and reshaping the chest.
After Chest Masculinization
Most patients return to non-strenuous work within 4-6 weeks. You will need to wear compression garments for several weeks.
Final chest contour continues to refine over several months.
Bottom Surgery (Phalloplasty)
Genital gender-affirming surgery is highly individualized. Some patients choose this step, while others do not.
We offer radial forearm phalloplasty, a procedure that constructs a penis and urethra using tissue from the forearm.
This procedure can:
- Create a phallus with aesthetic male appearance
- Lengthen the urethra to allow standing urination
- Include nerve connections to provide sensation
- Allow for placement of a penile implant at a later stage for erectile function
Phalloplasty is typically performed in stages to optimize safety and outcomes. Your surgeon will outline the timeline and phases of reconstruction during your consultation.
Hysterectomy & Removing Internal Reproductive Organs
Some patients choose to undergo hysterectomy (removal of the uterus), salpingo-oophorectomy (removal of fallopian tubes and ovaries), or both.
Patients may choose these surgeries for these reasons:
- Gender dysphoria relief
- Medical necessity
- To help with hormone therapy goals
- Personal preference
These procedures may be performed before or in coordination with other gender-affirming surgeries.
Facial Masculinization Surgery
Facial masculinization surgery can enhance masculine facial features through structural and contour changes.
Procedures may include:
- Jaw and chin contouring
- Cheek reshaping
- Brow augmentation
- Rhinoplasty (nose reshaping)
- Thyroid cartilage enhancement (Adam’s apple augmentation)
Techniques may involve bone reshaping, cartilage modification, or placement of biocompatible implants.
Facial surgery is optional and customized to your desired level of masculinization.
Questions? See our gender-affirming surgery FAQs.