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Body Contouring 101

The Ultimate Guide to Body Masculinization Surgery (BMS) and Body Feminization Surgery (BFS)

Finally, a group of expert body contouring surgeons inclusive of all identities and bodies, with a highly successful insurance concierge. Learn more about the gender affirming liposuction, Brazilian Butt Lift (BBL) and hip dip fat transfer services we offer to patients: what techniques they involve, how much they cost, what risks they involve, how to prepare for and recover from them.

What is Body Masculinization Surgery?

Body Masculinization Surgery (BMS) or masculinizing body contouring refers to a series of gender affirming surgical procedures designed to help a patient feel more comfortable in and aligned with the shape of their body. While body contouring can sometimes involve the use of silicone implants, at the Gender Confirmation Center (GCC), most if not all of our BMS procedures involve liposuction. Specifically for patients seeking a more conventionally masculine body frame, the areas we offer liposuction for the following areas: the chest, the back, the abdomen, the flanks (on the side of the abdomen), the thighs, the buttocks and the waist/hip zone.

What is Body Feminization Surgery?

Body Feminization Surgery (BFS) or feminizing body contouring refers to a series of gender affirming surgical procedures designed to help the patient feel more comfortable in and aligned with the shape of their body. While body contouring can sometimes involve the use of silicone implants, at the Gender Confirmation Center (GCC), most if not all of our BFS procedures involve liposuction and fat grafting. Specifically, for patients seeking a more conventionally feminine body frame, we offer liposuction for the abdomen and the flanks (the area on the side of the abdomen). Likewise, many body feminization procedures include fat grafting: most commonly, a Brazilian Butt Lift (BBL) and a hip dip fat transfer to augment the buttocks and/or hips.

What Body Contouring Options Exist for Non Binary Patients?

Regardless of a patient’s gender identity, gender expression or desired gender presentation, body contouring procedures are always tailored to an individual’s unique needs and gender euphoria goals. Our highly experienced, board certified plastic surgeons offer a vast array of liposuction and fat grafting techniques that can help a patient masculinize, demasculinize, feminize, defeminize and/or achieve a more androgynous body shape. While most information available about gender affirming body contouring–BMS and BFS–is presented in very binaristic terms, on the clinical end, all GCC staff are committed to serving patients of all gender identities. Internally, we use de-gendered language, unless a patient uses gendered terminology, to describe techniques, body parts and shapes. That said, many patients find it helpful to read informational materials that discuss conventions around masculine and feminine body forms in plastic surgery. The information below is tailored mostly to patients seeking out a body masculinization or body feminization surgery. That said, you can read more about body contouring options for non binary patients here.

What Can Surgery Do For Me? Designing Your Transgender Body Contouring Goals

Many patients have found it helpful to discuss the common effects of first puberty on bone structure, fat distribution and the resulting body types they tend to produce. The first factor we tend to pay attention to in surgical consultations for body contouring is a patient’s current and desired waist-to-hip ratio (WHR). The WHR is calculated as waist measurement divided by hip measurement (W ÷ H). An estrogenic first puberty has the common effect of widening or expanding the pelvis bone, making the waistline sit lower on the body. See the images below. Likewise, estrogenic puberties are often responsible for their being greater fat depositions in the hips and gluteal areas. As a result, it is very common for patients who have passed through and completed a first, estrogenic puberty to have a WHR that ranges between 0.65 to 0.80.

With this information in mind, our surgeons usually aim for a WHR of 0.85-0.95 for patients looking to “masculinize” their body shape. Additionally, a WHR of 0.70-0.85 is most commonly the goal for patients seeking a more “androgynous” appearance. Achieving these WHRs typically involves liposuction to the waist, hips and/or buttocks areas. Gender affirming liposuction is most often an outpatient procedure, even when performed in conjunction with top surgery, that patients undergo under general anesthesia. It involves small incisions being made to the targeted zones, wherein a cannula or thin suction tube will be inserted to remove the desired amount of fat. Incisions are then closed, and the treated areas will be wrapped in surgical dressings and an elastic compression garment.

On the other hand, our surgeons usually aim to give patients a WHR of 0.70 if they are interested in “feminizing” their body shape. This is typically achieved by liposuctioning the trunk and performing a fat grafting procedure–such as a BBL or hip dip fat transfer–to increase the circumference of the hips relative to the waist. The BBL and hip dip fat transfer involve using a cannula or thin suction tube to harvest fat from the body, most often the abdomen and flanks, though occasionally also the back, arms and thighs. The removed fat is then processed, purified and injected into the buttocks and/or hips. Some patients may opt just for feminizing liposuction without having their fat harvested for a transfer. Liposuction at the GCC generally involves a patient going under general anesthesia and leaving the hospital the same day as the procedure, even when conducted in concert with a breast augmentation. Liposuction alone has a much easier recovery process than a fat transfer. You can learn more about eligibility for and recovery from these procedures below.

Lastly, some patients find it helpful to look beyond WHR and discuss the common body shapes that estrogenic and androgenic first puberties produce. Using these models as a reference can sometimes help patients articulate their goals for gender affirming body contouring; for instance, a patient might realize that to achieve their goal, they would like to undergo a fat transfer procedure, upper body liposuction (to the back and/or arms) or liposuction to the saddlebag area (the inner and outer thighs). The models below should not be taken as guidelines for your surgery, but rather can be taken as inspiration if you wish.

  • A first, androgenic (testosterone-dominant) puberty most often produces three body shapes: ectomorphic (rectangular), endomorphic (apple-shaped) and mesomorphic (V-shaped). Many transmasculine patients seek out BMS to achieve a V-shaped silhouette, which is why colloquially it is sometimes called the ‘dorito-chip surgery.’
  • A first, estrogenic (estrogen-dominant) puberty commonly results in one of four body shapes: pear-shaped, rectangular, apple-shaped or hourglass-shaped. Most patients seeking out BFS combine trunk liposuction with a BBL and/or hip augmentation to achieve a pear or hourglass-shaped figure.
  • The common ground between these two models is the rectangular body-shape. That said, the vision that these models propose for androgyny centers on skinniness and does not fully take into account how other facets of your body–such as your voice, the volume of your chest, etc–play a role in how we as people are perceived and gendered. If you are interested in body contouring and/or other gender affirming surgeries to achieve results that are neither fully conventionally “feminine” or “masculine,” you can speak about your options with one of our surgeons through a free, virtual consultation.

Our world-class body contouring surgeons

To achieve natural-looking results, BMS, BFS and other forms of gender affirming body contouring require both technical expertise and nuanced artistry. For this reason, it’s very important to always select a board certified plastic surgeon for your surgery. When performed correctly, these procedures can offer long-lasting results without the need for touch-ups or additional rounds of fat injections.

Dr. Scott Mosser (he/him) is a board-certified plastic surgeon who has over 15 years of experience serving gender diverse patients. He has devoted himself exclusively to gender affirming care since founding the GCC in 2013. Dr. Mosser is a cofounder of the American Society of Gender Surgeons (ASGS), a member of the American Society of Plastic Surgeons (ASPS), the World Professional Association of Transgender Health, (WPATH), the United States Professional Association of Transgender Health (USPATH), and is a Fellow of the American College of Surgeons (FACS).

Dr. Alexander Facque (he/him) is a board-certified plastic surgeon and proud member of the LGBTQ+ community. Dr. Facque got his start in gender-affirming care as a resident at the Icahn School of Medicine at the Mount Sinai Medical Center in New York, where he first recognized the importance of providing safe and accessible surgeries to trans and non-binary patients. He then spent a year training and expanding his knowledge under Dr. Loren Schechter, one of the world’s foremost gender-affirming surgeons, as a fellow at Weiss Memorial Hospital’s Gender Confirmation Surgery and Practice Leadership in Chicago. Dr. Facque officially joined our team in 2020 and brought with him over 5 years of previous experience in gender affirming care.

Dr. Daniel Jacobs (he/him) brings over 30 years of experience in reconstructive plastic surgery and research. He completed a General Surgery residency at LAC/USC School of Medicine and a Plastic Surgery residency at USC School of Medicine. His exceptional work has been recognized through prestigious medical awards such as the ‘Sidney R. Garfield, MD Exceptional Contribution Award’ in 2017, San Jose Kaiser Permanente’s ‘Outstanding Inpatient Physician of the Year’ in 2017, and the ‘Outstanding Achievement in Medicine’ award from Santa Clara Medical Association in 2016.

Frequently Asked Questions: Preparations, Risks and Recovery

Since body contouring procedures can involve liposuction and/or fat grafting, there are specific questions that often surface for patients around qualifying for surgery, weight fluctuation and recovery. The guide below is a one-stop-shop to answer all your surgery questions: from booking your consultations, to figuring out how to pay for surgery, to arranging travel plans, to considering your unique medical history and surgical concerns.

  • Will my insurance cover this surgery?
  • You can leave the insurance worries to us. The GCC provides a free insurance concierge service to interested patients. After soliciting any necessary documents from you, our insurance advocacy team will get to work to secure full or partial coverage for your medically necessary, gender affirming procedure(s). Our team has a 90% success rate in securing coverage for insured patients. Learn more about that process here.

  • How can I finance my surgery if it’s not covered or only partially covered by insurance?
  • We have compiled a list of scholarships for gender affirming surgeries alongside trusted, medical credit agencies you can use to help finance your surgery with us. You can also find estimated costs for each procedure we offer if you plan on paying entirely out of pocket. Click here for more.

  • Do I need a letter of approval from a therapist, psychiatrist or primary care doctor to get surgery with GCC?
  • Letters of support or clearance letters from certified, mental health professionals are welcome and valuable, but not a requirement for adults who seek surgery with the GCC. This is because we use the informed consent model, which means that a letter from a therapist is not required unless the patient is seeking insurance approval. Insurance companies always require a letter of support from a mental health professional and, if our reconstructive surgeons are outside of your provider network, you will also need a reference letter from your primary care provider to request insurance coverage. For more information, click here.

  • What about patients who are traveling from out of town to San Francisco for surgery?
  • Many trans, non-binary and gender expansive patients need to travel to access a board-certified, highly experienced gender affirming surgeon. At the GCC, we are very accustomed to working with patients from out of town. For recommendations on travel and lodging, click here. We have also compiled a guide on preoperative consultations and post-operative follow-up protocols for patients who do not live in the San Francisco Bay Area.

  • Do I need to be taking testosterone or estrogen hormone replacement therapy to undergo Body Masculinization or Feminization Surgery?
  • Though hormone replacement therapy (HRT) is not a requirement for surgery, it can have a positive effect on fat redistribution and changing someone’s gluteal shape. For patients whose transition process involves HRT, we recommend that you wait until at least a year has passed on hormones before undergoing a body contouring procedure. Still, many patients experience difficulty with reducing or increasing fat reserves around the hips, legs and buttocks with HRT, exercise and diet alone. This is why even with hormone usage, some find it necessary to undergo a body contouring procedure to feel aligned with the shape of their bodies.

  • Can I undergo a body sculpting procedure with other operations like top surgery or a breast augmentation?
  • Absolutely! It is very common for our patients to undergo liposuction during their top surgery. Though they can be combined, the recovery processes for a fat transfer, such as a BBL, and a breast augmentation when combined can be particularly complicated. If you would like to discuss your eligibility for surgery and create a plan to meet your unique gender goals, you can speak with one of our board-certified plastic surgeons in a free, virtual consultation.

  • Will gaining weight before Body Feminization Surgery–or more specifically, a Brazilian Butt Lift or hip dip fat transfer–enhance my results?
  • When it comes to body feminization surgery, patients often ask how they can maximize their results. At the GCC, we caution patients against rapid weight gain before surgery for two reasons. First, it can be challenging to maintain a sustainable weight that is not natural for our lifestyle without significant continuous effort. Significant weight fluctuation post-op can affect your final results. Second, the type of fat that is available for grafting is called “subcutaneous fat” which refers to fat that is stored just beneath the skin. Often, the fat that appears from short-term, unsustainable weight gain is called “mesenteric,” referring to the fat that accumulates around the intestines. “Mesenteric” fat cannot be accessed by a surgeon as a part of body contouring, and if present in significant quantities, it can significantly contribute to cardiovascular risk. Learn more about our recommendations around preoperative weight gain and how to maximize your fat grafting results here.

  • How long will a fat transfer (a BBL or hip augmentation) last? What happens if I lose weight after my procedure?
  • Generally speaking, if the host tissue accepts the fat that is transferred or grafted into it, the results are essentially permanent, meaning they can be life long. By the six month mark post-op, patients should be able to see their final results. However, even if the fat transfer is successful, if the patient undergoes weight loss and loses overall body fat naturally, the area that was grafted will also shrink in size.

  • What is the recovery process for a liposuction procedure?
  • Pain usually only lasts up to five days after the operation, wherein a patient can discontinue their use of painkillers. Patients will experience heightened amounts of swelling, lumpiness and bruising of the liposuction areas during the first week, which may persist through the first month of recovery.

    At about 1-2 weeks post-op a patient will be cleared to return to work and resume most regular life activities. Light walking through the first few weeks is recommended to help with healing. That said, strenuous exercise should be avoided for at least the first six weeks after surgery.

    Incisions are often closed with absorbable sutures that will not need to be taken out later by your surgeon. Occasionally, a surgeon will keep the incisions open to insert surgical drains. Drains are used to expel unwanted fluid and are removed around a week after surgery.

    Patients will be sent home from the hospital with a compression garment over the liposuction area. They should follow their surgeons instructions around garment use.

  • What is the recovery process for a fat transfer procedure?
  • Patients can usually return to work 1-2 weeks after a Brazilian Butt Lift and/or hip augmentation fat transfer. Though patients should avoid strenuous exercise for the first two months post-op, they should engage in frequent walks as maintaining good blood circulation is essential to making sure the injected fat “holds.” 

    Patients will be sent home from the hospital with a compression garment that they should wear 24/7 for at least the first month after surgery. Additionally, during the first month, patients should avoid sitting on their buttocks and sleep head-down to not put any pressure on the augmented site. 

    Dietary recommendations include staying hydrated, eating healthy fats (e.g., salmon, avocado, walnuts) and lean proteins (e.g., white meats, red meats in moderation, fish, legumes, etc.) and avoiding a high-sodium diet.

  • When will I be able to see the final results of my body contouring procedure?
  • The final results of your liposuction procedure should be visible once three months have passed since your operation. The final results of a fat transfer procedure can take up to six months post-op to be visible.

  • What are the common surgical complications of liposuction and fat transfers?
  • Slight changes in skin sensation that last beyond the first month of recovery are normal. Though serious complications for body contouring procedures are rare, they can include fluid build-up, infection, blood clots, or nerve damage. For this reason, it’s important to choose a highly skilled and experienced board certified surgeon for your liposuction and/or fat grafting surgery.

  • What are the steps involved in getting a gender affirming body contouring surgery?
  • Since several patients of body masculinization surgery (BMS) undergo top surgery as a part of the same procedure we refer them to the top surgery timeline guide. Though specific to top surgery, steps 1-7 that cover how to get surgery–from requesting a consultation, to obtaining insurance approval and completing all other preoperative requirements–are all the same for any type of body contouring procedure.

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