Surgical Goals: Body Feminization Surgery
This article is an introduction for those interested in gender-affirming body contouring to demasculinize, feminize and/or androgenize their body shape. The procedures we offer are commonly referred to as body feminization surgery (BFM), hip dip fat transfer, buttock lift surgery, transgender BBL, and MTF transgender body sculpting, liposuction, and fat transfer. We discuss the common body types or shapes produced by estrogenic puberty–hourglass, rectangular, pear and apple–as reference points to demonstrate how liposuction and fat transfer procedures can alter a patient’s body frame.
Pre-Operative Assessment and Goal-Setting for Gender-Affirming Body Contouring: Feminization
In order to reduce the physiologic changes that occur during and after puberty, trans women and nonbinary people may take estrogen or estradiol. This hormone helps to achieve breast development, altered fat distribution, softening skin and altering mood. Patients may also take testosterone blockers such as spironolactone, gonadotropin-releasing hormone agonists, leuprolide, finasteride, and progesterone.
Although our surgeons don’t require anyone to be on hormone replacement therapy (HRT) for gender-focused body contouring or breast augmentation, being on estrogen for a year prior may have a positive effect on fat distribution and gluteal shape. In the text that follows, we go over the common differences in body forms produced by estrogen vs. testosterone-dominant puberties. Using these trends in development as reference points, we discuss how liposuction and fat-grafting can be used to help our patience experience gender euphoria.
The Difference Between Androgenic and Estrogenic Body Forms
Often, persons who go through an estrogenic puberty tend to store fat in certain regions of the body such as the hips, buttocks, and thighs. Sometimes, trans women, nonbinary and gender diverse trans folks who underwent an androgenic (testosterone-dominant) puberty may experience discomfort or gender dysphoria or incongruence related to their body fat distribution. It is possible to reduce these feelings of dysphoria or incongruence through a variety of surgical and lifestyle choices. However, there are limitations to these changes which we cover below.
The pubertal development someone undergoes in adolescence generally determines the bone structure they will have as an adult. Alterations in the bony framework are unlikely with hormone therapy, and surgical modification of the pelvis comes with significant risks that outweigh the benefits, based on current surgical techniques.
Below are the general trends we see in how body shape is formed by adolescent puberty:
Androgenic Body Forms (a testosterone-dominant puberty)
- Increased subcutaneous fat deposition along the abdomen and flanks
- Narrow pelvic brims (see figure A below)
- Lower body fat than estrogenic forms
- Common waist-to-hip ratio (WHR) in the ratio of 0.85 to 0.95
(differences in fat deposition lead to varying degrees of WHR)
- Gluteal form has a ‘flatness’ or concavity (see figure C below)
Estrogenic Body Forms (estrogen-dominant puberty)
- Greater proportion of fat deposited in the gluteal areas and hips
- Wider pelvic brims (see figure B above)
- Approximately 10% more body fat compared to androgenic forms
- Common waist-to-hip ratio (WHR) in the ratio of 0.65 to 0.80 (The WHR varies due to differences in fat deposition)
- Gluteal form has a ‘fuller’ round shape (See figure D above)
Different Body Types
Each body is unique, and here are four examples of conventionally “feminine” body types. Your body frame will play a role in the type of results you can expect to achieve, so we recommend scheduling a consultation with our surgical team to talk more about your unique goals.
Pear-Shaped
Pear-shaped bodies describe folks who have a hip measurement that is greater than their bust. While fat distribution varies, pear-shaped people are more likely to carry weight in the hips, buttocks and thighs than in the upper body.
Banana
Banana-shaped bodies often possess a very even distribution of fat among their waist, buttocks, chest and face, and have a banana or rectangular shape.
Apple-Shaped
Apple-shaped bodies often have shoulders that are comparably broader than their hips. They can possess larger busts, a less defined waist, and thin hips and thighs. Fat is mainly distributed in the face, chest and abdomen.
Hourglass
An hourglass shape describes a body type with fat that is distributed equally between the upper and lower body, paired with a very narrow waist.
Achieving a Lower Waist-to-Hip Ratio Through Body Contouring
Waist-to-hip ratio is found by dividing your waist measurement by your hip measurement. In general, AFAB people possess a lower waist-to-hip ratio than AMAB people. Some patients seek a lower WHR to reduce feelings of dysphoria.
The first area we generally target for patients seeking a conventionally “feminizing” effect through body contouring is the trunk or lower torso. Though the actual number varies, we generally aim for a WHR of 0.7 when performing body contouring through trunk liposuction, common for patients seeking to “feminize” their body shape.
Lowering the waistline through trunk liposuction in the abdominal and flank regions can have a significant impact on the fit of clothing generally made for women, which tends to accentuate the waist.
Buttocks enhancement or “feminization”
The buttocks is the second area we generally target for patients seeking a conventionally “feminizing” effect through gender-affirming body contouring.
As you can see in the figures below, gluteal forms differ in all people. What may be viewed as a conventionally “masculine” gluteal form tends to have a flatness or concavity at the mid-lateral buttock, and a relative absence of lateral hip fullness. A smooth inward sweep of the waist and lower back are characteristic of a conventionally more “feminine” form. Therefore, approaches in body contouring for trans women and nonbinary people aim at increasing the fatty tissue in the gluteal region to highlight a distinct transition from the lower back.
