Feminizing body contouring (a.k.a. body feminization) is the process by which trunk liposuction and buttocks feminization are combined to help alleviate feelings of dysphoria or discomfort that some feminine spectrum trans folks might experience based on the shape and fat distribution of their body.
Because feminizing body contouring relies on fat grafting — specifically grafting fat from the abdomen and waist area to the buttocks area — folks who are thinking about going through this procedure are sometimes counselled by some providers to gain weight before the procedure. Since the degree to which the buttocks can be filled, rounded out, and made to be more projected depends on the amount of fat that the surgeon has available for grafting, it might make intuitive sense for people to gain as much weight as they can in order to have enough fat available for grafting during surgery.
However, Dr. Mosser would advise caution with this “more is better” approach for two reasons. First, it can be challenging to maintain a sustainable weight that is not natural for our lifestyle without significant continuous effort. The second reason has to do with the type of fat that may accumulate. The type of fat that is available for grafting is called “subcutaneous fat” which refers to fat that is stored just beneath the skin. But, sometimes 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.
Sagittal view of mesenteric v. subcutaneous fat stores. Mesenteric fat surrounds the internal organs and is dangerous and inaccessible to surgeons. Subcutaneous fat, however, is just below the skin and is the targeted fat during body contouring procedures.
Axial view of mesenteric v. subcutaneous fat stores. Mesenteric fat surrounds the internal organs, and is not the target of body contouring procedures. Subcutaneous fat is stored just below the skin and is the only fat that can be removed by body contouring procedures.
When thinking about preparing for feminizing body contouring, it is important to keep in mind the distinction between sustainable and unsustainable changes to your diet, exercise, or lifestyle. Sustainable changes refer to changes that a patient could maintain for a long(er) period of time, whereas unsustainable changes would be temporary lifestyle shifts that would fade away quickly after surgery.
Generally speaking, as a practice, we tend to counsel patients away from making unsustainable changes to their lifestyle, diet, and exercise routines, including asking patients to gain weight before feminizing body contouring. If a patient were to gain weight by changing their lifestyle in a way that would not be maintained after surgery, then after an expertly performed body contouring procedure with fat grafting, the patient would likely return to their former weight and the bulk of the fat that had been transferred and grafted would also “deflate” from weight loss anddiminish in size.
However, if a patient has less body fat than would be ideal for fat grafting, and they might be candidates for sustainable lifestyle changes that would result in a small amount of weight gain, then indeed this might help their surgery outcomes.