Male to Female

Top and Bottom Procedures Offered

The following is a list of Male to Female (MTF) Gender affirmation surgeries that we currently offer. Each procedure is then described to assist you in choosing the best surgery to fit your needs. You may also find photos and WPATH requirements below the descriptions.


Top Procedures Offered

Breast Augmentation with Implants

Some transgender women will experience  breast growth in the first 2 years of taking hormones. For some, this result is satisfactory. However, some seek augmentation to increase breast size or complete feminizing mastoplasty to lift, reshape, or feminize the breasts.

There are many  options when it comes to breast augmentation. First, Dr. Gallagher will discuss a location for the scar – she typically recommends hiding it in the fold underneath the breast, but other options are available. Next, the client will discuss the material to be used in the implant, choosing between silicone or saline. . Silicone implants can feel softer and more natural. Saline implants are cheaper. Depending on the implant size the client is seeking, Dr. Gallagher will choose discuss  whether  the implant should be placed over or under the muscle.

Some transgender women may require more than just a breast augmentation to feminize their chest. Some may require a lift or reshaping, but  Dr. Gallagher will work with you to decide what is best for your particular case.

Breast augmentation is an outpatient operation and most patients are back to work in 1-2 week’s time.

Breast Augmentation via Fatgrafting or Lipofilling

It is possible to use a patient’s own fat in order to make the breasts bigger. It is removed from its original location  (liposuction) and injected into the breasts.With this particular procedure, sometimes fat can be removed from certain areas to create a more hourglass or feminine shape while augmenting the breasts. . Unfortunately, this procedure isn’t the best option for women who are seeking large breasts, as up to half of the fat may not “take” or sit correctly after the procedure. Due to the intensity of the surgery, clients will need more time off and experience bruising and swelling for a few additional weeks.

Bottom Procedures Offered

Some factors to consider when choosing a bottom surgery procedure are: availability for downtime, sexual practices, social and lifestyle factors, and medical readiness for a major operation.  Below are the current Male to Female (MTF) gender affirmation bottom surgery options Dr. Gallagher offers.

Penile Inversion Vaginoplasty

In this procedure, the penile (shaft) skin is used to create the new vaginal vault or inner lining of the vagina. The scrotal tissue is often used to create additional depth, and scrotal hair removal is completed at the same time during the surgery. The clitoris is formed using the glans penis to preserve sexual function and a labiaplasty is performed to give a  natural appearance. This procedure requires indefinite need for dilation. Vaginoplasty has the highest risk for complications as well as the most downtime. Every attempt is made to give the most natural appearing labia at the time of the first procedure. Patients may elect to do a labiaplasty at a later time as well. . Penile inversion does have a strict BMI limitation of 30.

MTF Vaginoplasty WPATH Requirement

Procedure Photos

Details and Requirements for Penile Inversion

Zero-depth or Dimple Vaginoplasty

For this procedure, rather than a vaginal vault being created, a penectomy (penis removal)  is performed along with an orchiectomy and scrotoplasty to create a  feminized genital area. A clitoris is created using the glans penis to preserve sexual function and then  a labiaplasty is performed. This procedure does not require hair removal pre-op or dilation post-op as there is no vaginal vault created. Zero-depth vaginoplasty will have a very similar outer appearance as a penile inversion vaginoplasty. Zero-depth does have a strict BMI limitation of 34.

MTF Vaginoplasty WPATH Requirement

Details and Requirements for Zero-Depth


This procedure involves the removal of the testicles. The incision is carefully hidden in “median raphe” which is the line in the middle of the scrotum. This procedure does not limit options for vaginoplasty at a later date.

Orchiectomy WPATH Requirement

Procedure Photos

Orchiectomy with Scrotoplasty

Patients can elect to have the scrotal tissue removed at the time of orchiectomy. However, if you are seeking a vaginoplasty at a later date, we do not recommend this procedure since there would not be sufficient tissue for  a vaginal vault.

Orchiectomy WPATH Requirement

Procedure Photos


Labiaplasty is a term used to describe a procedure a client  may pursue  to improve the appearance of the genitalia after the initial surgery. This may involve techniques to define the inner labia or to have the outer labia meet in the midline. The surgery is tailored to each client’s  preference. We encourage patients to wait until the area is completely healed after their first procedure, which can take up to about a year. . Many patients may never want or need this surgery.

*WPATH requirement handled on case by case basis.

Additional Male to Female Procedures Offered

Dr. Gallagher also offers the following procedures which on a requested basis. These procedures are not often covered by insurance, but we are able to offer them with and without insurance coverage.

  • Abdominoplasty/tummy tuck
  • Body contouring/liposuction
  • Buttock lift
  • Non-surgical facial feminization via jawline shaping with Botox
  • Other non-surgical cosmetic surgery “fillers” such as Juvederm, Lariesse, Restylne, Radiesse