Male to Female

Top and Bottom Procedures Offered

The following is a list of Male to Female Gender Affirmation Surgery procedures that we currently offer with a brief description to help you make an educated decision on which might be the best fit for you. With each procedure description there is also an option to view photos and the associated WPATH requirements based on procedure.


Top Procedures Offered

Breast Augmentation with Implants

Some transgender ladies will get a lot of breast growth in the first 2 years of taking hormones. For some ladies this will be satisfactory but many desire augmentation because they are not big enough or “feminizing mastoplasty” to lift or reshape the breasts to make them more feminine.

There are lots of options when it comes to breast enlargement. Firstly we have to decide where the scar goes. Dr. Gallagher usually recommends hiding the scar in the fold underneath the breast but other options are available. Next the patient can decide with Dr. Gallagher what type of implant to use – silicone or saline. Silicone implants can feel softer and more natural. Saline implants are cheaper. Depending on the size the patient wants Dr. Gallagher will choose with you where the implant should be placed over or under the muscle.

A lot of transgender ladies may require more than just a breast augmentation to feminize their chest. Some may require a lift or reshaping in order to achieve this. Dr. Gallagher will discuss with you what is required in your particular case.

Breast augmentation is done as an outpatient and most patients are back to work in 1-2 weeks time.

Breast Augmentation via Fatgrafting or Lipofilling

It is possible to use a patient’s own fat in order to make the breasts bigger. This is sucked out of where its not wanted (liposuction) and injected back into the breasts. The beauty of this procedure is patients can get rid of problem areas and help create a more hourglass shape while at the same time as enlarging the breasts. Unfortunately for ladies wishing to go a lot bigger this isn’t the first choice as up to half of the fat injected will not “take”. There is more “downtime” from the liposuction in this case and bruising and swelling may last for weeks afterward.

Bottom Procedures Offered

Factors to consider when choosing a bottom surgery procedure are availability for downtime, sexual practices, and medical readiness for a major operation as well as social and lifestyle factors. The following is a list of currently offered Male to Female gender affirmation bottom surgery procedures.

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. The clitoris is formed using the glans penis to preserve sexual function and a labiaplasty is performed to give the most natural appearance. This procedure requires indefinite need for dialtion. 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 to approve upon this if preferred. Penile inversion does have a BMI requirement/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 (removal of penis) is performed along with an orchiectomy and scrotoplasty to create the feminized genital area. A clitoris is created using the glans penis to preserve sexual function and lastly 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 the a very similar outer appearance as a penile inversion vaginoplasty. Zero-depth does not have a BMI requirement.

MTF Vaginoplasty WPATH Requirement

Details and Requirements for Zero-Depth



This procedure involves 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. This is not advisable however if the patient is considering later vaginoplasty.

Orchiectomy WPATH Requirement

Procedure Photos


Labiaplasty is a term used to describe whatever “nip-tuck” a patient may elect to undergo 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 the patient preference. We encourage patients to wait until the area is completely healed post-op which often takes 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 commonly less covered by insurance policies 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