Gender Affirmation Surgery

Gender-affirming surgery aligns your body with your identity. Recognizing the diversity of gender identities, gender-affirming surgery includes a variety of procedures, designed to meet your unique needs.

At Rush, we provide comprehensive gender-affirming care in and around Chicago. And we know that gender affirmation surgery (also known as gender confirmation surgery) is an important part of your gender journey.

We offer the full spectrum of gender-affirming surgical procedures. This includes top surgery, bottom surgery, facial feminization and masculinization, and more. We’ll tailor your care to your goals and expectations.

What to Expect Before Gender Affirmation Surgery

Our gender affirmation specialists will help you feel comfortable expressing your authentic self. You can expect to feel seen, heard and supported every step of the way. 

Here’s what you can expect when you meet with your gender affirmation surgery team:

• Getting to know you: We’ll start by getting to know you and understanding your goals and expectations.
• Discussing your options: We’ll review the gender-affirming services that might be right for you, including the advantages and disadvantages of different approaches. We’ll also discuss what to expect during surgery, your recovery process and your after-care plan.
• Helping you prepare: We’ll help walk you through paperwork and the insurance process. For instance, you may need letter(s) from a behavioral health provider (often referred to as an assessment for surgery).
• Focusing on you: Our goal is to take any burdens off you so you can focus on your surgery and your health. Our patient navigators will help coordinate your appointments, tests and procedures, as well as answer insurance questions. If you are traveling to Rush, our patient navigators can help you coordinate lodging and travel plans.

Gender-Affirming Procedures at Rush

We offer the full range of gender-affirming surgical services, as well as nonsurgical treatments. Following your discussion, you and your surgeon will develop a plan for your care. You and your surgeon will develop a personalized plan for your care that may include:

Facial reconstruction

Facial feminization and masculinization procedures can enhance and adjust your facial features. Recovery times for facial surgery vary. They typically range from two to three weeks for early recovery, and six to 12 months for final results.

These are some of the facial feminization and masculinization surgeries that may be part of your transition:

• Brow lift or brow reduction
• Hairline advancement
• Upper eyelid surgery (blepharoplasty)
• Facelift
• Nasal surgery (rhinoplasty) to reshape your nose
• Jaw and chin reshaping
• Cheek implants, lipofilling, or injectable fillers to enhance or soften cheekbones
• Lip shortening
• Fillers (lipofilling, hyaluronic acid)
• Skin resurfacing (chemical peel, laser resurfacing)
• Tracheal shave (Adam’s apple reduction)

Top surgery: chest and breast

Top surgery is typically done under general anesthesia (you’re asleep during surgery). These may be performed as outpatient procedures, which means you won’t need to stay overnight in the hospital.

Chest masculinizing and non-binary surgery

Masculinizing top surgery focuses on chest contouring in order to achieve a more masculine or flat chest. This includes removing skin and tissue, as well as reducing and repositioning the nipple and areola. These are some of the procedures available:

• Chest masculinization (mastectomy)
  • Double incision mastectomy with nipple grafts
  • Periareolar and keyhole incisions (nipple sparing) to create a masculine contour with minimal scarring
  • Chest liposuction

Feminizing breast surgery

Feminizing top surgery focuses on breast augmentation and breast reconstruction. These are some of the procedures available:

• Breast augmentation
  • Breast implants
  • Lipofilling (fat grafting)
  • Autologous flap reconstruction (using your own tissue to create a breast)

Genital or bottom surgery

For bottom surgery, you may work with a number of specialists including plastic surgeons, urologists, urogynecologists, colorectal surgeons and pelvic floor physical therapists (specifically for vaginoplasty, phalloplasty and metoidioplasty).

Masculinizing bottom surgery

For transgender men, bottom surgery may include removing the uterus and/or ovaries (hysterectomy and oophorectomy) and constructing a penis (metoidioplasty or phalloplasty) and scrotum.

These are inpatient procedures, meaning you’ll need to stay in the hospital for about three to 10 days. You’ll also have close follow-up for the next several weeks.

These are some of the surgeries available:

• Hysterectomy (removal of the uterus) and/or oophorectomy (removal of the ovaries)
• Phalloplasty (construction of a penis with or without urethral lengthening)
• Metoidioplasty with or without urethral lengthening (“simple release”)
• Penile implants/prostheses
• Scrotoplasty and testicular implants
• Genitourinary reconstruction following cancer, trauma or birth-related conditions

Feminizing bottom surgery

For transgender women, bottom surgery typically includes vaginoplasty. This procedure transforms existing anatomy into a vagina and vulva (labia and clitoris).

This is an inpatient procedure, meaning you’ll need to stay in the hospital for about three to seven days. You’ll also have close follow-up for the next several weeks.

These are some of the surgeries available:

• Orchiectomy (removal of one or both testicles)
• Vaginoplasty (also includes zero depth vaginoplasty/vulvoplasty)
  • Penile inversion vaginoplasty
  • Peritoneal vaginoplasty
  • Intestinal vaginoplasty (colon vaginoplasty)
• Genitourinary reconstruction following cancer, trauma or birth-related conditions

Body contouring

There are also a number of other procedures that can be part of your gender affirmation surgery plan. This may include body sculpting, including a tummy tuck procedure, liposuction and lipofilling.

Rush Excellence in Gender Affirmation Surgery

• A welcoming, inclusive environment: At Rush, you will find the expertise and support you need for gender affirmation surgery. All three Chicago-area Rush hospitals are designated as Leaders in LGBTQ Healthcare Equality by the Healthcare Equality Index.
• Leading the field in gender-affirming care: You’ll be receiving the best care possible from providers who international leaders in the field. The head of the gender affirmation surgery program is on the board of directors of the World Professional Association for Transgender Health. He is a founding member and president-elect of the American Society of Gender Surgeons. And another of our surgeons performed one of the world's first modern facial feminization surgeries.
• Expertise in after-surgery care: Many gender-affirming surgeries require comprehensive after-care. Before your surgery, your care team will walk you through what you can expect in the days, weeks and months after surgery.
• Travel coordination: Because of our high level of expertise, many patients travel to Rush from outside of the state for gender affirmation surgery. If you are traveling to Rush, our patient navigators can help you coordinate lodging and travel plans.
• Support for transgender children and teens: Rush works with families and parents across the country. We can help connect you to providers who can provide your child with gender-affirming care.
• Comprehensive care in a welcoming environment: Through Affirm: The Rush Center for Gender, Sexuality & Reproductive Health, we create a seamless experience for your care. We collaborate with our colleagues across Rush, including those in endocrinology, urology, gynecology, physical therapy, behavioral health, colorectal surgery and other specialties.