Surgical Gender Affirmation Program
What is gender-affirming surgery?
Surgery that supports a person’s gender identity is called gender-affirming surgery. This term covers a wide range of procedures for people of all genders. Often, it means surgery for a transgender, nonbinary or gender-diverse person to relieve lasting gender dysphoria.
People who choose gender-affirming surgery may have only 1 type of procedure, or they may have many, sometimes over several years. Their choices depend on their gender-related health goals. Each person is unique, and so is their treatment plan.
We work closely with patients and families to make decisions about surgery age and timing. For gender-affirming genital procedures, patients must be 18 or older by the time of surgery. For other surgeries, timing depends on many factors, like the patient’s stage of puberty and how surgery fits with the rest of their gender-related healthcare. A typical age is mid-teens or older. We treat some patients through age 26 for gender-affirming surgery.
What’s special about the experience at Seattle Children’s?
Seattle Children’s is the only pediatric academic medical center with fellowship-trained plastic surgeons who provide gender-affirming surgery in our region — Washington, Wyoming, Alaska, Montana and Idaho. We treat teens and young adults who are patients of Seattle Children’s Gender Clinic. We also accept patients who are receiving gender-affirming care through providers outside of Seattle Children’s.
- Our plastic surgeons have special training and experience in gender-affirming surgery for young people, as well as adults. Knowledge and expertise are important to plan and perform these procedures well so patients achieve the results they expect.
- A urologist, dermatologist and gynecologist are part of our team to provide expert advice and treatment in support of patients’ health goals. They work closely with our plastic surgeons.
- Our gender surgery registered nurse also works closely with the doctors. They help with care each step of the way. They know in detail what these surgeries involve, how surgery can affect patients and how to best support a good recovery.
- Everyone on the team specializes in pediatric gender-affirming care. At Seattle Children’s, patients will receive care in a respectful environment from pediatric providers committed to their well-being.
- We follow guidelines of the World Professional Association for Transgender Health (WPATH) and current best practices for young people who want transition-related treatment.
- Our team fully accepts each individual we treat. We meet each patient and family where they are, knowing that surgery is a step in a larger process. Before making a treatment plan, we talk with you in detail about your gender-related health goals, like how your body will look and work after surgery. Knowing these goals allows us to provide the most personalized care.
- We offer complete and accurate information about the range of surgery options, such as different techniques and what to expect during recovery. Our team knows how to explain treatments in ways that match a patient’s age and understanding.
- Our specialized gender-affirmation surgery care coordinator is here to help you throughout the process, starting from the first time you call us. They offer one-on-one help with topics like seeking approval from your insurance company and getting the medical and mental health letters of support that are required.
- Seattle Children’s has many resources to make the experience as smooth as possible, from financial assistance to LGBTQ-friendly spiritual care.
- For patients and their families who travel to Seattle Children’s for gender-affirming surgery, we can help coordinate travel and housing.
What services does the Surgical Gender Affirmation Program offer?
The Surgical Gender Affirmation Program for teens and young adults provides:
- An opportunity to talk with our care coordinator before your first appointment. They will answer questions, help you prepare for an appointment and connect you with our schedulers.
- One or more consultations with surgeons and a gender surgery nurse to talk about your goals and surgery options and to plan the surgery. We will offer to connect you with Seattle Children’s Fertility Preservation Program before surgery if you are interested.
- Help after preoperative consultations to get ready for surgery, including working with your insurance company to have surgery approved.
- Complex procedures, including face and neck surgery, top surgery (breast/chest), bottom surgery (genitals) and body contouring.
- Follow-up care after surgery to check and support healing and to smoothly transition back to your usual gender care team.
- Support from a social worker to help arrange transportation and places to stay when you come to Seattle Children’s for care.
Telehealth (virtual) visits may be an option for some of your appointments.
What age patients does the program treat?
The Surgical Gender Affirmation Program treats teens and young adults. We work closely with patients and families to make decisions about surgery age and timing. Patients must be 18 or older by the time of surgery for gender-affirming genital procedures. For other surgeries, timing depends on many factors, like the patient’s stage of puberty and how surgery fits with the rest of their gender-related healthcare. A typical age is mid-teens or older. We treat some patients through age 26 for gender-affirming surgery.
Genital surgeries for other reasons — such as tumors, differences in sex development (DSDs) or fertility preservation — are offered through other Seattle Children’s programs, like our DSD Program, Urology, Gynecology or Reconstructive Pelvic Medicine.
Face and Neck Surgery
Many different procedures can change the shape of the face to look more feminine or masculine. These are sometimes called facial feminization surgery or facial masculinization surgery. They include forehead reduction, forehead contouring or augmentation, brow lift, frontal sinus setback, facial fat grafting, cheek augmentation, nasal surgery (rhinoplasty), chin surgery (genioplasty), lower jaw surgery (mandible contouring) and others.
We use virtual surgical planning (computer modeling) and customized surgical models to guide facial surgeries and to show patients what results to expect.
This is surgery that can make the Adam’s apple (thyroid cartilage) less visible (laryngochondroplasty) or more visible (thyroid cartilage enhancement).
Top Surgery (Breast/Chest)
To increase breast size, surgeons can use implants filled with sterile salt water (saline) or a plastic gel (silicone), or they can use fat taken from another part of the body.
In this procedure, surgeons remove breast tissue to create a natural chest contour that aligns with a patient’s gender identity. One option is to remove the nipple completely and then reattach it in a new position that will look natural (free nipple grafting).
Some people assigned female at birth may feel most affirmed by keeping their breasts but making them smaller.
Bottom Surgery (Genitals)
Surgeons have several options to make a vagina for people who have a penis. In this option, the surgeon removes the penis and testicles. They make a tunnel in front of the rectum and use skin from the penis to line the tunnel. They might use skin from the scrotum or another part of the body, like the thigh. The surgeon also makes inner and outer labia and a new opening for urine. They can use tissue from the penis to make a clitoris. People who may want to have biological children in the future can choose to have their sperm frozen and stored before surgery to remove the testicles.
This is a method to reconstruct a person’s vagina or to make a vagina in a person assigned male at birth. The surgeon makes a vaginal canal using tissue from the lining of the abdomen (peritoneum). Based on the patient’s needs and wishes, the surgeon may also make inner and outer labia and a new opening for urine. For patients with a penis, the surgeon can use tissue from the penis to make a clitoris.
Another way to reconstruct or make a vagina is to use a section of the bowel. Usually, this is not the first choice for gender-affirming surgery, but it may be an important option for someone who wants revision of an earlier surgery (like a penile inversion or peritoneal vaginoplasty). Based on the patient’s needs and wishes, the surgeon may also make inner and outer labia and a new opening for urine. For patients with a penis, they can use tissue from the penis to make a clitoris.
Some people decide to have surgery to make a vagina with a canal that is shorter than typical. This is 1 of many ways that surgery choices depend on the patient’s goals for how their body will look and work after they heal. In minimal-depth vaginoplasty, the surgeon makes a clitoris, inner and outer labia, an opening for urine and an opening of the vagina with a short vaginal canal.
This is surgery to remove 1 or both testicles. Before the surgery, patients may choose to have their sperm frozen and stored so they will have the option to parent biological children later if they want to.
A series of surgeries, done in stages over several months, can make a penis for someone assigned female at birth. The surgeon may make the penis using tissue from the vulva, forearm, thigh or side. Based on the patient’s needs and wishes, the surgeon may also do procedures to make the urethra longer, make a tip for the penis, make the scrotum and add testicle implants, put in an implant to make erections possible and close the opening of the vagina.
For a person with a clitoris and labia, surgeons may be able to use these tissues to make a penis. This is done after the person has been on testosterone therapy, which will make the clitoris larger. Based on the patient’s needs and wishes, the surgeon may also make the urethra longer, make the scrotum and add testicle implants and close the opening of the vagina.
This is surgery to make a tip for the penis or to correct a problem with the tip of the penis. In people who have had surgery to make a penis (phalloplasty), this may make the penis look more like that of a circumcised cisgender male.
This is surgery to make a new scrotum or to correct a problem with the scrotum. In a person without testicles, the surgeon can also add testicle implants.
Other Gender-Affirming Procedures
Procedures like fat grafting and liposuction can be done to shape a person’s body to better match their gender identity.
If the results of gender-affirming surgery do not meet the patient’s needs or goals, our experienced surgeons may be able to offer options to improve the results. We have done surgeries like this for people who had their earlier gender-affirming surgery at other hospitals.
Scheduling an Appointment About Gender-Affirming Surgery
- If you would like a referral to the Surgical Gender Affirmation Program, talk to your gender care provider (the provider who handles your gender-related medical care, such as hormones or menstrual suppression). Patients who are not on hormones or menstrual suppression can be referred by their primary care provider or a medical doctor who knows about their gender care needs.
- If you have a referral, call , option 6, to talk about making an appointment. Our care coordinator will call you back to gather information and answer questions before we schedule.
- To schedule an appointment, you will also need to submit at least 1 of these letters:
- After we receive your referral and at least 1 of the required letters, our schedulers will call you to schedule an appointment.
- If you already have an appointment, learn more about how to prepare.
Resources for Patients and Families
- Templates for gender-affirming surgery letters:
- Help finding out if your insurance company must cover gender-affirming surgery under state law: Washington State Office of the Insurance Commissioner
- Masculinizing Top Surgery (PDF) (Spanish)
- Top Surgery Checklist and Resources (PDF) (Spanish)
- Fertility Preservation Program
- Gender-diverse care resources
- Plastic surgery resources
Contact Plastic Surgery at , option 6, to talk with the care coordinator for gender-affirming surgery about an appointment, a second opinion or more information.
Providers, see how to refer a patient.