Gender Affirming Surgery

Gender affirmation surgery, also referred to as gender reassignment surgery, sex reassignment surgery, or transgender surgery are procedures by which a transgender person’s physical appearance and function of their existing sexual characteristics are altered to resemble those socially associated with their identified gender. The goal of these procedures are to give you the physical appearance and functional abilities of the gender you strongly identify with.

Our clinic works individually with each one of our patients to find a treatment plan that will produce the desired outcome. Many of our patients report a re-affirmed sense of identity and improved quality of life after these procedures.

RHINOPLASTY

What is Gender Affirming Surgery?

Gender affirming surgery refers to a set of plastic surgery procedures that are performed on individuals with gender identity disorder (dysphoria) to help them transition to their desired and chosen gender. During this treatment, the plastic surgeon will transform the patient’s primary and/or secondary sex characteristics (e.g., breasts/chest, external and/or internal genitalia, facial features, body contouring) to match the identified gender.

Who is a candidate for Gender Affirming Surgery?

During your initial consultation with Dr. Walker, he will listen to your goals and desires, ask questions, and discuss options for particular procedures.

Dr. Walker follows WPATH (World Professional Association for Transgender Health) standards of care for all procedures he offers to provide the best care possible.

Per WPATH guidelines, for Top Surgery to reshape the chest/breast to your chosen gender, you should meet the following criteria:

The patient should have lived in their congruent gender role for over 1 year
Patients should have a mental health provider that has diagnosed them with gender dysphoria and present with one referral (letter of readiness) from that mental health provider stating they are a good candidate to proceed with Gender Affirming Surgery
Patients should be in good mental and physical health to allow for safe surgery and be able to give informed consent

For breast augmentation in patients desiring male to female Top Surgery, although not an explicit criterion, it is recommended that patients undergo feminizing hormone therapy when possible to allow maximize breast growth to obtain optimal surgical (aesthetic) results.

Our goal is to respect your privacy and make you feel well supported and comfortable and to answer all of your questions so that you can make the best possible decision to meet your desired outcome.

What Gender Affirming Surgeries does Dr. Walker perform?
Dr. Walker performs Top Surgery (Both Cis Male to Trans Female and Cis Female to Trans Male),
Facial Feminization Surgery, and Facial Masculinization Surgery.
(Read below for more detail. Before and After Photos available during consultation)

Breast augmentation. Doctor with marker preparing woman for plastic surgery operation agai

TRANSMASCULINE (CIS FEMALE TO TRANS MALE) TOP SURGERY

(AKA GENDER MASTECTOMY)

During female to male Top Surgery, or Gender Mastectomy, the patient’s breasts are surgically removed and the chest is sometimes further contoured with liposuction to give a Masculine Appearance that conforms well to the pectoralis muscle. The surgeon will also alter the shape of the nipple-areolar complex in order to give it a natural male appearance.

There are several techniques performed by Dr. Walker and he will assist you in confirming which can deliver the best result.

In general, patients who have smaller breasts can have this procedure performed via an incision in the lower half of their areola and the breast tissue is removed through this incision. This is known as the "Keyhole Technique" and there is a variation of this technique that uses an incision all the way around the nipple to allow for reduction of the nipple size. this is known as the "Periareolar Technique)

More often, for patients with larger breasts, a Double Incision Mastectomy (most commonly performed procedure) is performed with the resulting scar placed under the chest muscle (pectoralis major) crease along with a free nipple graft.

As an alternative, we can sometimes keep the Nipple Attached to the lower part of the breast to preserve blood and nerve supply and put it into it's new place after skin and breast tissue is removed, but this will leave some mild fullness and breast tissue and possibly a vertical scar. These are known as the "Inverted T" and "Button Hole" techniques.

It can be intimidating and confusing in choosing which technique is best for you. Dr. Walker will counsel you on which technique he recommends following a thorough evaluation and educate you on the pros and cons of each option to make sure you make the best decision to meet your goals.

FACIAL MASCULINIZATION SURGERY

The majority of female to male patients achieve male facial features after hormone therapy is administered (before surgery). However, some patients who are looking to achieve a higher degree of masculinity may benefit from facial masculinization surgery. This procedure may incorporate forehead augmentation (lengthening), cheek augmentation to create a more angular shape, rhinoplasty to create a larger or wider nose projection, jaw contouring, chin recontouring, and thyroid cartilage (Adam’s Apple) enhancement.

Examples of Different Techniques used in Top Surgery

(Click arrows to scroll through)

Example of Breast Reduction using "Keyhole Technique"

This patient underwent a Keyhole Technique for breast tissue removal, as they were a good candidate due to good skin quality and low amount of breast tissue

Example of Breast Reduction using "Keyhole Technique"

This patient underwent a Keyhole Technique for breast tissue removal, as they were a good candidate due to good skin quality and low amount of breast tissue

Example of Breast Reduction using "Keyhole Technique"

This patient underwent a Keyhole Technique for breast tissue removal, as they were a good candidate due to good skin quality and low amount of breast tissue

Example of Breast Reduction using Double Incision Technique with Free Nipple Graft

This patient wanted a more masculine appearance to the chest. The patient had excess skin present that would not have responded well to more conservative techniques, and therefore they underwent a Double Incision Technique with Free Nipple Graft. Note that this patient also wanted contouring of the bra line, and therefore the incision went farther than average and included the outside chest area. The patient also underwent a lower body lift for contouring of abdomen.

Example of Breast Reduction using Double Incision Technique with Free Nipple Graft

Example of Breast Reduction using Inverted T Technique

This patient underwent an Inverted T Technique, which allows them to maintain a small breast bud and maintain sensation to the nipple.

Example of Breast Reduction using Inverted T Technique

This patient underwent an Inverted T Technique, which allows them to maintain a small breast bud and maintain sensation to the nipple.

Example of Breast Reduction using Inverted T Technique

This patient underwent an Inverted T Technique, which allows them to maintain a small breast bud and maintain sensation to the nipple.

Example of Breast Reduction using Inverted T Technique

This patient underwent an Inverted T Technique, which allows them to maintain a small breast bud and maintain sensation to the nipple.

Example of Breast Reduction using Inverted T Technique

This patient underwent an Inverted T Technique, which allows them to maintain a small breast bud and maintain sensation to the nipple.

Breast Augmentation

This patient desired a more feminine appearance to the chest, and therefore they underwent breast augmentation using submuscular gel implants.

TRANSFEMININE (CIS MALE TO TRANS FEMALE) TOP SURGERY

(BREAST AUGMENTATION)

In this type of feminization surgery (breast augmentation), Dr. Walker will use an incision under the breast crease to insert breast implants to augment the male chest to give a more female appearance. This can be performed over the pectoralis muscle. If this is done, it can help to perform simultaneous thickening of the breast tissue with fat grafting or pre operative hormone therapy to allow for improved breast coverage of the implant to avoid a "stuck on" appearance of the implant. Alternatively, the implant can be placed under the muscle with proper release of lower attachments to let the implant sit correctly on the chest wall.

FACIAL FEMINIZATION SURGERY

This is another gender affirming male to female surgery that incorporates cosmetic procedures that address the appearance of the eyebrows, cheeks, lips, chin, hairline, eyelids, and nose. The surgeon may also reduce the patient’s thyroid cartilage (Adam’s apple). Typically, the main goal of facial feminization surgery is to ensure that the patient’s facial appearance has distinct female characteristics.

Can I use Insurance to cover my Gender Affirming Surgery at Walker Plastic Surgery?

While we do not currently accept Insurance, we do offer several flexible payment options, including multiple financing options, to allow you the tools you need to achieve your goals!

What financing options exist for gender affirming surgery through Walker Plastic Surgery?

Walker Plastic Surgery has partnered with Care Credit to help our patients finance the costs of their surgical procedure. The CareCredit card is North America’s leading patient payment program. The CareCredit card is easy to use, includes no hidden costs, and can be applied towards both surgical costs and follow-up appointments.

Through their website, you can access tools like the payment calculator and even find out if you qualify for a CareCredit card by starting a commitment free, instant application.

How visible will the scars be after my procedure? Is the benefit worth the required scars?

At Walker Plastic Surgery, we care about your scars almost as much as you do. As a Plastic Surgeon, Dr. Walker takes pride in optimizing every scar to its best potential. Each patient will naturally be prone to making a certain type of scar color, thickness, and width, but our promise at Walker Plastic Surgery is to do everything in our power to make the scars as hidden, as small, and as blended as possible to the surrounding skin. To do this, we use a multi stage evaluation and treatment method consisting of scar evaluations throughout your healing process. Using industry leading technology, we counsel and provide our patients with access to multiple scar reducing treatments including:

High quality, low tension skin closure and well designed scars
Early application of Medical Grade scar cream
Medical Grade Suncreen to prevent sun damage to sun exposed scars
Steroid injections as needed for scars that are raised or thicker than desired
Microneedling and/or Morpheus 8 Radiofrequency Microneedling for thickened scars or poor scar texture
Laser IPL Treatments for red pigment in scars
Hydroquinone lightening cream for brown pigment in scars
Scar revisions, usually under local anesthesia, for areas of scars less than optimal after final healing.

The scar healing process takes approximately 1-2 years from surgery to final result, and therefore we offer our patients multiple evaluations during the healing process so that proper treatments at the proper times for the best healing possible. With this multi stage evaluation and treatment scar program, we continue to put emphasis into producing the highest quality scars possible for our patients. Don't let the fear of a scar prevent you from having the shape and contour you deserve!

Examples of Long Term Scar Results after Optimization

(Click arrows to scroll through)

Short Term Scar Healing Extended Tummy Tuck

This patient underwent an Extended Tummy Tuck. This shows her 6 weeks after surgery. Scars were still red at this point, and we used a mix of scar cream, scar massage, and eventual laser treatments in the office to optimize her scars.

Long Term Scar Healing Extended Tummy Tuck

This shows the same patient before and after optimizing her scars, now shows approximately 1 year after surgery. Notice how the scars are blended into skin and similiar color.

Long Term Scar Healing Extended Tummy Tuck

This shows the same patient before and after optimizing her scars, now shows approximately 1 year after surgery. Notice how the scars are blended into skin and similiar color.

Long Term Scar Healing Extended Tummy Tuck

This shows the same patient before and after optimizing her scars, now shows approximately 1 year after surgery. Notice how the scars are blended into skin and similiar color.

Long Term Scar Healing Extended Tummy Tuck

This shows the final result of scar optimization.

Long Term Scar Healing Breast Lift and Extended Tummy Tuck

This shows a frontal view of the same patient, showing her Breast Lift and Tummy Tuck scars to be more red and noticeable than desired at 6 weeks post op

Long Term Scar Healing Breast Lift and Extended Tummy Tuck

This shows the patient at 6 weeks post op (left) vs 1 year post op (right) following scar optimization

Long Term Scar Healing Breast Lift and Extended Tummy Tuck

This shows the final before and 1 year after with well blended scars

Long Term Scar Healing Breast Lift with Implants

The same patient opted for breast augmentation 6 months later, and this shows further scar healing of her breast lift scars (left at 6 weeks, right at 1.5 years out)

Scar Optimization Following Open Rhinoplasty

Following a Rhinoplasty, the patient's scar showed signs of redness and swelling that made it more noticeable than ideal at 6 weeks post op (left). This shows her scar healing following multiple methods of treatment and further healing time, with significant improvement in final result (right).

Scar Optimization Following Open Rhinoplasty

This shows the final before and after with minimal visibility of the scar.

Scar Optimization Following Open Rhinoplasty

This shows the final before and after with minimal visibility of the scar.

Long Term Scar Healing Extended Tummy Tuck

This shows another patient who underwent an Extended Tummy Tuck for better shape of waist and buttocks. Her scars are red and noticeable at 6 weeks post op (right photo)

Long Term Scar Healing Extended Tummy Tuck

This shows the patient 6 weeks post op (left) vs 1 year post op following multiple therapies used for scar optimization.

Long Term Scar Healing Extended Tummy Tuck

Final Before and 1 year post op from Extended Tummy Tuck with optimized scars.

Scar Healing after Face and Neck Lift

This shows a patient before and 6 weeks after face and neck lift. She has improvement of her contour but at 6 weeks out she still has some swelling and redness to the scars around the hairlines.

Scar Healing after Face and Neck Lift

This shows a patient 6 weeks post op (left) vs 1 year post op following a face lift (right). Notice the improvement in scar healing around the hairline with scar treatments provided during healing.

Scar Healing after Face and Neck Lift

This shows final before and 1 year after with very minimal noticeable scar around the ear and hairline.

Breast Augmentation Scar Healing

This shows a patient 6 weeks vs 1 year post op from Breast Augmentation, and she has maintained a great result and also healed her scar to be very well blended with the surrounding skin following our scar care program.

Long Term Scar Healing Body Lift and Thigh Lift

This shows a patient's well healed abdominal scars 6 months after body lift and thigh lift

Breast Reduction Scar Healing

This shows a patient 6 weeks vs 1 year after Breast Reduction (she presented for abdominoplasty following breast reduction). You can see the difference in her Breast Reduction scars over time and also the difference between a fresh Tummy Tuck scar and Breast Reduction scar that has had more time to heal (right picture)

Mommy Makeover Scar Healing

This shows a patient 6 weeks vs 6 months after a breast implant exchange and lift revision and a Tummy Tuck with Liposuction. Notice how much better her scars look on the right image after she has had some time to heal and obtain proper scar care with our clinic.

Long Term Scar Healing Extended Abdominoplasty

This shows a patient following an Extended abdominoplasty. Notice the improvement in scar appearance 6 weeks (left) vs 6 months (right) post op

Long Term Scar Healing Extended Abdominoplasty

This shows the patient before and 6 months after extended abdominoplasty

Long Term Scar Healing Breast Augmentation Mastopexy and Extended Abdominoplasty

This shows the improvement of abdominal and breast scars 6 weeks (left) vs 6 months (right) post op from Breast Lift with Implants and Extended Abdominoplasty

To schedule an appointment, online consultation or learn more about a Gender Affirming Surgery, please Contact Us or call us at (469) 899-8758.