Surgical Gender Affirmation Program

• 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.

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).

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.

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.

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.