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Gender-Affirmation Surgery

At The University of Kansas Health System, we take a multidisciplinary approach to gender-affirming surgical care, also known as transgender surgery or sex-reassignment surgery. We combine plastic surgery, reconstructive urology and gynecology.

Our goal is to provide you with a patient-centered surgical experience alongside the expertise and resources of a large academic health system. Safety and aesthetics are of the utmost importance. Our board-certified, subspecialized experts provide gender-affirming surgery, also known as transgender surgery or sex-reassignment surgery, at The University of Kansas Hospital in Kansas City.

What is gender-affirmation surgery?

Gender-affirmation surgery gives transgender people a physical appearance that aligns with their gender. Multiple procedures are typically included as part of gender-affirmation surgery, including facial procedures, top surgery (above the waist) and bottom surgery (below the waist).

Call 913-588-6200 to request a consultation. For more information, email our nurse coordinators at

Who can have gender-affirmation surgery?

You should be fully prepared – physically and mentally – as you plan gender-affirming surgery.

Preoperative requirements optimize our patient outcomes and ensure the safest surgery possible. We adhere to the World Professional Association for Transgender Health Standards of Care (SOC). The criteria for initiation of surgical treatments for gender dysphoria were developed to promote optimal care:

  • 2 psychology letters in support of gender-affirming surgery.
    • Letter 1 needs to be from a mental health provider with a PhD or MD.
    • Letter 2 needs to be from a mental health provider with at least a master’s degree.
  • Adults of age of maturity for sterilization.
  • If significant medical or mental health concerns are present, they must be well-controlled.
  • 12 continuous months of hormone therapy as appropriate to gender goals.
  • 12 continuous months of living in a gender role that is congruent with gender identity.
  • Before and after surgery, it is recommended patients also have regular visits with a mental health or other medical professional.
  • BMI must be less than or equal to 30 kg/m2.
  • Patient must be a nonsmoker.

How does gender-affirmation surgery work?

We follow a specific preoperative process for gender-affirmation surgery:

  1. During your initial preoperative surgical consultation, the surgeon will extensively discuss the procedure and postoperative course.
  2. You will work with our transgender nurse coordinator, Judy Gay, to make sure all patient requirements are met.
  3. We will work with your insurance to get preauthorization for your procedure. If your insurance does not cover the procedure, then arrangements will be made for you to meet with our financial counselors.
  4. You will have preoperative visits with all surgeons who will be part of your gender surgery.
  5. You will receive your final surgery date.
Patient Terrell Smith

A leader in transgender medicine

For years, we have provided facial feminization (FFS), and mastectomy and chest contouring (top surgery) for patients in Greater Kansas City and beyond.

Terrell Smith discusses his transgender journey and the care he received during his transition.

Read Terrell's story

Benefits and risks of gender-affirmation surgery

Research shows that sex-reassignment surgery offers long-term mental health benefits to transgender individuals, including decreased rates of anxiety, depression and suicidal behavior. These rates continue decreasing over time.

Transgender surgery does require a significant time commitment, including multiple criteria that must be met before you can be considered a candidate. There are many complexities involved in transitioning from one gender to another, both medically and socially. Finally, surgery to change genders carries similar risks as any major surgery, such as bleeding or infection. Typically, multiple procedures are involved in gender-affirmation surgery.

What happens during gender-affirmation surgery?

The specifics of your gender-affirmation surgery will vary depending on your surgical goals. We offer a full range of transgender services.

  • Facial feminization includes combined procedures to give the face a softer, more traditionally feminine appearance. This can include surgeries for both bony and soft tissues of the face, neck and thyroid cartilage. FFS is often complemented by laser hair removal.

  • Mastectomy and chest contouring

    Masculinizing surgery, sometimes referenced as female-to-male top surgery or FTM top surgery, removes unwanted breast tissue to create a more masculine chest appearance. There are several surgical techniques that may be used based on your physique and amount of chest tissue present. The most common technique is bilateral mastectomy with free nipple grafts. Some people may be eligible for a periareolar, or keyhole, technique that minimizes scarring. These procedures are offered as a drainless technique.

    Breast augmentation

    Breast augmentation enhances the size, shape or fullness of the breasts. Ideally you will have taken hormone therapy for at least 12 months before getting breast augmentation. Hormone therapy results in nipple growth and development of some breast tissue, which means surgery is likely to be more successful with better cosmetic results.

  • Vaginoplasty

    Vaginoplasty is a feminizing genital surgery that includes several procedures performed at once. We use a penile inversion technique in which the penis is turned inside out to form the inner walls of the vagina. The head of the penis is then used to create a clitoris. Outer and inner labia are formed, and the urethra is shortened and repositioned. The surgery results in fully functioning external female genitalia that allow for urination, sexual penetration and orgasm. Preoperative electrolysis or laser hair removal from the scrotal sac is recommended. Follicles will be scraped and electrolyzed during surgery, but hair growth cycles prevent removing all dormant hair.


    Vulvoplasty is a feminizing surgery that creates a vulva and removes the penis, scrotum and testes. The vulva is created using scrotal and urethral tissue, and the urethra is shortened.


    Metoidioplasty is a masculinizing surgery where the clitoris is "released" to give the appearance of more length to the phallus. The final result is a normal appearing, but very small, penis. This surgery can be performed in conjunction with a vaginectomy and a hysterectomy with bilateral salpingo-oophorectomy. Urethral lengthening can also be done at the same time, or at a later time, to allow the patient to stand to urinate. The labia majora becomes the scrotal sac and customized solid silicone testicular implants can be placed. The surgery is minimally invasive, and sensation to the clitoris remains intact.


    Phalloplasty, a masculinizing surgery, is the formation of a phallus using skin taken from another spot on the body: sometimes the flank, lower abdomen or forearm. The principal advantage to this procedure is that it creates a penis of significant enough size and bulk to accommodate an erectile device that allows for penetrative sexual intercourse. Urethral lengthening can also be done at the same time, or at a later time, to allow the patient to stand to urinate.

  • Body feminization can be done to achieve an hourglass figure. Typically, this procedure involves trunk liposuction and buttocks augmentation. Fat is removed from the waist, abdomen, hips and mid/lower back. This fat can then be transferred to the buttocks area to form a shapely, feminine backside – a procedure known as the "Brazilian butt lift."

    Body masculinization can help a person attain the classic V-shaped figure. Certain areas of fat storage, such as the hips, legs and buttocks, can be difficult to change through diet and exercise alone. Body contouring can help achieve a broad and defined upper torso, trim waist and minimal fat in the lower body area.

Still the best
Our hospital continues to rank as the best in Kansas City and in Kansas according to U.S. News & World Report.
The University of Kansas Hospital has been designated a Magnet® facility by the American Nurses Credentialing Center since 2006.
Respect for all people
Named a leader in LGBTQ+ Healthcare Equality by the Human Rights Campaign.

Gender-affirmation surgery questions

Use this checklist as a guide during your surgery consultation. Our team of experts will answer all your questions.

  • Yes. Our gender-affirming surgery team includes 3 surgeons who are board-certified in their respective fields. Satish Ponnuru, MD, is certified by the American Board of Plastic Surgery. Joshua Broghammer, MD, is certified by the American Board of Urology and has specialty training in reconstructive urology. Meredith Gray, MD, is certified by the American Board of Obstetrics and Gynecology.

  • Yes. Dr. Ponnuru completed residencies in general surgery and specialty training in plastic surgery. He became a doctor in 1999 and has been performing surgery ever since.

  • Yes. Dr. Gray has been a member of WPATH since 2014. She presented research at the WPATH symposium in Amsterdam in 2016 and has attended several other training sessions and symposiums.

  • All 3 surgeons have privileges at The University of Kansas Health System. Our hospital has been continuously accredited by The Joint Commission since 2008. Your surgery will be done in a hospital with access to emergency services and specialty care. Our health system has earned Magnet designation by the American Nurses Credentialing Center's Magnet Recognition Program for 4 terms. This recognition indicates high-quality patient care and nursing excellence.

  • During your initial surgery consultation, a physician will thoroughly review your medical and surgical history. Our team will identify possible medical conditions that may need to be at their best prior to surgery. For example, if you have diabetes or high blood pressure, we will work with your primary care provider to make sure these conditions are well controlled. We also have a list of medical requirements for surgical candidates that includes no nicotine use and having a BMI of 30 or less. Gender-affirmation surgical procedures are only offered to adults aged 18 and over.

Gender-affirmation surgery at The University of Kansas Health System is only offered to adults aged 18 or older.