Transgender Surgery

At The University of Kansas Health System, we take a multidisciplinary approach to gender-affirming surgical care, combining plastic surgery, reconstructive urology and gynecology. Our goal is to provide patients with a patient-centered surgical experience while having the expertise and resources of a large academic institution. Safety and aesthetics are of the utmost importance.

Our board-certified, sub-specialized experts provide gender-affirming surgery, also known as sex reassignment surgery, at The University of Kansas Hospital in Kansas City. It is the No. 1 hospital in the state of Kansas as ranked by U.S. News & World Report.

We provide concierge service for gender-affirming consultation. Contact Judy Gay, RN, transgender clinic coordinator, at 913-588-8553.

Facial feminization surgery (FFS)

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.

Top surgery

Mastectomy and chest contouring

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 the patient’s physique and amount of chest tissue present. The most common technique is bilateral mastectomy with free nipple grafts. Some patients may be eligible for a peri-areolar, or keyhole, technique that minimizes scarring. These procedures are offered as a drainless technique.

Breast augmentation

Breast augmentation procedures enhance the size, shape or fullness of the breasts. Ideally the patient will have taken hormone therapy for at least 12 months before undergoing 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.

Bottom surgery

In 2018, The University of Kansas Health System began offering gender-affirming surgery (bottom surgery). 

Vaginoplasty is 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 allows sexual penetration, orgasm and urination. 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.

Metoidioplasty, in which 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 salpingooophorectomy. 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  entails 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 size and bulk that can accommodate an erectile device to allow 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 contouring

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, love handles 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. Contouring can help achieve a broad and defined upper torso, trim waist and minimal fat in the lower body area.

Gender reassignment surgery criteria

Patients should be as physically prepared as they are mentally for gender surgery. Obesity, poor diet and use of tobacco negatively impacts surgical recovery, impairs wound healing and increases the risk of complications. Your surgeon(s) will discuss whether smoking or use of other substances is a contraindication to your surgery.


Psychiatric evaluations

The University of Kansas Health System follows the World Professional Association for Transgender Health (WPATH) Standards of Care. We do not want psychiatric evaluations to cause an undue burden on the patient; however, most insurance companies adhere to these requirements:

  • For any genital surgery: 2 letters of recommendation must be provided.
  • Our health system requires 1 letter from a PhD or MD therapist/psychiatrist and a second letter from a licensed therapist who is at least master’s prepared. Both letters must follow the format outlined in the WPATH Standards of Care.
  • For face, body or chest surgery: 1 letter of recommendation must be provided.
For concierge gender-affirming consultation services,
contact Judy Gay, RN, transgender clinic coordinator.
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

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