Gender Confirmation Surgery refers to the surgical process that has enabled transgender people to transition fully and cure themselves of dysphoria. This process oversees a number of procedures that will shape the face, chest, and genitalia to ensure your body corresponds to your gender identity.

If you a transgender woman who was assigned male at birth and are currently looking into transitioning, allow Dr. Christopher J. Salgado and his team of multidisciplinary experts at the University of Miami to aid you in your journey.


Complete Gender Confirmation Surgery can take any number of years once Hormone Replacement Therapy has begun. This process varies from person to person and largely depends on the recovery time between surgeries, their schedule and desires and essentially many other factors of daily life. While some procedures may be performed in unison with others, it is still advisable to take your time and allow your body to adapt to the changes.

FACE Total: 1-10 hours
Depending on
Total: 4-6 weeks, estimated.
CHEST 1-3 hours
for one day
2 weeks w/ 1-month post-op care
GENITALIA Total: 4-9 hours
Inpatient for 3-5 days
Total: 3 months w/ 12 months +
regular dilation treatment

Male to Female (M2F) Gender Confirmation Surgeries

Gender Confirmation Surgery enhances three major areas of the body bring out the female form within. This process oversees a number of procedures that will shape the face, chest, and genitalia to correspond with your gender identity.


The first step in your journey involves the consultation of a qualified therapist who specializes in gender transition. While this may be very difficult for some, Gender Confirmation Surgery in some cases is not reversible and your emotional and mental well-being is very important to reduce the risk of any complications you may have in the future.

Consultation with a specialized therapist is required before you can begin Hormone Replacement Therapy. However, surgeons will require one letter for top surgery, two letters for bottom surgery and none for facial feminization procedures.


The effects of Hormone Replacement Therapy (HRT) can have a profound effect on your emotional and physical well-being. Dr. Salgado can connect you to a reputable endocrinology team who can provide you with an informed understanding of the potential risks and benefits from HRT and is guided by the World Professional Association for Transgender Health.

  • Estrogen Therapy
    The main form of Estrogen is Estradiol, which embellishes feminine physical traits during HRT. It indirectly suppresses the production of testosterone and works directly on your tissues. Estradiol can be applied orally (tablet), transdermally (skin patch/gel), subdermal application (implant), and through a sub-muscular injection. Our recommendation is to avoid oral estrogens due to their increased venous thrombogenic effects.
  • Anti-Androgen Therapy
    In order to suppress the production of testosterone, Androgen blockers will be administered. This treatment slows male-pattern baldness and reduces the growth of facial hair. Anti-Androgen is usually prescribed with estrogen since the two treatments complement one another.


Because of the differences in male and female skulls, facial surgery can leave a more profound impact than a vaginoplasty and may very well be the most important decision of your journey. This combination of procedures alters the face to create a softer, more feminine appearance.

  • Thyroid cartilage reduction (Adam’s Apple) Shave
  • Forehead Reduction/Contouring
  • Jawline/Chin Contouring
  • Rhinoplasty
  • Voice Surgery (By our University of Miami ENT surgeon)

It is worth remembering that the differences between male and female features differ with age, ethnicity, genetics, and the age hormone replacement therapy began.

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The breasts are the central part of the female form. While it comes in various shapes and sizes, it provides the body with a definition that is unique to the gender. For many transwomen, estrogen therapy allows the breasts to develop. The breasts begin to bud during the sixth month of treatment. While some patients are happy with the natural development, many undergo breast enhancement to attain a figure that is definitively feminine.

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This series of surgical procedures is what allows your body to align with your gender identity. Gender Confirmation Surgery of the genitalia oversees a number of procedures, including:

  • Orchiectomy
  • Vaginoplasty
  • Clitoroplasty
  • Labiaplasty

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Body Contouring

A series of surgical procedures that enhance the newly-feminized shape of your body. Procedures include:

  • Liposuction/Liposculpture
  • Gluteal Enhancement
  • Silicone Removal

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What is Gender Identity Disorder?

Commonly known as “Gender Dysphoria”, it refers to the internal and emotional conflict many transgender individuals experiences. Transgender people do not feel their gender identity corresponds to the gender that was assigned to them at birth and will display behaviors that are often associated with the opposite gender.

Do all Transgender people undergo Gender Confirmation Surgery?

Not all transgender women are the same. In most cases, the amount of surgery a transwoman undergoes correlates to the level of dysphoria they experience. A trans woman who undergoes Gender Confirmation Surgery in her genitalia may not desire to undergo breast surgery. Some transwomen who have undergone chest and genitalia surgery may not wish to opt for facial surgery. It all depends on the experiences and needs of the individual.

Are there any procedures a Transgender person must take before undergoing Gender Confirmation Surgery?

Mental health evaluations are required before beginning Hormone Replacement Therapy. While the method has been met with controversy from the Transgender community, it is a procedure that safeguards their emotional stability and as well as their future. But most often than not, transwomen who have made it this far are very certain about their decisions. One letter from a mental health therapist is required for top surgery and two letters for bottom surgery.

What is Hormone Replacement Therapy?

Essentially, Hormone Replacement Therapy enables the change of secondary sexual characteristic people in order to align your body with your gender identity. While it can not reverse the effects of puberty, Hormone Replacement Therapy can go a long way to relieve the emotional distress from dysphoria. Unlike testosterone in the transgender male, estrogen has no effect of voice characteristics in transgender women often prompting them to needs voice therapy and/or voice surgery.

How long is the recovery period?

Moderate pain is expected for the first five days after surgery. It is important to get as much rest as possible during in the weeks to come and to dilate regularly as prescribed by Dr. Salgado starting at 10 days after surgery when the Foley catheter is removed from the bladder. Strenuous activity and exercise must be avoided during this time. Sexual activity, including intercourse, may begin after three months.

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