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Align Surgical | Gender Affirmation Surgery For You

Gender affirmation surgery for transmen, transwomen, non-binary, and gender diverse individuals. For queries, please call us or send your questions through the form below.

SERVICES WE OFFER

We are located in San Francisco and Los Angeles and are one of the few private interdisciplinary surgical practices in the United States that is 100% focused on gender-affirming surgery. Our surgeons offer the full array of gender-affirming procedures, including facial feminization, facial masculinization, breast augmentation, mastectomy, body contouring and many forms of genital surgery, such as phalloplasty, metoidioplasty, vaginoplasty and more.

During your consultation, our experienced team will meet with you to better understand your goals and discuss surgical options that will help you achieve your most authentic self. We will closely collaborate with you throughout your surgical journey to meet your desired embodiment goals.

PATIENT STORIES

Choosing Align Surgical for your gender-affirming care means entrusting your health and identity to a skilled, compassionate team. Hear firsthand from patients who’ve experienced expert care from our renowned doctors.

TOP SURGERY CONSULTATION: WHAT TO EXPECT

DOUBLE INCISION

PERIAREOLAR INCISION (KEYHOLE)

INVERTED

BUTTON HOLE

DOUBLE INCISION TOP SURGERY (WITH NIPPLE GRAFTS)

This is one of the most common types of masculinizing chest surgery, especially for people with medium to large chests.

How it works:

The surgeon makes two horizontal incisions across the chest to remove breast tissue. The nipples are removed and then grafted back onto the chest in a more masculine position.

Pros:

  • Works well for larger chests
  • Allows more control over chest shape and nipple placement
  • Often creates a flat, defined chest

Cons:

  • Leaves two visible scars across the chest
  • Some loss of nipple sensation is common

PERI-AREOLAR (KEYHOLE) TOP SURGERY

This method is best for people with smaller chests and good skin elasticity.

How it works:

A small incision is made around the edges of the areola (nipple area), and the breast tissue is removed through this opening. Since the nipple stays attached, nipple sensation is more likely to be preserved.

Pros:

  • Smaller scars that blend with the edge of the areola
  • May preserve more nipple sensation
  • No need for nipple grafts

Cons:

  • Not ideal for larger chests
  • Less control over chest contour and nipple size.

INVERTED-T OR ANCHOR INCISION SURGERY

This option is sometimes used for people with very large chests or extra skin, or in those patients who desire a reduction of breast size, rather than a more flattened contour.

How it works:

It combines a vertical incision from the nipple down to the chest crease with a horizontal incision along the bottom of the chest, forming an anchor-like shape.

Pros:

  • Can remove more tissue and excess skin
  • Helps reshape the chest more dramatically when needed

Cons

  • Results in more scarring (anchor-shaped)
  • Longer healing time and slightly more complex recovery

BUTTONHOLE TECHNIQUE

This method is ideal for people with small to moderate chests who want to attempt to preserve nipple sensation, though results are unpredictable and can vary widely.

How it works:

It involves removing chest tissue through incisions at the base of the chest and creating a small opening (the “buttonhole”) to reposition the nipple while keeping it attached to nerves and blood supply. This can theoretically help maintain sensation.

Pros:

  • Better change of preserving nipple sensation
  • More natural nipple appearance and color over time
  • Avoids vertical scar between nipple and chest crease

Cons:

  • Not ideal for very large chests or heavy tissue
  • Slightly more complex surgery and healing

BOTTOM SURGERY MAY INCLUDE

For transgender, non-binary and gender diverse patients who are ready to take this step, Align Surgical offers the full array of bottom surgery options, including:

 

PHALLOPLASTY

METOIDIOPLASTY

PENILE IMPLANT

VULVOPLASTY

VAGINOPLASTY

PENECTOMY

MONSPLASTY

ORCHIECTOMY (SIMPLE & BILATERAL) 

PULL-THROUGH VAGINOPLASTY

LIFE-CHANGING TESTIMONIALS

Our mission is to align body and mind through compassion and surgical excellence so that all people can experience the freedom of living as their true gender.

With the safety and well-being of our patients and staff as our highest goal, our team is committed to providing needed medical care and planning. Please do not hesitate to reach out to us with any questions.

 

Before getting gender affirming surgery, you’ll need to have a consultation with your surgeon. This is your chance to talk about your goals, learn more about the surgery, and ask any questions you may have. It’s totally normal to feel nervous, but remember, this appointment is for you. You’re taking an important step toward a more comfortable and confident future.

HOW TO PREPARE FOR YOUR CONSULTATION

To make the most of your gender affirming surgery consultation, it helps to be prepared.
Here are a few tips:

  • KNOW YOUR GOALS
    Think about how you want your final results to look and feel after surgery.
  • MAKE A LIST OF QUESTIONS
    Write them down so you don’t forget anything.
  • BRING MEDICAL INFORMATION
    If you have any past medical records or medications, bring those with you.
  • HAVE A SUPPORT PERSON (IF YOU WANT)
    A trusted friend, partner, or family member can come with you if it helps you feel more comfortable.

Your surgeon will likely go over your medical history, check your chest and skin, and talk about which surgery technique might be best for your body and goals.

QUESTIONS TO ASK YOUR SURGEON

Here are a few beneficial questions to ask during your consultation:

  • What type of top surgery / bottom surgery do you recommend for me?
  • How much experience do you have with gender-affirming surgery?
  • What will my scars look like?
  • How long is the recovery?
  • What are the risks or possible complications?
  • Can I see before-and-after photos of past patients?
  • What kind of results can I realistically expect?

These questions can help you feel more informed and confident about your decision.

MENTAL HEALTH EVALUATIONS OR LETTERS

Depending on where you live or the clinic’s policies, you might need a mental health letter from a licensed therapist or psychologist. This letter usually confirms that:

  • You understand what the surgery involves
  • You’re mentally and emotionally ready for the procedure
  • The surgery is a medically necessary part of your gender-affirming care

Some clinics don’t require this if you give informed consent, while others may still follow older requirements. Your surgeon or clinic should let you know exactly what’s needed.

TIPS FOR OPTIMAL HEALING

  • Follow your surgeon’s instructions: they know your body and procedure best
  • Rest and hydrate: healing takes energy
  • Take pain meds as directed: don’t try to “tough it out”
  • Sleep on your back with your upper body slightly elevated
  • Don’t smoke or vape, as this can slow healing
  • Wear your compression garment exactly as advised
  • Stay in touch with your care team if anything feels off or unusual

INCLUSIVE CARE AND SAFE PRACTICES

It’s essential to choose a surgeon who practices inclusive care and understands the unique needs of transgender and gender-diverse individuals. This means your surgeon should be knowledgeable about the mental, emotional, and physical aspects of gender-affirming surgery.

An informed approach means the surgeon is sensitive to the potential emotional and psychological challenges you may have faced throughout your life. They should create an environment where you feel safe, heard, and respected.

Make sure your surgeon takes time to listen to your concerns, explain the procedure in detail, and respects your gender identity and individual needs. You deserve a provider who sees you as a whole person, not just a patient undergoing surgery.

Align Surgical Associates is proud of its affirming and LGBTQIA2S+ inclusive care. Our surgeons are specifically trained to provide gender-affirming surgeries with empathy and professionalism.

CLINIC VALUES THAT SUPPORT LGBTQIA2S+ IDENTITIES

In addition to finding a skilled surgeon, it’s important to choose a clinic that values and supports LGBTQIA2S+ identities. A clinic that fosters a welcoming environment will make your experience more comfortable.

Look for clinics that openly advertise their commitment to LGBTQIA2S+ care, such as:

  • Non-discrimination policies that explicitly include gender identity and sexual orientation.
  • Staff training in cultural competency and understanding the unique needs of transgender patients.
  • Respectful language: The clinic should use correct pronouns and be respectful of all gender identities.

Align Surgical Associates prides itself on being a 100% dedicated gender-affirming care clinic that celebrates diversity and provides comprehensive care for LGBTQIA2S+ individuals. Our mission is to offer compassionate and respectful treatment throughout the entire surgical process.

No. 1 Gender Affirming Surgeons in Los Angeles and San Francisco

“An incredibly professional, welcoming, supportive, and affirming experience”