Gender-Affirming Plastic Surgery

The George Washington University Hospital is one of the top providers of gender-affirming plastic surgery in the region, including facial feminization surgery, breast augmentation, mastectomy and chest reconstruction.

“Out of the institutions in the DMV area, GW Hospital is performing probably the highest volume of gender-affirming surgeries,” says Jerry Chao, MD, Assistant Professor of Surgery at The George Washington University School of Medicine & Health Sciences. “We get a lot of referrals from all over the region. I think that is due to positive feedback from the patients we’ve been treating, as the region’s transgender and gender diverse community is very tight-knit.”

Facial Feminization Surgery

Comprehensive facial feminization surgery requires a very particular skill set. “My background is in craniomaxillofacial surgery, which is important for safely performing surgery all over the facial skeleton. These bony changes are so critical to a successful facial feminization are not something that all general plastic surgeons are going to be able to offer,” Dr. Chao says. “This includes things like setting back the frontal sinus bone to recontour the brow region or doing osteotomies of the mandible or the zygoma in order to feminize facial proportions.”

Top Surgery for All Genders

Many transgender patients choose top surgery as their first — or only — gender-affirming surgery. For transgender female patients, the breast augmentation procedure is similar to that performed on cis-gender females seeking augmentation, though with important anatomical nuances, and typically involves placement of breast implants. For patients seeking chest masculinization, surgeries can include a nipple-preserving mastectomy or a mastectomy with chest reconstruction to provide a masculine or gender-neutral appearance. 

Most patients referred for surgery have been in different stages of transition for years. “The rewarding thing about working with the transgender and gender diverse community is that so many people have been waiting for this surgery for so long,” Dr. Chao says. “It’s wonderful to be able to help ensure their physical appearance is congruent with their gender identity.”

Genitourinary Reconstruction

The GW Hospital urology department performs orchiectomy for patients as part of the transition process. It also provides treatment and surgery for transgender patients who have experienced complications after bottom surgery.

“For female to male surgery, most of the complications come from the reconstruction of the penis and the neourethra, and the most common complication would be ureteral stricture or fistula,” says Michael Phillips, MD, FACS, clinical professor of urology at The George Washington University School of Medicine & Health Sciences. “From male to female patients, complications that we see include stenosis and atrophy of the neovagina as well as urethral strictures and occasional fistula formation from the urethra to the neovagina.”

The urology program also sees transgender women who may still be at risk for prostate cancer, and who require ongoing screenings as they age. “We see patients during all aspects of transitioning, and we strive to provide nonjudgmental and respectful care for every person, whatever medical needs they may have,” Dr. Phillips says.

While Dr. Chao does not currently offer vaginoplasty or phalloplasty, he is able to provide the appropriate referral given close relationships with other gender-affirming surgeons in the region.