Body Contouring

• Body contouring is a gender-affirming procedure that focuses on changing the curvature of the trunk area including the waist, abdomen, hips, and buttocks using a combination of liposuction and fat grafting.
• For transfeminine and nonbinary patients, liposuction and fat grafting are used to increase the projection of the buttock and hip area to create a more feminizing or de-masculinizing waistline.
• For transmasculine and nonbinary patients, liposuction is used to reduce the curvature of the hip and buttock areas to create a masculinizing or de-feminizing waistline.

It’s important to note that while fat transfer and body sculpting can improve your contours, the procedure is not a substitute for weight loss, a healthy diet and exercise. Body contouring is ideal for individuals within range of their baseline weight and have good skin elasticity. Two important considerations for body contouring are:

• Skeletal bone structure - Hormones influence the development and structure of our bones, specifically our pelvic bone associated with our waistline. Individuals who experienced an estrogen puberty, typically develop wider pelvic bones that increase torso curvature and individuals who experienced a testosterone puberty typically develop narrower pelvic bones reducing curvature. Body contouring will not change the underlying pelvic structure.
• Fat distribution - Bodies have a combination of subcutaneous, fat between the skin and muscle layer; and mesenteric, fat below the muscle layer. Body contouring consists of the removal or movement of subcutaneous fat only. Weight gain is not a guarantee for surgical eligibility due to how bodies store fat differently.

Surgeons identify an ideal surgical candidate for body contouring by considering a combination of factors including, but not limited to:

Subcutaneous fat:

Also known as “under the skin” is where liposuction is effective, and enough excess fat in the subcutaneous zone is needed for surgery to be successful. Surgeons will perform a skin test to determine available subcutaneous fat.

Skin elasticity

Skin elasticity is the ability of your skin to shrink or retract back into place after being stretched, this is largely determined by the body’s supply of collagen and elastin.

Weight fluctuations

Patients should be at their baseline weight, gaining or losing weight is not indicated for good or long-term outcomes. Significant weight fluctuations can lead to revisions.

Ideal Body Mass Index (BMI) range

25 to 32 BMI. This may vary with surgeon. Surgeons perform an evaluation to determine candidacy for body contouring.

There is a continuum from being a poor candidate to an excellent candidate considering all the above factors; thus, results vary from mild to moderate improvement. These considerations and limitations should be discussed with your surgeon, PCP and navigator to set realistic surgical expectations.

Bring a list of questions to ask your surgeon at the consultation to help you plan for your surgery and set expectations. If you don’t understand something, it’s okay to ask your surgeon to repeat or explain it in a different way.

• What is surgically possible or not possible with body contouring? Do you use implants?
• What kind of scaring will I have?
• How should I prepare for an optimal surgical outcome?
• How will weight fluctuation before or after this procedure affect my results? → What if I have poor skin elasticity, will this effect outcomes?
• How much fat can be harvested and what outcomes can I expect?
• What type of compression garment will be recommended for my surgery?
• What are your recommendations for sitting, moving, sleeping, and activity while recovering?
• Are there benefits to lymphatic massage and how can I access this?
• Will I need multiple surgeries, and how common are revisions?
• What are the possible complications of this surgery?
• What can I expect healing to look/feel like?

Your PCP, surgeon, and Gender Health Navigator can help you achieve optimal surgical outcomes by actively preparing for your surgery and making sure expectations are surgically possible.

PHYSICAL HEALTH

• Maintain a healthy body weight, high body weight can increase complications and interfere with wound healing.
• Although there is not a strict Body Mass Index (BMI) requirement, your surgeon may discuss specific anesthesia risks or considerations, depending on your BMI. It is beneficial to reach your own personal sustainable goal weight prior to surgery

MENTAL HEALTH/WELLNESS

• Having surgery takes both physical and mental preparation.  Surgery is stressful, some people feel an increase in depression or anxiety after surgery. 
• If you notice any changes in your mood or sleep, especially with anesthesia, please discuss with your care team.
• If you struggle with mental health, reach out to your mental health provider or navigator for support.

SMOKING

• Nicotine intake by smoking, patches, chewing gum, or vaping may interfere with wound healing. If you use nicotine, you should discuss a quit date with your PCP and surgeon. Surgeons require patients to stop nicotine prior to surgery and may test for confirmation.
• If you inhale cannabis, it’s important to find another way to use it, for example, topical, edibles, and tinctures, or to stop altogether.

SUPPORT

Build your network of support with providers, family, and community to help you plan and organize your recovery prior to and after surgery

• Transportation to and from appointments 
• Meal planning and preparation
• Providing a calm and supportive healing space

Everyone heals differently. Patients will experience different levels of pain, bruising, swelling, and fluid drainage at incision sites. Each aftercare recovery plan is catered to a patient’s unique medical needs.

You will receive post-op care instructions from your surgeon so make sure to review these instructions with your surgeon, PCP, and navigator as needed.

For optimal results and to help avoid complications, it is essential to follow post-op directions and engage in follow-up care appointments as scheduled. Your surgeon will cover post-surgery topics, such as:

• When to resume exercise, physical, and sexual activity
• Healing process & pain management
• Complications

• Medicare A&B
• Full Scope Medi-cal
• San Francisco Health Plan (Medi-cal, Healthy Workers and Healthy Families)
• Anthem (Medi-cal)
• Healthy San Francisco (Health Access Program)