Gender-affirming surgery sets out to let the body match a person's identity. It is planned individually, with clear information about what can be achieved, what is reversible and what is not.
There is no single gender-affirming surgery: there are several, and each person decides which ones they need and which they do not. Some want changes to the chest — masculinising chest surgery with reconstruction of the contour, or breast augmentation — others changes to the body contour, and others to the face. Some people have one operation and some have none at all: a person's identity does not depend on having been through an operating theatre, and in this consultation that is taken as given.
It is worth being precise about what is performed here and what is not. Chest, body contouring and facial procedures are performed by Dr. García, in accredited clinics and hospitals in Lima. Genital surgery — vaginoplasty, phalloplasty, metoidioplasty — is a subspecialty worked on together with urology, and if that is what you are looking for, you will be pointed towards the team dedicated to it. We would rather say so from the start than leave it ambiguous, because in this area imprecise information does real harm.
It usually helps when there is
- A persistent wish for the body to match your gender identity.
- Masculinising chest surgery with reconstruction of the chest contour.
- Breast augmentation as part of a feminising process.
- Body contouring surgery to redistribute volumes.
- Facial procedures for harmonisation or feminisation.
Worth discussing first if
- Insufficient mental health support, or a process only recently begun.
- Hormone treatment only just started, with changes still to settle.
- Expectations that do not match what surgery can achieve.
- Medical conditions or habits that increase surgical risk.
- Genital surgery: referred to the team working on it with urology.
None of these rules the procedure out on its own; all of them change the conversation.
What is performed here
Each person chooses which procedures form part of their process.
Chest surgery
Masculinising chest surgery with repositioning of the nipple-areola complex, or breast augmentation depending on the case.
Body contouring
Redistribution of volumes with liposuction and fat grafting, to go alongside the changes from hormone treatment.
Facial procedures
Harmonisation of features, which for many people is what has the greatest impact on daily life.
Information before haste
The starting point is that the decision is yours and the information has to be complete before you take it. That includes saying clearly which changes are irreversible — chest surgery is, and fertility can be affected by other parts of the process — what the real risks of each procedure are and what results are achievable in a particular body, which do not always match the images circulating on social media.
Mental health support is not a bureaucratic requirement or an exam to be passed: it is support during a process that usually brings significant changes in family, working and social life. It is coordinated with professionals who work with trans people and who have real experience in the field.
The order and the timing are planned together. In many cases it is best to wait until hormone treatment has settled its effects before operating on the chest or the contour, because hormones change the distribution of fat and breast volume, and operating earlier can mean having to repeat. And in the case of genital surgery, you will be pointed towards the team that works on that subspecialty with urology.
What the process is like
With no deadlines imposed from outside.
First consultation
A conversation about what you are looking for, in a respectful space. Which procedures are performed here and which are referred is made clear.
Planning
Medical assessment, coordination with endocrinology and with mental health support, and agreement on the order and timing of each procedure.
Surgery
The agreed procedure is carried out, with the same standard of safety and informed consent as any other operation.
Follow-up
Postoperative reviews, scar care and assessment of whether any later adjustment is appropriate.
What to expect
These indicative timings are for chest surgery; they vary with the procedure.
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Days 1 to 7
A compression binder or garment, drains in some cases and discomfort manageable with painkillers. Relative rest.
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Weeks 2 to 4
Everyday life and desk work. No lifting and no arm exercise. Stitches out and reviews.
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Weeks 6 to 8
Gradual return to exercise. The contour settles as the swelling goes down.
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Months 6 to 12
The scars mature, which is when they lighten and flatten. Final result and assessment of any touch-ups.
Risks, and what is not promised
Those specific to each procedure: bleeding, haematoma, seroma, infection, visible or poor-quality scars, asymmetry, altered or lost sensation — in chest surgery, loss of nipple sensation is frequent and may be permanent — loss of the nipple-areola complex and the need for a later touch-up.
It is important that this is said explicitly: masculinising chest surgery is irreversible, and the ability to breastfeed is lost. Other parts of the gender-affirming process, especially the hormonal one, can affect fertility; if preserving your fertility matters to you, that is a conversation worth having beforehand rather than afterwards.
A result identical to the images circulating on social media is not promised: each body's starting point determines what is achievable, and what is sought is a result that is coherent, stable and in proportion to your anatomy. These risks are reduced by careful planning, the right surgical timing and an experienced team. They are not eliminated. The ones that apply to your case are set down in writing in the informed consent.
The information on this page is for guidance and does not replace an in-person medical consultation. Medical practice is an obligation of means, not of result.
The questions we are asked most
No. Vaginoplasty, phalloplasty and metoidioplasty are a subspecialty worked on together with urology, by a team dedicated to it.
If that is what you are looking for, you will be pointed towards that team. We would rather say so at the first consultation than leave it ambiguous.
We work alongside mental health support, not as an exam to be passed but as support during a process that usually brings significant changes.
The decision is yours. What is required, as in any surgery, is the medical assessment and informed consent.
Not always, and it depends on the procedure. For chest and contouring surgery it is usually best for hormone treatment to have settled its effects, because it changes the distribution of fat and breast volume.
Operating earlier can mean having to repeat. It is planned case by case, coordinating with endocrinology.
Respectful and without judgement, using the name and the forms of address you tell us from first contact, and with only the examination that is strictly necessary.
The information about what can be achieved, its limits and its risks is given in full, including the part that is not pleasant to hear: that is part of the respect too.
Question not answered here? There are more answers in the frequently asked questions.
