How body feminization surgery puts your feminine features in the spotlight

Body feminization surgery (BFS) is the lesser-known sister of facial feminization surgery. 2pass Clinic offers multiple surgeries for trans women under the BFS flag. These are performed by plastic surgeon Dr. Maarten Doornaert. In this interview he explains what you as a patient can expect.

Dr. Doornaert, could you briefly explain what body feminization surgery entails?

“Literally, of course, it means making the body more feminine. We actually spotlight the typical characteristics of the female body. Consider wider hips, breasts, a slim waist and a typical female fat accumulation. This accumulation of fat is not at the level of the abdomen, such as in the male apple model, but follows a pear pattern with more adipose tissue at the level of buttocks, thighs and hips. All of these characteristics can be adjusted, either by liposuction or lipofilling, i.e. the moving of fatty tissue, or by implants in humans who do not have enough fatty tissue to make a difference.”

What procedures are available?

“Generally, we can use both implants and patients’ own fatty tissue. Lipofilling may be chosen for the breast, provided the enlargement does not need to be huge. This has the advantage that you can live the rest of your life without complications. An implant can be as large as the patient chooses, considering the existing anatomy, of course. But we know that the larger the implant, the more chance there is of a complication such as capsular contracture.

We can narrow the waist by liposuction. If it is really necessary, a tummy tuck can also be done by tightening the abdominal muscles. This also makes for a slimmer waist. If we go a little lower, we get to the hips that need to be widened. Hip augmentation can be done by means of own fatty tissue. Closely associated with this is gluteal or butt augmentation, where we can also work with fatty tissue or but implants, but for which we also like to carry out further liposuction of the flanks, as this accentuates the buttocks.

How do patients get to you?

“There are patients who were treated by my colleague Dr Bart van de Ven, so they know where to go. There are also those who have searched on the Internet. Most patients come for MtF breast augmentation surgery."

Are there differences for you as a plastic surgeon between operating on cisgender women and operating on transgender women?

“That is the case particularly in the areas that we cannot address, such as the shoulders. If you have broad shoulders and a broad rib cage, you should choose a breast prosthesis that is larger, because if you use the same prosthesis as you would for someone born with a female body, this might not be suitable, or may not bring about a major change relative to the shoulders. The shoulders will also demand that you place a little extra on the hips so that everything comes into proportion a little better. There are limits, though. I am sometimes requested to remove the lower ribs for a slimmer waistline, but such measures increase the chance that functionality might be impaired. We won’t do this. These remain external affairs and we must not endanger health.”

Are there any risks associated with this surgery?

“After liposuction and lipofilling everyone has bruises. The patient then walks around with bruises for a short time, and feels some unpleasant tingling, but otherwise there are no complications, except possibly an infection such as is possible with any surgery. The implantation story is different. There you have to loosen tissues and create cavities. You can get an infection on the prosthesis. Usually, that is annoying, because antibiotics only go where the blood flows and the blood stops at the edge of the prosthesis. The implant must then be removed so that the tissue can converge again and the blood can go everywhere to purify everything. The implant can then be placed back after three months. In the long term the body creates a capsule around the implants to separate the foreign material. That in itself is no problem, but in some cases, the capsule begins to contract after a period of time and this causes pain or deformation. Then the implant must be momentarily taken out and the capsule must be removed, and then the implant can be placed back.”

What are the implants made of?

“Mostly silicon. We use a softer silicon for the breasts and a firmer silicon for the buttocks. Implants for the breasts come in all sizes and can simply be ordered ex-stock from the factory. If I place an order enter on Sunday, I will get it on Tuesday afternoon. Prostheses for buttock augmentation, also come in different sizes and can simply be ordered.”

How long is the recovery period, and what must a patient take into account?

“Liposuction/lipofilling may be repeated after a week, so the recovery period is not too bad. You do have to wear pressure garments for four to six weeks, which can be annoying in the summer because it’s hot. With implants, it’s different. The anatomically best place is often in or under the muscle. The chances of capsule formation and infection are less pronounced there, and the edges are less visible. it looks more natural. It is technically more difficult and postoperatively causes considerable pain for the patient for three-four days. Painkillers may be used, however. Then there is a recovery period of three-four weeks, during which pressure garments must usually be worn, or a pantyhose for the buttocks and a sports bra for the breasts. You have to give your muscles the necessary rest and you must not make any sudden movements, in order to ensure that the implants don’t move and are able to set into position.”

So after a few weeks a person can function normally again?

“Even people having gotten butt implants are expected to walk short distances after a week. You cannot play sports during the first five weeks, though.”

Does walking feel different to you after such surgery?

“At first it does. Patients tell me that it feels a bit rubbery at first but the feeling passes quickly. We will not do anything that may cause permanent functional impairment.”

Can you show a simulation during a consultation?

“Yes, but only for the breast implants for the time being. It remains just a simulation, however. It doesn’t guarantee anything..”

Are corrections possible, if a person might find after surgery that things came out different than expected?  

“Yes, but we will not drag people with really unrealistic expectations along into the story. We will not take functional risks for aesthetic-tinted surgery. For this reason, plenty of time is taken during the preoperative consultation to find out exactly what the patient wants and whether the expectations can really be fulfilled. It’s difficult in retrospect. That’s why we insist on a second consultation before booking an operation. All information of the first consultation should sink in, there will always be questions.”

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