Frank Agullo, MDBoard Certified Plastic Surgeon

Transgender Female to Male

When a person seeks plastic surgery for sexual reassignment or gender reassignment, this is a very big decision. By the time they reach Dr. Frank Agullo at Southwest Plastic Surgery in El Paso, very often they have already come to the conclusion that yes, they do indeed wish to change their body’s gender. They feel comfortable with whom they are and they want to take the next step in their phase of development.   Dr. Frank Agullo is a highly qualified, reputable, award-winning plastic surgeon in Southwest Texas. His compassion and enthusiasm for helping individuals who want to undergo a transgender operation is unsurpassed. Dr. Agullo is board certified and has many years’ experience in performing thousands of cosmetic and plastic surgery procedures. He listens to his patients’ needs, desires and visions and is able to give them a preview of many of their operations on a 3D Vectra Imaging system, which is very accurate. This step is done during the consultation.   What is Required for F to M Transgender Surgery?   At the El Paso and Las Cruces, NM plastic surgery centers, we do not take transgender surgery lightly. Patients must have a medical clearance prior to going through gender confirming surgery (GCS), which is one in the same. Although we do not do the more extensive sex reassignment surgery (SRS), which is when the female genitals are replaced with the male, Dr. Agullo performs all of the rest. He can transform your buttocks, face and breast to resemble a male physique. This is so that your appearance can match your true personality and identity.   You do not have to be going through hormone therapy in order to have the surgeries done, although some of our patients do them at the same time. Patients over the age of 40 must have proof of a mammogram prior to breast surgery.   Women wishing to become men must also have a signed letter from a primary care doctor, psychologist, gender therapist or psychiatrist that states something to the effect that “This patient is ready for the next phase in the transition of transgender/identity changeover.” The wording is not as important as the message, but it is important that we get this type of clearance to make sure you truly want to go through with this life-changing transformation.   Although the clients we serve may choose to go through transgender female to male surgery for a multitude of personal reasons, there are those who suffer from physical dysphoria, which is an overwhelming discomfort between an individual’s body and their identity. Some also suffer from social dysphoria, which is a lack of confidence in how others perceive them.   Either way, our offices, staff and plastic surgery center gives you a comfortable, safe and non-judgmental environment where you can truly be who you were meant to be. Dr. Agullo can help you achieve that. We want you to feel comfortable in your own skin, both literally and figuratively!   Procedures for Female to Male Transformation   It starts with Female-to-Male Top Surgery   As one of the first procedures, the FTM (Female-to-Male) patients will have their female breasts removed. This enables the person to begin living under their genuine, authentic self and immerse into their new, male identity. Depending on how much breast tissue is prevalent; Dr. Agullo will remove the fat and tissue through one of the following two methods, and then mold the chest into a new, more masculine form.   ➢ What is a periareolar incision? This small incision is made along the outer edge of the breast areola and is used to remove the breast tissue from the chest. Once the tissue is removed, the plastic surgeon will pull the remaining skin to the center and reattach the areola. Depending on its original size, Dr. Agullo may also need to trim along the outer edge to decrease the appearance and adjust the nipples to be more in proportion with the new male chest. ➢ Double Incision/Free Nipple Grafts: This method is typically reserved for patients with less elasticity in the breast skin, either because of having large or saggy breasts. Dr. Agullo uses a U-shaped or horizontal incision across both breasts, just underneath the nipple. He then removes the excess fat, breast tissue and skin before tightening and bringing the skin together and sealing it back up. With this method, there may be a faint scar just underneath the pectoral muscle. Free nipple grafts are placed where the original nipples were removed, whereupon they are trimmed and grafted in perfect position back on their original or best position on the chest.   Sometimes, the Next Step is Pectoral Implants or Fat Injections After either one of these methods has been implemented, Dr. Agullo can use pectoral implants to give you a more defined, muscular contour similar to a male physique. You will be required to wait approximately three months for the chest to heal before coming back to do this procedure. To install pectoral implants, the use of semi-solid chest implants will be inserted where the breasts were formerly positioned. These implants are FDA-approved and will feel very natural after your body heals. To perform this task, the doctor will make small incisions from the armpit region or your mastectomy incision and will then create a pocket underneath the pectoral muscles. After positioning the implants, he will seal it back up so that it heals nicely and looks as natural as possible. The results are long lasting, but once again, patients will be required to wait at least a period of three months prior to returning for the pectoral implants. With both breast removal techniques, the risk of ever getting breast cancer is greatly reduced. Mammograms will no longer be necessary, although getting a mastectomy does not guarantee that all of the breast tissue will be removed. The chances of getting breast cancer will be very slim, although there may be as much likeliness as in any male who develops cancerous breast tissue.   Body Masculinization, Liposuction and Contouring After the above, or as part of your second surgery, patients may also choose to have liposuction to remove fat from the abdomen, hips, buttocks and thighs; or other body zones. This can also help to eliminate the naturally voluptuousness of the female form, giving you a more masculine appearance.   Preparing for Transgender Plastic Surgery Changing from a female to male is both exciting and anxious for many of our patients, but rest assured you are in good hands! Here are some preparation strategies for your time of transition:
  • Prepare for the surgery day by lining up a friend or relative to drive you to and from the procedure. Although this is most often an outpatient procedure, you can’t drive after anesthesia.  
  • Since you’re not spending the night, just bring your paperwork and ID. Wear a button up shirt or loose-fitting clothing.
  • Don’t eat or drink after midnight on the day prior to your scheduled procedure.
  • Don’t use lotions or sunscreen on the chest area or anywhere you have designated for the surgery.
  • Quit smoking a minimum of two weeks in advance of your surgery and for at least two weeks after, as smoking increases the risk of blood clots and can take longer to heal.
  Most often, FTM top surgery and masculine transitioning is a procedure that can be done right at Agullo Plastic Surgery.   Recovering From FTM Top Surgery   For the first few days after surgery, be aware of how you feel. Notice if you feel dizziness, shortness of breath, increased heart rate, or chest pain. These are signs for blood clots. Do not take any aspirin or smoke any tobacco products. Follow the doctor’s orders.   After a several weeks, you will start to feel better and notice a lot of changes, especially in your chest region.  Finally, you can start feeling good about who you really are! The change from a woman to a man will give you renewed self-confidence and inner strength. Your appearance will slowly change. Don’t rush things.   Are There Any Risks I Should Know About? Most patients go through the female-to-male transition with clear sailing. However, everybody is different, and some people take longer than others. It depends upon your overall health, genetics, mental and physical strength, and other characteristics. As with any type of implants, there is a minor risk of leaking or rupturing. Implants of any kind are not designed to last a lifetime. They are generally safe and FDA approved. At some point in the next decade or so, it may be time to “update” your chest implants, so bear this in mind. Other chest augmentation or lipo risks include:
  • Hemorrhages, blood clot or anesthesia risks
  • Visible scars
  • Possible infection or unstable healing
  • Decreased nipple sensation
  • Pain, soreness or swelling
  • Possible leaking of chest implants
  • Pulmonary or vein problems
  • Some people may have to redo chest surgery, in rare cases
  Cost of F2M Transgender Operation in El Paso The cost of changing over from a female to a male varies greatly, depending on how extensive you want to undergo plastic surgery procedures. It also depends on the region you live and whether or not you require a sex change operation. We do not perform sex changes here at Agullo Plastic Surgery, however we can make recommendations. As with all of our patients, we can show you before and after images of your desired results by viewing them on our amazing 3D Vectra Imaging System, which is a unique tool to see your own body’s proportions and what your surgery outcome will be. It is highly accurate. On the lowest scale for pectoral implants, chest augmentation and lipo will probably vary between: $3,700 to $??,000 in major metropolitan cities. The Southwest is a great place to get your Female to Male surgery, and our board-certified doctor is one of the country’s best plastic surgeons. If you are interested in learning more, we would recommend scheduling an appointment today. Call 915-590-7900 today!

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