Gender Affirmation Surgery

Reconstructive surgical procedure that alters the structure of the genitals to create a vagina using penile or colon tissue. We apply a one-stage procedure, and revisions can be necessary to enhance the final surgical result.

This is a different approach to an original vaginoplasty. The colon or small bowel can be used to line the vaginal wall, creating depth and dilation, and providing a natural source of lubrication. We use a robotic-assisted surgical approach to minimize incisions in the abdomen, which allows for a faster recovery while providing better access for the revision.

Reconstructive surgery that creates a penis using a free flap or pedicled flap of skin. These sections of the skin can be taken from the arm (radial forearm free-flap, RFF) or thigh (anterior lateral thigh pedicled flap phalloplasty, ALT).  These procedures are performed in a combined team that include a reconstructive urologist and plastic surgeons.

The use of local tissue to create an enlargement to the penile area (clitoral release/enlargement, may include urethral lengthening).

Breast tissue is removed and the nipples and areolae are altered to help masculinize the chest.

Reconstructive surgery procedures that alter the shape and size of facial features to make them closer to typical female facial features. This may include a brow lift, forehead re-contouring, hairline correction, and rhinoplasty (nose reshaping).

Reconstructive surgery that alters the shape and size of facial features to make them more masculine. This may include forehead lengthening and augmentation, cheek augmentation, chin re-contouring, jaw contouring, thyroid cartilage enhancement (Adam’s apple surgery), and rhinoplasty (nose reshaping).

Reconstructive surgery that reduces the size of the thyroid cartilage, also known as the “Adam’s Apple.” It is shaved down to create a more feminine appearance.

Surgery to reshape, enlarge, and modify the breasts to achieve a more desired shape and look in the chest region.

Procedure to remove excess fat from the abdomen, hips, or thighs, typically performed to create a more feminine or masculine silhouette in line with the patient’s goals.

Tummy tucks and other procedures, performed to create a more defined and toned appearance, contributing to the achievement of a more feminine or masculine body shape.

The decision to pursue gender affirmation surgery is a personal and individual choice. It is important to have open and honest conversations with mental health professionals, gender specialists, and experienced surgeons to explore your feelings, expectations, and options. They can help you determine if surgery aligns with your goals and needs.

Age requirements can vary depending on the specific surgery and the surgeon or clinic you choose. Effective November 2023, MedStar Health established new eligibility requirements for  gender affirmation patients. Consultative care is available for minors (those under the age of 18). Surgical procedures can be scheduled once the patient is 18 years of age or older.

Choosing the right surgeon is crucial. Spend some time researching surgeons who are experienced in gender affirmation surgery and check their credentials, read reviews their patients, and analyze before-and-after photos shared by their patients. It is a good idea to consult with multiple surgeons before making a decision. Find the one you feel comfortable with and who understands your unique goals and needs.

The cost of gender affirmation surgery varies widely depending on the procedures and surgeon you choose, and the location where your care will take place. Some insurance plans may cover part or all of the costs associated with your care, so it's essential to understand your policy and work with your healthcare provider to confirm coverage as well as explore financing options.

The recovery process varies depending on the type of surgery you choose to pursue. In general, you can expect some downtime, pain, and restrictions on physical activity. Follow your surgeon's post-operative instructions carefully and be diligent about scheduling and keeping all follow-up appointments. Recovery times can range from several weeks to several months, depending on the procedure.

Like any surgical procedure, gender affirmation surgery carries risks. These risks can include infection, scarring, anesthesia complications, and unsatisfactory results. It's essential to discuss these risks with your surgeon so you can make educated and informed decisions.

The effects of gender affirmation surgery are typically permanent. However, some procedures may require revisions or touch-ups over time. Your surgeon will provide information on long-term care and maintenance.

Many surgeons and healthcare providers strongly advocate for therapy or counseling both before and after gender affirmation surgery. Pre-surgery counseling offers a valuable opportunity to explore into your gender identity journey, facilitate informed decisions, and ensure your readiness for the changes ahead. Post-surgical counseling serves as a vital support system during the recovery phase, aiding in emotional adjustments and providing a safe space to navigate any challenges that may arise. With comprehensive counseling services, individuals can embark on their gender affirmation journey with confidence, knowing they have the necessary support every step of the way

Telehealth appointments can be an option for patients who reside in Maryland, Pennsylvania, and Washington D.C. only. This limitation is based on Dr. Del Corral's clinical licensure.

The insurance plans accepted by our practice are listed below. Please remember, however, that coverage varies. We recommend that you reach out to your insurance company to confirm what is/is not covered, prior to the start of services.

• DC Medicaid (AmeriHealth, MedStar Family Choice of DC, Amerigroup of DC, straight DC Medicaid)
• Maryland Medicaid (straight Maryland Medicaid [red and white card], Aetna Better Health of MD, Wellpoint, MedStar Family Choice of Maryland, Priority Partners, United Health Care, and Carefirst Community Plan)
• Aetna
• Anthem Commercial Plan
• First Health
• CareFirst Blue Cross Blue Shield (excluding DC Carefirst Community Medicaid Plans; if an out-of-state plan, please confirm with your plan that our local Maryland Carefirst/BCBS office can be billed.)
• Cigna Health Care
• Coventry Health Network
• Johns Hopkins EHP and Uniformed Family Services Family Health Plan [USFHP]
• MedStar Select
• PHCS
• United HealthCare 
• UMR
• UPMC
• Tricare (consult covered; waiver needed from VA for surgery and process takes 1-12 months)
• Medicare Advantage Plans (Aetna, Humana, United Healthcare, and Cigna)

Important to note: Amerihealth Caritas of D.C, Amerigroup of DC, straight DC Medicaid, and Carefirst Community Plan require single-case agreements. MedStar Franklin Square is not in-network with them, and this process can take 2-4 weeks after insurance authorization). 

Authorization generally starts 6 to 8 weeks from time of your consult.  It can take us anywhere from 2 to 3 days to 4 to 6 weeks to hear back from your insurance company.  We will message you in the portal when insurance authorization has started and when we have received a response.  Should you not hear from us, you can email our patient navigator, Erin Maxwell, at erin.c.maxwell@medstar.net or call 443-777-1427.

Great news! Please send us a message in the portal (if you are registered, or go ahead and create an account). You can also contact us via email at gender.affirmation@medstar.net.

If you have received a denial and the services was deemed medically unnecessary, there are two options.

1. A peer-to-peer in which Dr. Del Corral speaks directly with the medical director to provide evidence as to why this decision should be overturned or.
2. A direct appeal, if option #1 does not work.  This part unfortunately largely falls on the patient, as our office is not equipped to handle appeals.  What we can do is provide you with your records and a medical letter of support to assist in overturning the decision.  If you do get the decision overturned, you can message us the approval letter and we can proceed with getting your surgery scheduled. If your authorization was denied because services are not covered/gender affirming surgery is not a benefit provided by your plan and your insurance is through your employer, it is highly advised you work with an attorney in your state on how to challenge your employer to update their coverage. You can also consider utilizing out2enroll.org as a tool to see if there is a state plan you could enroll in if this is financially feasible for you.

It means that the procedure is neither approved nor denied by the plan.  This happens a lot for outpatient procedures like chest masculinization or facial feminization.  If allowed, we can submit a pre-certification to determine is official approval can be granted, but this isn’t always an option. The procedure codes will be provided to you by our surgical scheduling team when we receive the official response from your insurance company, and it will be up to you to call member services to confirm your benefits, deductible, and potential copays.

No, your previous authorization will still be valid.  Please note: we may not be able to update your name in our system to match your legal one until after surgery to ensure there are no issues with billing.