Gender-affirming Surgery

Virginia Mason is proud to provide skilled and compassionate health care services to transgender and gender non-conforming patients in a welcoming and supportive environment.

Chest Reconstruction Surgery

The plastic and reconstructive surgery team at Virginia Mason Hospital and Seattle Medical Center offers chest reconstruction surgery, which is commonly referred to as female-to-male (FTM) top surgery. During FTM top surgery, the surgeon removes the breasts through a surgery similar to a mastectomy. While removing the breast tissue, the surgeon reduces the size of the areola and repositions the nipples.

The surgeons at Virginia Mason Plastic and Reconstructive Surgery follow the WPATH Standards of Care to help us in our delivery of transition related care. WPATH is the World Professional Association for Transgender Health, devoted to transgender health services. Virginia Mason utilizes the published standards of care from WPATH to help us in our delivery of transition related care. Learn more about these standards at

The current WPATH criteria for FTM top surgery, which we follow, includes:

  1. Persistent, well-documented gender dysphoria
  2. Capacity to make a fully informed decision and to consent for treatment
  3. Significant medical or mental health concerns, if present, must be reasonably well-controlled at the time of surgery

In addition to the WPATH standards, our surgeons will work with you to share his/her professional opinion as to what he/she feels is the most appropriate surgery, based on your body type, chest size, and most importantly, your personal goals.

Preparing for Your Visit

Please carefully read and understand your health care insurance policy’s coverage. Because insurance policies vary, we do not always know what your policy may require prior to a consultation, such as a referral for specialty care. To learn what your insurance company provides, please contact your insurance company directly or visit our list of insurance plans accepted at Virginia Mason.

Prior to scheduling time with a surgeon, please find a checklist that you may print at home and utilize to collect all of the information needed at your first consultation. We require any patient interested in trans-related medical services, to establish care and be actively working with a behavioral/mental health professional. In order to help achieve the best outcome for you from surgery, we feel having a relationship with a behavioral health provider will ensure you have the support and information you need throughout the process.

To help you get started, we require a letter from your behavioral/mental health professional specifying the following information:

  1. Your general identifying characteristics.
  2. Results from your psychosocial assessment, including any diagnoses.
  3. The duration of your professional relationship with your behavioral health provider, including the type of evaluation and therapy or counseling to date.
  4. An explanation stating the criteria for surgery have been met, along with a brief description of the clinical rationale for supporting your request for surgery.
  5. A statement indicating informed consent, to share this information with other health care providers, has been obtained from you.
  6. A statement ensuring your behavioral health professional is available for coordination of care and welcomes a phone call to establish this relationship with us.

If you do not have a relationship with a behavioral health professional yet, we recommend contacting your primary care provider to help you find a trans-welcoming behavioral health provider.

If you have questions or want to inquire about other reconstructive surgery procedures, please call (206) 223-6831.

Request a Cosmetic Services Consultation


Some patients feel overwhelmed if they have not yet established care with a behavioral/mental health provider. It can be challenging to think about finding the right behavioral/mental health provider to meet your needs and sharing your personal information. We have developed a list of resources below that can help direct you to professionals in your area.

This is a list of professionals that have self-identified as working with the LGBTQ community. We do not screen these providers and cannot guarantee your experience. We recommend that you research all services and providers before services are rendered.