Gender Affirmation

Gender Affirmation Surgery

Gender Affirmation Surgery Washington D.C.

At West End Plastic Surgery, both Drs. Ruff and Dr. Ramineni are happy to offer the most advanced, personal care in your transition process. We work closely with several institutions in the area and have years of experience in top surgery, facial feminization, body contouring including body implants, and genital reconstruction.

They are both members of the World Professional Association for Transgender Health (WPATH). The physicians work closely with local therapists and regional centers of excellence in the field. At West End Plastic Surgery, our surgeons and team are well versed in making your experience as comfortable and informative as possible. Our AAAASF accredited Class C Operating Suite affords our patients 1:1 care with maximum discretion.

Top Surgery

We offer all types of procedures for reduction of breast tissue to allow you to lead life without having to bind anymore. Most patients are well versed in the more common techniques of mastectomy including a standard incision with free nipple grafting and keyhole technique.  We also offer liposuction with J-Plasma skin tightening to provide a virtually scarless technique for select patients.

Mastectomy with Free Nipple Grafting

This is the most common technique. The surgeon makes an incision in the inframmamary fold and carries it

to the side (usually along the border of the “pec” muscle shadow) for the best contour. Your surgeon removes and resizes he nipple to create a typical cis-male position, shape and size (2X2.5 cm oval).

  • Pros: great contour, removal of excess skin, excellent areolar shape/position.
  • Cons: loss of nipple sensation, some loss of pigment (can be tattooed back on), larger scar than the other techniques, and sometimes ‘dog ears’ that may need revision under local anesthesia.

Keyhole incision

Your surgeon removes the breast through an incision in the areolar border. The nipple can be resized and moved. This technique is best for patients with minimal excess skin.

  • Pros: smaller incisions, faster healing, possible retention of some nipple sensation, less likely to lose pigment.
  • Cons: this procedure is not possible in all patients and there is still a chance of some excess skin that may need to be removed in the future. Areolar spread is also a possibility.

Liposuction + J-Plasma

In the past, we have successfully used tiny incisions with VASER liposuction to remove breast tissue and obtain some tightening of the skin. This has worked well in patients with minimal breast tissue and excellent skin tone. The issue was that most patients did not fit in this category. J-Plasma is the newest cutting-edge technology that uses radiofrequency and plasma energy to contract skin much more effectively than any other device used in the past. This allows us to combine VASER liposuction with the J-Plasma to tighten skin and remove breast tissue on patients with even larger breasts and who’s skin tone is not perfect.

  • Pros: virtually no scarring, permanent results, no nipple loss, likely to keep nipple sensation.
  • Cons: insurance will not cover this procedure, may need touch up surgery to shrink and reposition nipple/areola.

Breast Augmentation

At West End Plastic Surgery, we strive to give patients the perfect breasts. At your consultation, we have an extensive discussion about your goals about size/shape/position. We offer small incision augmentation with silicone implants and can give you the breasts you’ve always wanted in about an hour. We modify the techniques to make the breasts as feminine as possible and frequently perform revisions for surgery performed elsewhere in the United States or internationally.

Breast Augmentation Washington D.C. | Top SurgeryFacial Feminization

Facial feminization is a particular focus of expertise for the surgeons at West End Plastic Surgery.  We perform both facial feminization and masculinization procedures to have your face match your identity.  We offer the full range of procedures including:

  • Rhinoplasty – In the center of your face, your nose is likely one of the first things that people see when you are in public. Whether it’s a more delicate nasal tip, a large hump that needs to be reduced, or a nose that’s too wide for your face, we can help you achieve your ideal aesthetic with rhinoplasty. We also have Vectra 3D imaging that can help you visualize what your nose will look like after surgery
  • Jaw surgery – Whether it’s a chin augmentation with an implant, filler or fat, a chin reduction, mandibular angle implants for a square jaw or fat grafting and angle shaving for a smooth contour, we at West End can work with you to define how you want your lower face to appear. We perform bone remodeling, implants and fat and filler towards this end
  • Cheek surgery – We can perform cheek augmentation with deep fillers, cheek implants placed through the mouth, or facial fat grafting. This can give you the prominent/high cheekbones that you’ve always wanted
  • Forehead reduction – Through small incisions in the hairline, we can reduce your brow bone. We can do this with burring/shaving or in some cases a bone setback to reduce the prominent brow ridge. Your hairline can also be advanced to round out and feminize your hairline and shorten your forehead.
  • Other procedures – Facial aging procedures, Botox, fillers, J-Plasma and eyelid surgery are for everyone.


Body Contouring

Your general body shape, muscle structure, and fat distribution can certainly masculinize or feminize your body. The use of liposuction, fat grafting and body implants can help achieve your goals of transitioning. “Manscaping” liposuction to masculinize your body by removing fat deposits from areas that are typically feminine areas – inner and outer thighs, lateral chest, etc can create a more male figure. Similarly, fat grafting to the buttock area (brazilian butt lift), hips and thighs can feminize your figure. Body implants such as pec implants, buttock implants, bicep/tricep and calf implants can also be used to this end.

Bottom Surgery

At West End Plastic Surgery, we are offer orchiectomy, metoidioplasty, phalloplasty and vaginoplasty surgery.  We work closely with our urology and gynecology colleagues at George Washington University Hospital. We also have been trained through WPATH sponsored training.

Revisional Surgery

We have extensive experience in dealing from complications/issues that have arisen from surgery. Whether at other institutions, overseas, or by practitioners who may have not been as experienced in gender confirming surgery. Options were limited in the past and our patients have had to take extreme measures as part of their transitions process. We have a multitude of patients who have had bad experiences with free silicone injections (or other injections), poorly performed breast, facial, or genital surgery that has led to scarring, pain, and deformity. We will do our best to get you the result that you deserve.

Does Insurance Cover Gender Reassignment Surgery?

As healthcare becomes more progressive, so have the laws and the insurance companies.  At this time, insurance can partially/totally cover many procedures. Each insurer is different, and the policies are frequently changing, however we can help you navigate this confusing process.  Dr. Ramineni participates with Blue Cross, Cigna, United Healthcare, Aetna, Humana, Tricare, Medicaid, Amerihealth, and Amerigroup.  We have had success obtaining coverage for top surgery, bottom surgery and in some cases even facial feminization surgery.  Dr. Ramineni can review your policy and work with you to minimize your out of pocket cost.  For procedures that aren’t covered by insurance, we offer financing plans through CareCredit that can make costs more manageable.

Schedule a Consultation

To learn more about any of these gender affirmation procedures , contact West End Plastic Surgery. Call us at 202-785-4187 to schedule a consultation with Dr. Ramineni or Dr. Ruff. Our practice serves Washington D.C. and surrounding areas.

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