Questions & Answers

If your straight abdominal muscles have separated (a so-called rectus diastasis), we can bring them back together in the middle and fixate them during the tummy tuck. This not only results in a flatter stomach, but also stabilizes your core and can define your silhouette in a significantly more masculine or feminine way.

There is no standardized "non-binary operation." Instead, existing surgical techniques are individually adapted to achieve a neutral, androgynous, or individually defined result. The planning is always personalized.

The incisions for liposuction are only a few millimeters small and are placed in inconspicuous areas (e.g., in natural skin folds). After healing, these puncture sites are usually little more than tiny dots and are not noticeable in everyday life.

For lip shaping for trans* women, we position the incision extremely precisely in the natural fold at the base of the nose. As a result, after the lip shaping for trans women has fully healed, the scar is nearly invisible to outsiders, as it follows the natural contours of your face.

For a BBL, we need a certain amount of "donor fat". If you are very slim, it can be difficult to obtain enough of your own fat for a significant volume upgrade. In a consultation, we will check whether your fat deposits are sufficient or whether alternative methods (such as implants or a pure lift) are better suited for you.

The choice of incision technique is always an individual decision that is made during the consultation. If your anatomy allows it (sufficient skin elasticity, less excess tissue in the center), the incisions can also remain separate. We will advise you honestly on which option promises the best medical and aesthetic result for your body.

Of course, and it is expressly recommended – both during the consultation and on the day of the surgery. Your companion can stay in the immediate vicinity during the procedure.

Yes, this is actually the core of the treatment. It's often referred to as "Liposculpting." By performing liposuction at the waist (Midsection), the contrast with the hips is enhanced. The fat we obtain there is used directly to build up your hip curves. This way, we kill two birds with one stone: less fat on the belly, more curves at the hips.

Yes, and this is even frequently recommended. A rhinoplasty can visually lengthen the philtrum – the Lip Lift compensates for this effect. Both procedures together produce a particularly harmonious result.

For lipofilling (fat transfer to the hips/buttocks for feminization), we need fat reserves. In very slim patients, this is difficult. In that case, we focus on defining the waist during body contouring or discuss alternatives (e.g. implants, although we prefer your own fat).

Yes, absolutely. A mastectomy (top surgery) is an important step toward reducing gender dysphoria, regardless of whether you define yourself as a trans* man or non-binary. Together, we will discuss which incision technique and which aesthetic (e.g., a completely flat chest or a more neutral contour) best suits how you feel about your body.

With a large breast (from B or C cup) with a lot of excess skin, a periareolar (scar-saving) technique is usually not recommended, as the skin cannot be tightened sufficiently. In these cases, techniques such as the Double Incision or the Buttonhole method lead to a significantly flatter and aesthetically more pleasing result without wrinkling.

Yes, absolutely! This is a very popular option. With medical 3D tattoos (areola pigmentation), strikingly realistic results can be achieved. The advantage: you can determine the position, size and color of your nipples yourself, down to the millimeter, after the mastectomy has completely healed. This is even possible at our clinic.

Yes. Implant replacements are possible at any time. The Preservé® pocket design facilitates later corrections compared to the conventionally prepared pocket.

Yes, with techniques using free nipple grafts (Double Incision), we can choose the position of the nipples very precisely to adapt them to your new masculine chest musculature. With scar-sparing incisions (periareolar), the natural position is largely preserved. We mark the new position together with you before the surgery.

Yes, generally. We coordinate the timing in consultation with your hormone treatment. With a stable regimen, no waiting is necessary. We pause some estrogen preparations shortly before the procedure – we will discuss this individually.

Yes. It is possible to carry out individual measures independently of one another – for example, a breast surgery without hormone therapy or without further procedures. There is no fixed treatment path.

Absolutely. Lip lift surgery for trans* women is very often performed together with a rhinoplasty or a chin reduction. Combining it with other feminizing procedures ensures a particularly harmonious and coherent overall appearance of your face.

Yes, lip shaping for trans women using autologous fat is a very popular, permanent alternative to fillers. A small amount of fat is taken from another part of the body and prepared for lip shaping in order to create a particularly natural and soft volume.

Surgery cannot "create" real muscle, but we can make it visible. Through special high-definition contouring, we can remove fat deposits so precisely that the underlying musculature (e.g. on the flanks or the abdomen) is brought out much more effectively. As a result, the outcome appears more athletic and defined.

Yes, the goal of the Buttonhole Mastectomy is a flat, masculine profile. However, a small difference compared to the classic Double Incision is that a minimal amount of tissue must remain under the nipple to protect the blood supply and the nerves (the tissue pedicle). In most cases, this is not visually noticeable and even contributes to a natural contour.

Yes, a reduction of the areola is easily possible during the procedure. However, the height of the nipple itself can only be reduced to a limited extent, as the internal blood supply must be preserved. Here we will advise you at one of our locations in detail about the aesthetic limits of this technique.

Yes, this is actually very often the case. This combination (lipoabdominoplasty) allows us not only to tighten the skin, but at the same time to shape the waist and the flanks. This way, we achieve a particularly aesthetic and holistic result for your midsection.

No. During the operation, your surgeon takes care to model the tissue under the skin so that an even, flat contour is created. Since no "hole" remains, but rather the skin is closed smoothly, an aesthetic, masculine or neutral chest is created.

According to the current BGA guidelines (assessment guidelines), hormone therapy is not a mandatory prerequisite for a mastectomy, provided that the medical necessity can be justified in another way. However, many MD assessors like to see hormonal pretreatment as part of the "everyday life test". We will advise you in a personal consultation on how best to document your individual path.

We discuss this individually with your endocrinologist. Since estrogens can slightly increase the risk of thrombosis, we often recommend a short break or reduction around the time of the surgery.

We register the name you tell us and use it in all internal documents. For invoices and prescriptions, we are legally bound to your official name – but we will inform you about this and handle it discreetly.

As a rule, yes. Each gender-affirming measure must be applied for and justified individually. However, your therapist can often build on the existing progress report and supplement it with the specific indication for the new procedure (e.g. correction of the body contour or breast reconstruction).

No. Many non-binary people forgo hormones. Surgically, this is not a problem for the mastectomy or reduction.

This depends on the preparation used and your individual medical history. As a rule, modern estrogen preparations no longer necessarily need to be discontinued today, as the risk of thrombosis is low. However, we will discuss this in detail with you and your endocrinologist as part of the surgery preparation.

No, this is not a medical requirement. We also operate on patients who do not wish to undergo hormone therapy or who identify as non-binary. However, if you take testosterone, this is often an advantage: The chest musculature develops more strongly, which helps us to align the incision precisely with the natural muscle contour.

Yes, wearing a special compression garment or girdle for about 4 to 6 weeks after Body Masculinization is essential. It helps to minimize swelling, supports the skin in retracting, and ensures that the new contours heal evenly and smoothly.

No. Medical treatment is not a prerequisite for a non-binary identity. Some people do not want any physical changes, while others choose individual gender-affirming measures. Every decision is individual and legitimate.

Yes, the horizontal scars typical of a double-incision mastectomy do develop. However, since no circular scars form around the nipples, the overall result often looks very clean and calm. With good care, the scars fade over time and can often be well concealed later through muscle training or tattoos.

Yes. During breast augmentation for trans* women, we usually place the implants beneath the chest muscle. This ensures a soft transition and a natural feel to the touch, even when there is little of one's own glandular tissue.

We use state-of-the-art techniques to conceal scars as much as possible. Incisions are often placed within the hairline, inside the mouth, or in natural skin folds (such as under the chin or on the neck). After complete healing, these are usually extremely inconspicuous or no longer visible at all.

No, the incisions for liposuction and transfer are only about 2 to 3 millimeters in size. They are placed in inconspicuous locations and usually heal so well that they are barely noticeable after a few months. There are no long incisions like in a tightening surgery.

Yes. Many non-binary people do not want a binary result (i.e. not "typically male" or "typically female"), but rather a neutralization of the characteristics that trigger dysphoria. This can be, for example, a breast reduction to a minimum that preserves some remaining softness, or liposuction on the hips that makes the body appear more linear.

Not necessarily. However, it is often combined with rhinoplasty, jaw, or chin feminization.

Usually no, as it is considered an aesthetic procedure (regardless of whether masculinization or feminization). We mostly offer this as a self-pay service, which we can combine cost-effectively with the main surgery.

Only in exceptional cases. Insurance companies usually only pay if, despite hormone therapy (over 2 years), virtually no breast growth (below an A-cup) has occurred or if there are severe asymmetries. We will advise you on whether an application has a chance of success.

Whether the costs are covered depends on the individual medical indication and the decision of the respective health insurance provider. A non-binary identity does not exclude coverage of costs; however, the assessment is always carried out on a case-by-case basis.

No, the surgery does not alter the skeleton. Since the bony pelvis no longer grows after puberty, we focus on the soft tissue. By strategically building up fatty tissue over the pelvis and thighs, we visually simulate a wider, more feminine pelvis that perfectly matches your proportions.

No. After puberty is complete, the bony structure remains unchanged.

Yes, we often recommend professional manual lymphatic drainage starting from the second week after the procedure. It helps to drain accumulated fluid in the tissue, soften hardened areas (fibrosis), and make the final result visible more quickly. It's best to discuss the frequency directly with us at your first follow-up appointment.

Absolutely. Testosterone promotes muscle growth and aids in overall fat burning. Nevertheless, there are often genetically determined fat deposits that persist despite diet and exercise. The BMS targets exactly where hormones alone are not enough to provide the finishing touch for a masculine contour.

Yes, since this technique involves removing excess skin, horizontal scars form beneath the chest muscles – just like with the classic Double Incision. Additionally, there is a fine scar around the repositioned nipple-areola. With good scar care, these lines usually fade very well over time.

Yes, we are happy to support you. For non-binary identities, the path to cost coverage is sometimes a bit more complex, as the insurance companies' guidelines are often still thought of in very binary terms. We help you to clearly present the medical necessity of your individual treatment and to prepare the necessary documents for the MD (Medical Service).

Possibly, if your health insurance has approved the breast augmentation as a gender-affirming measure or if you are privately insured. We advise you on the formal procedures and help with documentation. We cannot provide a guarantee.

That depends on your insurance status. Private health insurance providers often cover the costs without any problems, depending on the tariff. For those with statutory insurance, coverage of costs in a purely private clinic is usually only possible through the cost reimbursement system (according to § 13 para. 3 SGB V), if no comparable treatment is available in a contracted clinic in a timely manner. We are happy to inform you about the options at our clinic.

Yes, under certain conditions, coverage of the costs is possible. Health insurance companies usually require proof that natural growth through hormones is insufficient after two years (an A-cup is often cited as the threshold). We are happy to support you with the necessary medical documents for your application.

This varies depending on the individual case, psychological indication, and insurance status. Individual consultation is required before the facial adjustment.

That depends on the individual case and the respective health insurance. We are happy to advise you on which documents you need for an application and how we can support you with it.

As a rule, forgoing the nipple transplantation has no impact on the health insurance coverage for your mastectomy. It is a surgical decision within the procedure. We will discuss your wishes during the consultation and document them in the surgery plan.

Yes, this is one of the main reasons for this method. "Dog Ears" are small excesses of skin that can often form at the end or in the middle of scars. The continuous incision allows the skin tension to be distributed optimally, which significantly minimizes the risk of tissue protrusions (particularly in the sternum area).

The scar is located directly at the fold between the nose and the upper lip – an area that is "hidden" by the anatomy of the face itself. With careful surgical technique and good scar care, it is usually not noticeable to others after healing.

As with any surgical procedure, temporary numbness can occur. However, because we work in a tissue-sparing manner, sensitivity usually returns completely during the healing phase. In rare cases, the sensation may be permanently slightly altered, which we discuss in detail beforehand in the consultation.

Yes, that is the great advantage of autologous fat compared to implants. Since we use your own tissue, your buttocks feel completely natural after healing and also move that way. There are no visible implant edges, and the shape can be modeled very individually and softly through the injection technique.

Approximately 50% to 60% of the transferred fat permanently takes hold and remains part of your body for life. The cells that survive the first two months behave like normal fatty tissue: if you gain weight, your buttocks will also become fuller; if you lose a lot of weight, the volume can decrease.

Testosterone helps with fat redistribution, but the bony pelvis and stubborn fat deposits on the flanks often remain. Body contouring is the most effective way to permanently remove these genetic stores and straighten the torso (V-shape).

We recommend avoiding normal sitting for a full 6-8 weeks. However, with a BBL relief cushion, you can slowly begin to put pressure on the buttocks again from the 3rd week, ideally initially only for short periods and still with the support of a special cushion. After about 8 weeks, the fat cells are usually stable enough for everyday life.

You should give your body rest. Light walks are important for circulation from the first day after the surgery. You can start light training again (no glute training!) after about 6 weeks. You should only resume intensive strength training for the legs or buttocks as well as high-impact sports (such as jogging) after 3 months.

An initial effect is visible immediately, but the final result requires patience. Only when all the swelling has subsided and the skin has fully regenerated – usually after 3 to 6 months – does your new contour reveal itself in its full glory. The small puncture sites also fade during this time and become almost invisible.

The most effective and natural method for hip widening is autologous fat transfer (lipofilling). In this procedure, fat is liposuctioned from other areas (e.g., the abdomen or back), medically processed, and injected specifically into the hip region. This allows us to widen the contour and achieve a softer, more feminine line.

This is the challenge in breast augmentation for trans* women, as the nipples are often positioned further to the outside. We often use a hybrid technique (implant + autologous fat). With the autologous fat, we pad the décolleté in the center so that the breasts visually move closer together and the transition appears softer.

Bruising and swelling are completely normal after liposuction and no cause for concern. They usually peak after 3 to 5 days and then slowly subside. Drinking plenty of fluids, light exercise, and consistently wearing the compression garment are the best ways to speed up this process.

A detailed medical consultation is the most important first step. It involves discussing personal goals, health prerequisites, risks, and realistic outcomes. The aim is an informed decision that contributes to your well-being in the long term.

The healing phase of the large incisions in the Buttonhole Mastectomy is identical to the Double Incision. The major advantage lies in the healing of the nipples: Since they do not have to grow on as a graft, the critical phase in which one has to worry about the nipples "taking" is eliminated. They are supplied with blood immediately after the surgery and usually retain their natural color.

Healing is often less complicated and faster with this method. Since no free nipple grafts have to heal in place, a critical part of the aftercare is eliminated. You don't have to worry about the "survival" of the nipples or about crusting at that spot. Care focuses purely on the horizontal main scars.

The most effective method is so-called lipofilling (autologous fat transfer). In this procedure, fat is suctioned from areas where it is perceived as bothersome (e.g., on the abdomen or flanks) and specifically injected into the hip region or buttocks. Since it is your own tissue, the result looks particularly natural and soft.

The bone structure in trans* women is often somewhat broader than in cis women. We take this into account when choosing the implants. Often, broader implants are chosen to create a harmonious décolleté and to prevent the breasts from appearing too far apart. The goal is a natural, feminine contour that suits your body proportions.

After a lip lift as part of lip shaping for trans* women, the first few days are characterized by mild swelling. With this form of lip shaping for trans women, the fine suture directly under the nose usually heals very quickly, so that you will be fully presentable again after about 10 to 14 days.

The Motiva Ergonomix2® adapts to your body position. It behaves almost like natural breast tissue – no hard feeling during sports, no unnatural movement.

The incision is made horizontally above the pubic skin, so that the later scar can usually be comfortably hidden in your underwear or swimwear. The length of the scar depends on how much excess skin needs to be removed. We always ensure fine suturing so that the scar can fade well over time.

In hairline advancement surgery, the entire hair-bearing scalp is surgically moved forward. This delivers an immediate result with high hair density. A hair transplant, on the other hand, fills in bald areas (such as receding hairline corners) hair by hair, with it taking months for the hair to grow. We often use the advancement for the height of the forehead and the transplant for the fine contouring of the corners.

Very flexible. Especially in the area of top surgery, there are various options – from horizontal to diagonal to connected scars or forgoing nipples. In the consultation, we discuss exactly which scar appearance you prefer and what is surgically feasible in order to realize your individual vision.

Skin elasticity plays a crucial role. If your skin is very elastic, it can contract well after a periareolar surgery. If the connective tissue is rather soft or strained by years of binding, we often recommend techniques with skin tightening (such as Double Incision) to avoid "sagging" of the skin after surgery.

The scars are minimal. For the suction and injection of the fat, we only need tiny incisions of about 2 to 3 millimeters in length. These are strategically placed so that, after healing, they are barely more than small, light dots and are not noticeable in everyday life – even in a bikini.

Choosing the size is a collaborative process. For a breast augmentation, we take into account your shoulder width, your chest circumference and your height in order to create a harmonious overall appearance. In our consultation, you can test different sizes with trial implants to get a feel for your new body image.

Since the skin on the male chest is often tighter, the volume in the first step is sometimes limited ("healthy C-cup"). Too much tension can interfere with wound healing. Sometimes a second procedure is necessary if very large breasts are desired.

As a rule, after liposuction you should consistently wear your compression garment day and night for about 4 to 6 weeks. The garment exerts even pressure on the treated areas. This not only helps against swelling, but also supports your skin in adapting to the new, slimmer contour and prevents the formation of fluid accumulations (seromas).

This is the most important rule for a good result: So that the transplanted fat cells can grow optimally after the buttock reshaping, you must avoid sitting or lying directly on your bottom for about 2 to 3 weeks. We recommend using a special BBL cushion, which shifts the pressure to the thighs and lets your buttocks "float".

We recommend a physical recovery period of about two weeks, during which you should not raise your arms above shoulder height. Most patients are able to resume their daily activities after 14 days. However, you should wait at least six weeks before doing sports, especially strength training for the upper body, in order not to stretch the scars unnecessarily.

Since we as a Praxisklinik are more flexible than large hospitals, the waiting times are often shorter. As soon as the cost approval is in place (or the financing is clarified), we usually find an appointment promptly.

1–2 days of light rest are sufficient in most cases. Most patients are able to work again after 2–3 days (office work). Sports only from week 6 onwards.

The surgical lip lift is permanent. Lip augmentations with hyaluronic acid last approximately 6 to 18 months; lipofilling with autologous fat is long-lasting and in many cases permanent, although a portion of the fat may be resorbed.

Once your application has been received by the health insurance company, it usually has three weeks to make a decision. If the Medical Service (MD) is called in for an assessment, the deadline is extended to five weeks. We recommend always sending the application by registered mail so that you have proof of when it was received.

A change is visible immediately after the Body Masculinization Top Surgery, but swelling initially conceals the final result. After about 6 to 12 weeks, the swelling has largely subsided. However, the skin needs up to six months to fully adapt to the new, masculine contour.

After the surgery, you should wear a special compression bra for about six weeks. This supports the tissue and keeps the implants in the desired position. Most patients are presentable again after one to two weeks. However, you should refrain from sports and heavy lifting for at least six weeks.

External wound healing is usually complete after about two weeks. As with any mastectomy, you should wear a compression vest for about six weeks so that the skin can optimally adhere to the underlying tissue. You should also refrain from sports and heavy lifting for at least six weeks in order not to jeopardize the aesthetic result.

The first stitches are usually removed about 10 to 14 days after the hairline lowering. Swelling in the area of the forehead and eyes may occur in the first few days, but subsides quickly. The scar is initially still slightly reddened, but fades within a few months. Since your hair grows through the scar, you can usually wear your hairstyle completely normally again after a short time.

You should allow yourself about two to three weeks of rest before returning to your everyday work routine. For a period of about six weeks, you will need to wear a special compression garment. This supports healing, reduces swelling, and helps your skin to adapt optimally to the new contour.

This depends on your available donor fat and the elasticity of your skin. As a rule, a significant harmonization of the silhouette can be achieved in one session. If an extremely pronounced build-up is desired, a second procedure can be carried out after complete healing (after approx. 6 months) to maximize the result.

A portion of the transferred fat (about 60 to 80%) grows in permanently and becomes firmly integrated into the tissue. These cells behave like normal body fat: if you later gain or lose weight, this volume changes accordingly. Once the healing phase is complete after about three months, the result remains stable.

The safety of our patients comes first. We use state-of-the-art techniques in which the fat is injected exclusively into the subcutaneous fatty tissue and never into or beneath the muscle. This drastically minimizes the risks of classic BBL methods and ensures a safe, aesthetically high-quality result.

The healing rate is excellent with proper execution and good aftercare. In the first few days, the graft depends on the nutrient supply from the underlying tissue. Therefore, a strict smoking ban and physical rest during the first two weeks after the surgery in Cologne are essential to avoid compromising blood circulation.

Many patients are surprised that the pain is often less than expected (similar to severe muscle soreness). You will of course receive pain medication. Wearing the compression vest and sleeping on your back are often perceived as more bothersome.

Every surgery leaves traces. With the Double Incision technique, we place the incisions as much as possible in the shadow of the chest muscle, so that they later appear like a natural contour. Scar maturation takes up to a year – with good care (silicone patches, massage) they usually fade very well.

Absolutely. The result can be individually designed – we work with the volume and shape that suit your body image. Subtle changes are just as possible as more pronounced ones. No specifications, no standard.

This is individual, but for facial harmonization we often begin with the upper face (forehead and hairline design), as this has the strongest effect on how one is perceived by others. However, many people opt for a combination of several procedures in one session in order to minimize downtime and achieve an immediate, holistically harmonious result.

Yes, breast augmentation with autologous fat (lipofilling) is an alternative or complement to implants. In this procedure, fat is removed from other parts of the body (e.g. abdomen or hips) and injected into the breast. This method is particularly suitable for patients who want subtle growth or wish to refine the result even further after implant surgery.

Theoretically, there are hip implants, but in our clinic we primarily rely on shaping with your own fat. Your own fat offers a significantly lower risk of complications, feels more natural, and leaves no visible edges or implant borders. In addition, by performing liposuction at the waist, we kill two birds with one stone.

Hormones bring about a redistribution of body fat over the long term, but this process has its limits. Often, the volume at the sides of the hips (the so-called "hip dips") is not sufficient to form a pronounced curve. Surgical contouring can specifically help here and create volume where biology alone cannot reach.

Yes. Non-binary people can – but do not have to – undergo hormone therapy. In some cases, a low-dose or individually adjusted hormone treatment is chosen. Specialist medical supervision is necessary in this process.

Yes, there are high-quality silicone prostheses that look deceptively real and are attached with a special skin adhesive. This gives you the flexibility to decide, depending on the situation, whether you want to have a flat chest or a look with nipples (e.g. under tight shirts). Alternatively, there is also the option of tattooing nipples.  We even offer this option at our clinic.

This is highly individual. In many trans women, hormone therapy leads to a more feminine breast shape, but the volume often does not reach the desired size or projection. A surgical procedure can help close the gap between the growth achieved through hormones and your personal body image in which you feel comfortable.

A major advantage of periareolar mastectomy is that the nipples do not have to be removed and re-transplanted (as with the Double Incision). Since the nerve connections are spared as much as possible, there is a high chance that the sensitivity and erogenous feeling in your nipples will be preserved, with minor reductions.

In principle yes, as long as there is enough tissue for the inner pedicle. With extremely large breasts or very deeply sagging tissue, your surgeon must individually assess during the consultation whether the tissue pedicle is long enough to bring the nipple to its new position without too much tension.

In most cases yes, if a truly flat result without folds is desired. Only the Double Incision allows large amounts of excess skin and tissue to be radically removed and the remaining skin to be stretched tightly over the chest muscle. Alternatives would here often lead to an unsatisfactory "sacking".

As a standalone procedure, yes – it is then performed under local anesthesia and takes about 20 to 45 minutes. When combined with other FFS procedures, the operation is performed under general anesthesia.

Yes, the result is permanent. Since the scalp is surgically repositioned and fixed, the new, lower position of your hairline is maintained for life. The natural aging process also generally does not significantly change this result, so you can permanently benefit from a more harmonious facial proportion.

Yes, this is possible. If your areola appears too large for an overall masculine appearance, it can be reduced directly as part of the periareolar incision. Your surgeon removes a narrow ring of skin around the areola, so that the nipple appears smaller and more harmonious afterwards.

Since blood supply is maintained through the tissue pedicle, the risk of complete necrosis is lower than with a free graft. Nevertheless, in rare cases, circulatory problems may occur in the peripheral areas, which is why close monitoring during the aftercare phase of the top surgery operation is important.

Unfortunately, the nipple-sparing method is anatomically limited. It is primarily suitable for patients with small to medium-sized breasts and very good skin elasticity. In addition, the distance between the nipple and the inframammary fold must not be too large, as otherwise the tissue pedicle that supplies the nipple would be stretched too much.

Testosterone helps a lot with the redistribution of body fat, but often genetically determined fat deposits on the hips or the "saddlebags" stubbornly persist. The BMS comes in exactly where hormones and training reach their limits. It is the perfect complement to accelerate or complete the process of physical alignment.

If fat was injected into your hips or buttocks during your body contouring, caution is advised. Pressure is the enemy of freshly transplanted fat cells. During the first 6 to 8 weeks, you should try to avoid direct pressure on the augmented areas. Special cushions or an adjusted sitting position help to avoid disrupting the blood circulation of the new fat cells.

These are small excesses of skin at the outer ends of the scar under the armpits. We use special techniques to avoid them. Should they occur nonetheless, we can correct them later in a minor procedure (under local anesthesia).

"Hip Dips" are the natural indentations between the pelvic bone and the upper thigh. In trans women, these are often more pronounced, as the male-read pelvis is narrower. Through targeted hip contouring, we can fill these dimples with the patient's own fat, thereby creating a harmonious transition from the waist to the outer thigh.

Due to the sophisticated surgical technique and the high-tech implants, the costs are higher than those of a "regular" breast augmentation. Depending on the initial findings, costs of between 10,000 and 11,500 euros must be expected.

A rejection is, first of all, no reason to despair. You have the right to file a written objection within one month. Often, the insurance funds merely request further details or specific wording in the reports. In this case, we are happy to support you with a medical statement to once again substantiate the necessity of the procedure.

The "Big 5":

• Indication letter & progress report (therapist)
• Gynecological/Urological exclusion findings (intersexuality ruled out)
• Endocrinological findings (hormones, if applicable)
• Trans curriculum vitae (personally written)
• Our surgical certificate

For a complete application to the Medical Service (MD), you usually need:

• A specialist psychiatric or psychotherapeutic indication (confirmation of the diagnosis and necessity of the surgery).
• A detailed psychiatric/psychotherapeutic progress report.
• The surgeon's findings report (which you will receive after your consultation with us).
• A findings report from your endocrinologist (hormone status).
• A trans-identity CV (this is still requested by some insurance companies, but is legally disputed).

It means that we don't follow a fixed scheme. We look at which areas of your body cause you discomfort. Perhaps you only want to masculinize your waist, but keep the volume on your buttocks? Or do you wish for more feminine hips, but don't want breast augmentation? We combine liposuction and autologous fat transfer exactly as is right for your well-being.

Non-binary describes a gender identity that does not define itself exclusively as male or female. Non-binary people may locate themselves between, outside of, or independently from these categories. The identity is individual and can be expressed in different ways.

That depends on the effort and the method. After the consultation, we will create a binding complete offer for you, so that you have planning security.

While the double incision leaves two horizontal scars, the periareolar method leaves only an inconspicuous scar around the areola. The result often looks very natural, as no major surgical traces are visible on the chest. However, it requires a suitable starting condition to achieve a tight, flat result without excess skin.

After healing, a fine, horizontal line runs across the entire chest. Initially, this is reddish, but with good scar care it fades to a light, flat line within 12 to 18 months. Many patients find the continuous symmetry of the scar to be more aesthetically harmonious than two separate, possibly asymmetrical scars.

Depending on the chosen approach, the scar may run in a circle around the areola or be combined with an additional short vertical incision. We always try to place the incisions so that they visually blend with the edge of the areola and are barely noticeable after healing.

In a Joined Incisions Mastectomy (also called "connected incision technique"), the two horizontal incisions of a Double-Incision surgery are connected to each other in the middle of the chest. Instead of two separate scars, this creates one continuous, usually flat scar across the chest. This technique is used to achieve a particularly smooth and masculine chest profile.

Body Masculinization Surgery (BMS) is a set of surgical procedures to masculinize the body contour. The focus is usually on targeted fat removal (liposuction) at typically feminine-read problem areas such as the hips, buttocks, thighs, and lower back. The goal is to reduce the curves and create a more angular, straight silhouette.

If the skin does not contract as desired after the periareolar mastectomy, slight wrinkling may occur. In such cases, a small correction (a so-called "touch-up") is usually possible after about 6 to 12 months. Excess skin can be minimally tightened to perfect the result.

Some corrections (e.g., a re-tightening for "Dog Ears") are easily possible afterward. Nevertheless, it is important to plan the basic technique (e.g., with or without nipple) precisely in advance. Our goal is to design the operation so that you feel comfortable in your body in the long term.

Since these are living fat cells, they react like the rest of your body to changes in weight. If you lose a lot of weight, the fat cells on the hips will also become smaller. A stable weight is therefore the best prerequisite for maintaining the newly gained feminine shape in the long term.

During a complete tummy tuck, the belly button is usually precisely cut around and, after the skin has been tightened, sewn back into its new, anatomically correct position. So it remains your natural belly button, but is aesthetically integrated into the new overall appearance.

Since the nipples often sit too low on large breasts, they are removed as a "free graft," reduced to a masculine size, and repositioned at the anatomically correct location. This step allows for free shaping of the breast aesthetics, independent of the tissue's original position.

You have direct access to your treating doctor. We will give you a direct number for emergencies. Your well-being after the procedure is just as important as the procedure itself.

That's okay. Bring pictures with you! Photos of desired results help us more than terms. We'll look together at what's feasible – whether completely flat, "nipple-less" (without nipples), or just a reduction.

A BBL is a special form of buttock shaping in which no silicone is used, but rather your own body fat. First, we remove fat from areas where you find it bothersome (e.g. the abdomen or flanks). This fat is processed and specifically injected into the buttocks to build volume, improve projection, and create a feminine roundness.

The buttonhole technique is a variant of mastectomy with large horizontal incisions (similar to the Double Incision), but in which the nipples are not completely removed and re-transplanted. Instead, they remain connected to the body via a tissue bridge (the so-called pedicle) and are guided to the outside through a new opening in the skin – similar to a button through a buttonhole.

The periareolar mastectomy is a particularly scar-sparing technique of top surgery. In this procedure, your surgeon makes the incision in a circular shape along the edge of your nipple (areola). The glandular tissue is removed through this small opening. Since the scar lies exactly at the color boundary between the nipple and the skin, it is often virtually invisible later on.

Hairline lowering (also called forehead reduction) is a surgical procedure in which the hairline is moved forward and down in order to reduce an overly high forehead. Since a high, rather angular forehead is often read as a masculine feature, a lower, rounder hairline instantly gives your face a softer and more feminine appearance.

The decisive advantage lies in the fact that the nipples remain connected to their original nerve pathways and blood vessels. As a result, the chance of preserving sensitivity and responsiveness (erection of the nipples) is significantly higher than with a free transplant, which can be very valuable for the later body sensation.

The decisive advantage is the preservation of sensitivity. Since the nipples remain connected to their original nerves and blood vessels throughout the entire operation, sensation (including erogenous sensitivity) is preserved in most cases. In addition, blood circulation remains more stable, which minimizes the risk of losing the nipples.

In a buttock lift, we remove excess skin and tighten the tissue, which is particularly useful after significant weight loss. A buttock augmentation (BBL), on the other hand, aims to increase the volume and perfect the shape. We often combine both procedures to achieve both firm skin and a feminine curve.

With body contouring for feminization, we are less concerned with an extremely large bottom, but rather with widening the hips and filling in the lateral dimples (hip dips) to create a harmonious, feminine hourglass figure

In the classic double incision, the nipples are reattached as a free graft; sensation is usually lost in the process. With the buttonhole method, the nipples remain connected to the nerves (pedicle), which massively increases the chance of preserving sensitivity. The choice depends on how important the sensation in your nipples is to you compared to an absolutely flat chest wall.

The goal is to create a feminine-read silhouette. Often this means making the waist appear narrower while simultaneously increasing the volume at the hips and in the buttocks area. This creates the typical hourglass shape, which many trans* women perceive as very harmonious and fitting to their identity.

Your garment is your best friend for the first 6 weeks. During the first 4 weeks, you need to wear it 24 hours a day (except when showering). In weeks 5 and 6, it is often sufficient to wear the garment only during the day or at night. It helps to reduce swelling at the liposuction sites and to stabilize the skin around your new curves.

Depending on individual wishes, various measures may be considered, for example:

• Breast surgery (removal, reduction, or augmentation)

• Body contouring

• Hormone therapy (also low-dose)

• Facial surgery

• Genital surgical adjustments
  The selection depends on personal goals and medical prerequisites.

We know that gender identity is a spectrum. That's why we don't offer "off-the-shelf" solutions. Whether you want a mastectomy without nipples, a breast augmentation to a very specific size, or a masculinization of your body contour without undergoing full hormone therapy – we adapt the surgical techniques to your individual goals.

In addition to the already mentioned hormone therapy, accompanying psychotherapy as well as a corresponding diagnosis (gender dysphoria) is usually necessary for the costs to be covered by the health insurance. Medically speaking, you should be healthy and have realistic expectations of the result. In a consultation, we clarify all your individual requirements.

Since trans women often have less of their own tissue and firmer skin tension at the beginning, the implant is frequently placed under the chest muscle (submuscular). This ensures better coverage of the implant edge and a more natural result in terms of touch and appearance.

After a hip or buttock augmentation, it is extremely important not to put any direct pressure on the treated areas for several weeks, so that the fat cells can grow optimally. You will wear a special compression girdle that supports the areas where liposuction was performed, but protects the newly shaped curves.

• Week 1–2: Rest.
• Week 4–6: Light activity, but no arms above the head.
• After 6–8 weeks: Start with fitness/jogging.
• Chest muscle training: Only after full healing, to avoid stretching the scars.

Your body needs time to recover. Light walks are good shortly after the surgery to get your circulation going. However, you should wait at least 6 weeks before doing intensive sports, strength training, or stretching exercises in the area of the liposuction. Always listen to how your body feels and consult with your surgeon.

If you have an office job where you sit a lot, you should plan for at least 2 to 3 weeks off after the buttock augmentation or work from home (lying down or with a BBL pillow). For physically demanding jobs, we recommend a downtime of at least 3 to 4 weeks to avoid jeopardizing the healing process through premature strain.

Bruises usually fade within the first 2 to 3 weeks after buttock contouring. Swelling is somewhat more persistent: the most severe swelling subsides after about a month, but it can take up to 3 or even 6 months for the last residual fluid to disappear from the tissue and for your buttocks to show their final, soft shape.

This technique is usually recommended when there is a lot of excess skin tissue or when skin elasticity is low. By joining the incisions in the middle, the surgeon can more precisely remove excess skin in the center. This prevents the formation of skin folds between the pectoral muscles and ensures a flatter overall result.

A tummy tuck is ideal for you if you suffer from sagging skin or stubborn fat aprons on the abdomen that cannot be reduced through exercise or diet. This often occurs after significant weight loss. The goal is a flat, firm abdominal area and a harmonious body contour that better matches your desired appearance.

Double Incision is the "gold standard" for a maximally flat and masculine result, especially with larger breasts. If perfect contouring and the reliable removal of excess skin are more important to you than small scars, this is usually the right technique for you.

The first 2 to 3 weeks after the surgery are crucial for your final result. During this time, the transplanted fat cells decide whether they will take hold in their new location. Since they do not yet have their own blood supply, they react extremely sensitively to pressure. That is why consistently lying on your stomach or using a BBL pillow is absolutely mandatory during this phase.

Surgical breast augmentation should generally only take place after a certain period of hormone replacement therapy (HRT). We usually recommend a waiting period of at least 12 to 24 months under stable hormone administration. During this time, natural breast growth takes place. Only when this development is largely complete can the final surgical result be planned precisely.

The most common technique is the incision in the new inframammary fold. As a result, the fine scar is later hidden in the natural fold under your breast and is invisible when wearing underwear or swimwear. Alternatively, in some cases the access can be made via the edge of the areola.

The incisions are precisely planned and usually placed parallel to the lower edge of the large chest muscle (M. pectoralis major). The goal is for the scars to later lie inconspicuously within the natural shadowing of the chest contour. Over time and with good care, these lines often fade so significantly that they are barely perceived as surgical scars anymore.

The incision is made very precisely directly at the edge of the hairline (trichophytic incision technique). The incision is made at a slight angle so that the hair follicles are preserved and the hair can later grow through the scar. As a result, the fine scar is almost completely covered by your own hair after healing and is virtually invisible.

The most common areas are the so-called "love handles" (hips), the outer thighs, and the area below the buttocks. By removing these fat pads, the typical hourglass shape disappears, and the upper body appears broader and more defined in relation to the lower body.

In trans women, we place the implant in most cases under the large chest muscle (submuscular). Since there is often only little of your own mammary gland tissue at the beginning, the muscle provides an additional covering layer. This ensures that the edges of the implant are not visible after the breast augmentation and that your breast gets a soft, natural shape.

A facial adjustment is highly individual. Common procedures include the reduction of the forehead bossing (forehead remodelling), correction of the hairline, nose correction (rhinoplasty), reduction of the chin or the jaw angles, as well as the surgical reduction of the Adam's apple. We will create a treatment plan for you that is precisely tailored to your bone structure and soft tissues.

We use exclusively high-quality, cohesive silicone gel implants from renowned manufacturers. These are particularly safe, shape-stable, and feel very natural. Depending on your anatomy and your desired result, we choose between round implants for more fullness in the décolleté or anatomical (teardrop-shaped) implants for a particularly natural profile.

There is no one-size-fits-all "best" technique, only the method that best suits your body and your goals. The decision depends primarily on your breast size, your skin elasticity, and your desire to preserve nipple sensitivity. In a consultation, we examine your tissue and discuss together whether a scar-sparing method or a classic procedure will lead to the best result.

For lip shaping for trans* women, we primarily use two methods: the surgical lip lift (bullhorn lift) for permanent shortening of the white lip and volume building using autologous fat or hyaluronic acid. We decide which lip shaping technique for trans women is ideal for you based on your anatomy and your aesthetic goals.

In Germany, statutory health insurance funds (GKV) generally cover the costs of gender-affirming surgeries that are deemed medically necessary in cases of diagnosed gender dysphoria. These usually include mastectomy, breast augmentation (under certain conditions), as well as gender-affirming genital surgeries. Treatments such as facial feminization surgery (FFS) or permanent hair removal are often decided on a case-by-case basis.

The focus of masculinizing body contouring is on areas with typically female fat storage: the hips ("love handles"), the buttocks, and the outer thighs (saddlebags). Through targeted liposuction in these zones, the silhouette is straightened, which emphasizes the V-shape of the upper body and creates a significantly more masculine appearance.

This method is ideal for you if you have a naturally high forehead and good hair density in the front area. The procedure is particularly effective for significantly reducing the forehead area. If there are also deep receding hairlines, the lowering can in some cases be combined with a hair transplant to achieve a perfect result.

This method is ideal for you if you have a medium to large chest, want a very flat, masculine result, but do not want your nipples to heal as a free graft. It is the perfect choice for people for whom preserving nipple sensitivity is particularly important.

This technique is ideal for you if you have a rather small breast (A-cup or a small B-cup) and good skin elasticity. Since hardly any skin is removed during this procedure, your skin must contract on its own over the new, flat profile after the surgery. During the consultation, we will check carefully whether your anatomy is optimal for this procedure.

The reasons for a "no-nipple" mastectomy are varied. Many appreciate the aesthetic freedom – for example, for large-scale chest tattoos that are not interrupted by nipples. Others prefer a completely smooth, minimalist result or want to avoid the risks of a nipple transplant (such as healing complications or pigment loss). For some non-binary people, this look also better matches their sense of their body.

This is due to a combination of swelling and the natural breakdown process. During the BBL, we deliberately inject a little more fat, as experience shows that the body breaks down about 20 to 40% of the cells again. The volume that remains after about 3 to 4 months will then be permanently retained. So don't be alarmed if your butt deflates a little after the initial "wow effect".

The operation is only the first step toward your new silhouette. Proper aftercare ensures that the skin grows back smoothly onto the underlying tissue, that swelling subsides quickly and – if a fat transfer was performed – that the transplanted fat cells at the hip survive optimally. Without consistent aftercare, you risk the formation of dents or a less pronounced result.

Lip shaping for trans* women plays a central role in passing, as masculine-read faces often exhibit a longer distance between the nose and upper lip as well as narrower vermilion portions. Through targeted lip shaping for trans* women, we shorten this distance and create fuller, curved lips that make the entire face appear immediately more feminine and softer.

No, the healing time and the sensation of pain with the Joined Incisions Mastectomy do not differ from the classic Double Incision with separate scars. Wound healing in the middle area of the chest is usually unproblematic, as there is less movement here than in the armpit area, for example.

That largely depends on the method.

With the small incision (Semicircular/Periareolar), the pedicle to the nipple is preserved, which is why sensitivity often remains very good.

With the large incision (Double Incision) involving a free nipple graft, the nerves are severed. Erogenous sensation is usually lost, but a rough sense of touch often returns a few months after the mastectomy.

Once fat cells have been removed through liposuction, they do not grow back in that area. The result of body contouring is permanent, as long as you keep your weight stable.

Yes, provided that there is a cost approval for a mastectomy (gender-affirming surgery), the specific incision technique (whether separate or joined) is part of the surgical procedure. The choice of technique is at the discretion of the surgeon in consultation with you, in order to achieve the best possible medical outcome.

The system is often still very binary (diagnosis "transsexualism"). Many patients formally use this diagnosis for the application, even if they identify as non-binary. We word our medical reports in such a way that they meet the insurance requirements, but take your individual wishes (e.g. radical reduction) into account.

Yes, the removed skin cannot grow back. However, to keep the result looking this good in the long term, you should maintain a stable weight. Significant weight fluctuations after the surgery could stretch the remaining skin again. A healthy lifestyle is therefore the best support for your new body feeling.

The incision (approx. 2.5 cm) is located in the inframammary fold – not visible in everyday life or in a bra or bikini. With consistent scar care, it usually heals to be barely visible.

Yes. You will receive a detailed surgical information letter (doctor's letter) from us, which explains exactly why the surgery is medically necessary. We know which wordings the MDK pays attention to.