How Dr. Charles Garramone helped shape a generation of gender-affirming care, one chest at a time.
When Dr. Charles Garramone first began offering gender-affirming top surgery, he was stepping into largely uncharted territory. While the first known masculinizing chest surgeries date back to the 1940s, performed on British physician Michael Dillon by plastic surgery pioneer Harold Gillies, few surgeons had refined or formalized the procedure for a modern transgender population. In the early 2000s, top surgery remained rare, stigmatized, and inaccessible for most. For Garramone, a board-certified plastic surgeon with a passion for serving underserved communities, it quickly became clear that this work wasn’t just important, it was essential.
“Early in my career, I realized that transgender patients had extremely limited options for surgical care that was both affirming and specialized,” he recalls. “What began as a few consultations turned into a clear calling.”
That calling became a career, and eventually, a cornerstone in the evolution of modern top surgery. Today, Garramone is one of the most recognized names in the field, with thousands of procedures behind him and a legacy that continues to shape how top surgery is performed, perceived, and taught.
Breaking Ground in Unchartered Territory
In those early years, the challenges were not just technical but cultural. Garramone remembers the skepticism from peers who questioned the idea of building a surgical practice centered on transgender care.
“Some peers didn’t understand it, and others questioned the viability of dedicating a practice solely to gender-affirming surgery,” he says. “But I saw the need.”
What cemented his commitment wasn’t just demand or data, it was his patients. One early case involved someone traveling across the country just to have a consultation.
“Their outcome changed not just their physical body, but their life trajectory,” he says. “The emotional weight of that experience solidified my decision to focus entirely on this field.”
From that point forward, Garramone focused on refining his technique. Rather than rely on rigid surgical templates, he prioritized individualized results. Over time, he developed a method that balances anatomical precision with aesthetic nuance, tailored to each patient’s body and goals.
“I’ve moved away from one-size-fits-all approaches and toward truly individualized surgical planning,” he explains. “It’s not just about removing breast tissue—it’s about building a chest that feels naturally masculine or aligned with the patient’s identity.”
Technique and Artistry
Ask Garramone what makes top surgery an art, and his answer is immediate.
“Sculpting the chest involves symmetry, proportion, tissue behavior, and long-term healing dynamics,” he says. “No two patients are the same, and no template applies universally.”
His approach blends technical mastery with surgical intuition. Listening is just as important as operating, he says, and understanding a patient’s vision for their body is foundational to a successful outcome.
“Like any art form, it’s about mastering technique while knowing when to adapt intuitively.”
Changing Landscape
In recent years, gender-affirming care has become more visible, and more surgeons are entering the field. For Garramone, the growth is promising, but not without concern.
“It’s encouraging to see more surgeons interested in this field, but rapid growth comes with risks,” he says. “Inexperienced surgeons or those who don’t take the time to understand the community can cause real harm.”
Training and mentorship are key. While he hasn’t established a formal fellowship, Garramone has consulted with and guided many surgeons across the U.S. and internationally, sharing insights to help elevate standards of care.
“Don’t assume this is just another cosmetic procedure,” he advises. “Listen first. Understand the lived experiences of your patients. Build trust. Technical skill is just the beginning—empathy matters just as much.”
A Legacy of Dignity
After more than two decades of dedicated work, Garramone’s name is nearly synonymous with top surgery. His methods have influenced how the procedure is taught and performed, and his reputation draws patients from around the world. Yet when asked about his legacy, he doesn’t speak about numbers or notoriety.
“That I treated every patient with dignity, precision, and respect,” he says. “And that I elevated standards for what top surgery can be, both technically and humanistically.”
In a field that has gone from marginal to increasingly mainstream, Dr. Charles Garramone remains an influential presence. His work has helped thousands of people see themselves more clearly and helped redefine what gender-affirming surgery can achieve.