Understanding FTM Bottom Surgery: Techniques and Outcomes

Bottom surgery for transmasculine individuals offers several options for genital reconstruction. This comprehensive guide explores available techniques, expected outcomes, and important considerations for decision-making.

Available Techniques

Metoidioplasty

Metoidioplasty utilizes existing genital tissue that has been enlarged through testosterone therapy.

Key Features:

• Preserves natural erectile ability

• Maintains original sensation

• Shorter recovery time

• Lower complication rates

• Can be performed with or without urethral lengthening

• Optional scrotoplasty with testicular implants

Considerations:

• Results in smaller phallus size

• May not allow penetrative sex

• Often requires multiple stages

• Lower cost than phalloplasty

Phalloplasty

Phalloplasty creates a penis using tissue from another body area (typically forearm, thigh, or back).

Key Features:

• Creates average-sized penis

• Options for erectile devices

• Standing urination possible

• Penetrative sex possible

• Can include glansplasty for natural appearance

• Includes scrotoplasty with testicular implants

Considerations:

• Multiple surgeries required

• Longer recovery period

• Higher complication rates

• Visible donor site scarring

• Higher cost

• Different sensation patterns

Expected Outcomes

Metoidioplasty Results

• Final length typically 4-6 cm

• Preserved erogenous sensation

• Natural erection capability

• 85-95% satisfaction rates reported

• Lower complication rates

Phalloplasty Results

• Final length typically 12-15 cm

• Different sensation patterns

• Requires erectile device for firmness

• 75-85% satisfaction rates reported

• Higher complication rates

Recovery Timeline

Initial Recovery (0-6 weeks)

• Hospital stay 3-7 days

• Limited mobility

• Catheter management

• Pain control

• Regular follow-up

Intermediate Recovery (6 weeks - 3 months)

• Return to light activities

• Begin scar care

• Sensation changes

• Gradual return to work

Long-term Recovery (3-12 months)

• Final healing

• Sensation development

• Secondary procedures if needed

• Return to full activities

Insurance and Costs

• Coverage varies by location and provider

• Multiple procedure stages affect total cost

• Additional costs for complications

• Travel expenses consideration

• Recovery care costs

Questions for Consultation

1. Surgical technique recommendations

2. Expected outcomes

3. Complication rates and management

4. Recovery support

5. Cost breakdown

6. Insurance navigation

7. Emergency protocols

Remember that choosing between surgical options is highly personal. Consider working with a gender-affirming healthcare provider to discuss which approach best aligns with your goals and circumstances.