University of Virginia Plastic Surgery
1300 Jefferson Park Avenue 4th Floor
Charlottesville, VA 22908
Phone: (434) 924-1234
Location Hours: Monday–Friday | 8 a.m.–5 p.m.

How Does Bottom Surgery Work (FTM): Consultation to Recovery

Transgender person smiling and waving. (MODEL)

Embarking on the journey of FTM bottom surgery is more than a physical transformation; it’s a deeply personal and profound step toward aligning your body with your true self.

How does bottom surgery work for an FTM realignment? Understanding the intricacies of the process, knowing what to expect, and preparing both mentally and physically is vital in this life-altering experience. While each journey is unique, this blog post will discuss the essential steps to help demystify the process.

1. Consultation

Consulting with an experienced surgeon is necessary to understand what FTM bottom surgery entails. Your surgical options, the process involved, and the outcomes that can be expected will be discussed in detail. Questions about your personal goals, concerns, and lifestyle are explored to make sure they align with the surgical objectives. Learn more about what you need to know when considering transgender surgery in this related blog post.

2. Medical Evaluation

A comprehensive medical evaluation consists of a physical assessment and psychological evaluation. Health conditions that may affect surgery are identified, and letters of recommendation from 2 mental health professionals will be required prior to your initial consultation. This step ensures that your body and mind are prepared for the changes to come. You can find the answers to frequently asked questions about preparing for gender affirmation surgery in this related blog post.

3. Pre-Surgical Planning

The pre-surgical planning phase involves coordinating with your medical team. You’ll address pre-operative preparations as well as insurance and financial considerations.

Your surgeon will discuss options such as metoidioplasty or phalloplasty with you in detail. Depending on your goals, a hysterectomy may be required prior to either of these procedures.

  • Metoidioplasty involves a single-stage surgery using clitoral tissue to create a more defined phallus.
  • Phalloplasty, a 2- to 3-stage process, involves constructing a phallus using tissue grafted from another part of the body—typically the forearm or thigh. These stages are spaced apart about every 6-9 months, depending on healing and specific surgical goals.

Each procedure has specific advantages, recovery paths, and potential challenges.

An open conversation with your medical team about potential risks, complications, benefits, and post-surgical life will help you make an informed decision. It’s important to consider factors such as sexual functionality, aesthetics, potential for future surgeries, and the implications of each option on daily life.

4. Surgery

When you arrive at the surgical facility on the day of your procedure, you’ll be guided through the pre-surgical preparations, focusing on your comfort and addressing any last-minute questions or concerns. The anesthesiologist will explain the process involved with general anesthesia and monitor you throughout the procedure. Depending on the chosen method, your surgeon will perform metoidioplasty or phalloplasty and any additional elected procedures. Each of these procedures take a varied amount of time to perform, this will be discussed in detail prior to your surgery.

5. Postoperative Care & Home Recovery

Expect a hospital stay—about 1 to 2 days for metoidioplasty and 4 to 7 days for phalloplasty—as the medical team ensures that your initial recovery is on the right track. Upon discharge, you’ll continue with prescribed medications and wound cleaning as directed. Phalloplasty requires an extensive amount of wound care. Our team will walk you through wound care teaching and set up home health to assist in this care. Regular check-ups with your surgical team are essential and generally begin two weeks post-operative. Most patients need about 6 weeks to recover before resuming their usual activities.

Schedule a Consultation

Whether you’re at the beginning of your transition or ready to take the next step, our supportive team is here to help guide you along the way. If you’d like to meet with an experienced UVA surgeon to learn more, please call our office today at (434) 924-1234 or request a consultation using our online form.

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