FTM Bottom Surgery: Options, Staging, Risks and Recovery

FTM bottom surgery is not one operation. It is a group of procedures, usually staged over months or years, and the right combination depends on what matters most to you: standing urination, penetrative sex, retained sensation, scarring you can accept, and how many operations you are willing to go through.

This guide sets out the options honestly, including what each one cannot do. It is background reading for planning and questions, not a substitute for individual assessment.

For readers in South Africa, our guide to gender-affirming surgery in Turkey for South African patients looks at flights from Johannesburg and Cape Town, the e-Visa and how long a stay to plan for.

The two main routes

Metoidioplasty uses the tissue that testosterone has already enlarged, releasing it to form a phallus. It is a shorter operation with a shorter recovery, keeps erogenous sensation, and can allow spontaneous erection. The result is proportionally small, and penetrative sex is usually not possible.

Phalloplasty builds a phallus from a flap of tissue taken from elsewhere — commonly the forearm, the thigh or the abdomen. It produces a larger result and, with an implant at a later stage, can allow penetrative sex. It is far bigger surgery, leaves a visible donor-site scar, is staged across multiple operations, and carries a substantially higher complication rate.

Neither route produces a penis that behaves like a natal one. Sensation, appearance and function are all different, and surgeons who describe the outcome in absolute terms should be treated with caution.

The parts that are decided separately

• Urethral lengthening — needed for standing urination. It is also the single largest source of complications in this surgery: strictures and fistulas are common and often need further operations. Choosing to go without it makes the surgery simpler and safer, at the cost of standing urination.
• Vaginectomy — removal of the vaginal lining. Often required before urethral lengthening; sometimes declined for personal or medical reasons.
• Scrotoplasty and testicular implants — the scrotum is formed from labial tissue, with implants placed at a later stage once healing allows.
• Erectile and testicular prostheses — fitted well after the main reconstruction, and only once sensation and healing are adequate.
• Hysterectomy and oophorectomy — frequently required beforehand, depending on the surgical plan.

What decides the choice

Anatomy and prior surgery, how long you have been on testosterone, body mass, smoking status, donor-site tissue quality, whether you want standing urination, whether penetrative function matters, and how many stages and how much risk you are prepared to accept. Two people with the same identity and goals are routinely offered different plans.

Smoking is not a minor point here. Flap survival depends on blood supply, and most surgeons will not operate until you have stopped.

Risks worth understanding before you start

Urethral strictures and fistulas, partial or total flap loss, wound breakdown, infection, altered or reduced sensation, donor-site scarring and functional limitation, prosthesis infection, erosion or failure, and the need for unplanned revision surgery. Complication rates in phalloplasty are high compared with most elective surgery, and revision is common rather than exceptional.

This is why the aftercare arrangement matters as much as the operation. Ask what happens if a complication appears after you have returned home, who manages it, and who pays for it.

Recovery, realistically

Metoidioplasty typically involves a few weeks before returning to light activity. Phalloplasty involves a longer inpatient stay, restricted mobility, catheterisation, and months before the result settles — with further stages after that. Full completion of a staged phalloplasty pathway is measured in years, not months.

Plan time off, support at home, and the possibility that a stage does not go to plan.

Questions to ask at assessment

• Which route is proposed for me, and why that one rather than the alternative?
• How many stages, and what is the expected interval between them?
• Is urethral lengthening part of the plan, and what is this surgeon’s experience of stricture and fistula in their own patients?
• What donor site, and what will that scar look like?
• What sensation can I realistically expect?
• Who is the operating surgeon, what is their registration and case volume in this specific procedure?
• What is the arrangement if revision is needed?
• Who manages complications after I fly home, and how?

The answers belong in a written treatment plan, not in a phone conversation.

Where this is set out on our site

See our FTM bottom surgery page for what is offered and how assessment works, and transgender phalloplasty for that procedure specifically. Chest surgery is covered on the top surgery page and in what top surgery involves.

Treatment arranged through Revitalize takes place in Izmir. The surgeon and the hospital are contracted providers named in your written treatment plan, so their registration and experience can be checked before you travel. See our contracted surgeons and specialists and contracted hospitals pages, the treatment process page for the stages, and the treatment guarantee page for the limited written warranty that applies.

Whether any of this is appropriate for you, and in what order, is a clinical decision made with you after assessment.