Many transmen and transmasculine people experience dysphoria related to their genitals. To address this issue, FTM (female-to-male) bottom surgery is available. Patients in Beverly Hills and the Los Angeles area can turn to Dr. Ourian for excellent FTM bottom surgery results.

What is FTM Bottom Surgery?

FTM (female-to-male) bottom surgery is an option for transmen or transmasculine people. The goal is to construct an aesthetically appealing penis which allows the patient to urinate from a standing position and feel a sensation as well as relieve gender dysphoria. FTM bottom surgery is also referred to as “gender-affirming surgery,” “gender reassignment surgery,” or “sex reassignment surgery (SRS)”.

Who is a Good Candidate for FTM Bottom Surgery?

Before choosing FTM bottom surgery, patients should be in good overall health. This includes being a nonsmoker, as smoking can interfere with the healing process. Patients generally should also have received counseling regarding their gender identity and may require a letter from a mental health professional. FTM bottom surgery is best for patients who feel persistent gender dysphoria, and in most cases, patients should receive hormone replacement therapy (HRT) before pursuing the procedure. In addition, patients often must have a hysterectomy and oophorectomy (removal of ovaries) prior to their FTM bottom surgery. You should also be at least 18 years old before having FTM bottom surgery. Dr. Ourian will review your health history and other factors to determine whether you are a good candidate for FTM bottom surgery. 

How is FTM Bottom Surgery Performed?

There are two basic types of FTM bottom surgery: metoidioplasty and phalloplasty. Choosing between these options largely depends on results from HRT and the patient’s preferences and goals. For some patients, FTM bottom surgery is broken into separate stages. For example, a patient may have a phalloplasty first, followed by a scrotoplasty after the initial recovery period. Dr. Ourian will advise the best treatment plan for you. 

Metoidioplasty 

A metoidioplasty is a simpler option and method of FTM bottom surgery. This procedure repositions a clitoris which has become elongated by HRT so that it matches the natural position of a penis. Then, the urethral is lengthened and positioned to the tip of the newly-created penis. The vaginal canal lining is removed and the opening is closed. Finally, a scrotum is created using the labia majora tissues. 

Phalloplasty 

A phalloplasty involves the use of skin grafts from the thigh, forearm, abdomen, or back to create the neopenis. These various donor sites make up the different types of phalloplasty, which include:

  • Radial forearm free flap
  • Anterolateral thigh flap
  • Musculocutaneous latissimus dorsi flap (side/back)
  • Supra-pubic (abdominal)

Donor tissue from the same site is also used to lengthen the urethra. Most surgeons prefer to use the forearm as the donor site as it allows for sensitivity with good aesthetic results, however, scarring at the donor site are more noticeable compared to other options. 

In addition to the use of skin grafts to construct the phallus, a phalloplasty typically includes a vaginectomy, in which the vagina is removed, and a scrotectomy, in which the labia majora is used to create a scrotum. Testicular implants can also be placed. 

Finally, most phalloplasty techniques allow for implantation of a penile implant (an erection rod or inflatable pump) if the patient chooses. This is usually done after the patient has fully recovered from their phalloplasty; typically, a penile implant is not placed until about a year after the initial bottom surgery. 

What is FTM Bottom Surgery Recovery Like?

Most patients must stay in the hospital for around five days after FTM bottom surgery. Following the procedure, you will have a catheter in place. Swelling and discomfort are expected. Dr. Ourian will prescribe medication as necessary to keep you comfortable throughout the recovery process. Bandages will be in place, and you will have a splint on the donor site of any skin grafts. Dr. Ourian will provide instructions regarding caring for bandages and ensuring proper healing throughout your recovery. 

FTM bottom surgery patients are generally ready to return to work and their normal routine about a month after the surgery. Strenuous exercise and lifting heavy objects should be avoided for at least two weeks after a phalloplasty. Gaining full sensation takes time after a phalloplasty, as nerve tissue is slow to heal. Full healing in this regard can take up to two years after FTM bottom surgery.  

What Procedures Can I Combine with FTM Bottom Surgery?

Many FTM bottom surgery patients are also interested in FTM top surgery. FTM top surgery involves removing breast tissue to create a masculine chest. 

Another procedure which can enhance a masculine appearance is a chin augmentation. A chin augmentation utilizes a chin implant to create a more prominent chin and defined jawline. This can create a more masculine-looking face while enhancing visual balance and symmetry as well. 

Finally, both cis- and transmen alike are often interested in abdominal etching to create an athletic, muscular, and masculine-looking abdominal region. Abdominal etching is a liposuction technique in which fat is strategically removed to enhance the appearance of the abdominal muscles. 

For many patients, it may be recommended that you have complementary procedures in a separate setting from your FTM bottom surgery to allow for a smoother recovery period. Dr. Ourian will recommend the best plan for you to meet your overall goals while maintaining your health and safety. 

How Much Does FTM Bottom Surgery in Beverly Hills Cost?

The final cost of your FTM bottom surgery will vary depending on factors such as the techniques used and the geographic location where your surgery is performed. Beverly Hills FTM bottom surgery patients can expect their procedure to cost around $25,000 on average. 

Health insurance may cover the cost of your FTM bottom surgery. By California law, health insurance providers are required to cover gender-affirming surgery in most instances. Your health insurance plan will likely require you to have a letter from a mental health professional which states that you experience persistent gender dysphoria, have all mental and medical health concerns reasonably under control, and are capable of making an informed decision.