Bottom Surgery (FTM)

A powerful step toward alignment, we’re here to guide you with empathy, expertise, and respect.

Bottom Surgery - FTM (3)

What Is Bottom Surgery?

Bottom surgery refers to procedures that create external genitalia aligned with a masculine identity. At The Center for Gender Affirmation, we offer:

  • Phalloplasty: Creation of a penis using tissue from the forearm (radial forearm flap), abdomen (abdominal flap),  or thigh (ALT flap), with staged placement of erectile devices.
  • Metoidioplasty: Utilizes a hormonally enlarged clitoris to construct a smaller phallus, with or without urethral extension.
  • Urethral Lengthening: Involves connecting the native urethra to a constructed urethra in the neophallus to allow for urination from the tip of the neophallus. 
  • Prosthetics: We offer placement of both inflatable and malleable penile prostheses, as well as testicular implants, tailored to your goals and timing preferences.
All procedures are performed with your individual goals at the center of every decision. Our team takes the time to walk through all options to build a plan that’s safe and aligned with your vision of self.

These surgeries can help align a person’s body with their gender identity, support sexual function, and foster emotional well-being. Many patients pursue bottom surgery as part of a multi-stage, full-spectrum transition process.

Explore the Benefits of Bottom Surgery

TCGAICON - Restore Autonomy
Restored bodily autonomy
TCGAIcon - Improved self-image and confidence
Improved self-image and confidence
TCGAIcon - Enhanced congruence between body and identity.svg
Enhanced congruence between body and identity
TCGAIcon - Enhanced intimacy and sexual function.svg
Enhanced intimacy and sexual function

Real People. Real Stories.

Learn More About 
Life After Transformation.

What to Expect

During the Procedure
Our surgeries are performed by skilled microsurgeons specializing in genital reconstruction. Phalloplasty and metoidioplasty are multi-stage procedures that require approximately 12 weeks of recovery, with a 6-month interval between stages (if needed). Nerve coaptation techniques are used to maximize sensation and sexual function. Most procedures are performed under general anesthesia, with hospital stays ranging from one to five days. You’ll have a dedicated team monitoring your comfort, healing, and early mobility from the moment you wake up. Catheters, drains, and wound dressings are typically in place for the first few days, and our team will walk you through every step—before, during, and after surgery.

Risks and Recovery
As with any major surgery, these procedures pose risks such as fistula, stricture, scarring, or sensory changes. Initial healing takes several weeks, followed by longer-term monitoring of urinary function, sensation, and tissue integration. Many patients return to daily routines within 2–3 months, with full recovery often continuing up to a year.

Healing doesn’t stop when you leave the hospital—and neither does our care. You’ll have regularly scheduled follow-up visits to monitor healing, manage any complications early, and track sensory return. Our team also partners with  pelvic floor therapists, urologists , and behavioral health practitioners to ensure your post-op recovery and long-term follow up needs are met.

The Surgeons Who Stand with You

Planning for Surgery

Travel and Accommodations 
We welcome patients from all over. Our care coordinators can help arrange lodging and travel support for out-of-town patients.

Insurance and Financial Planning
Our team will help you verify coverage and understand your financing options.

Additional Resources
Looking for more information? Visit our Patient Resource Center for recovery checklists, videos, and community referrals.

Contact Us Today

TCGA - Bottom Surgery (FtM) - Ready to Take the Next Step

Ready to Take the Next Step?

Frequently Asked Questions

How do I know if I'm a good candidate?

You should be in good physical and mental health and ready to move forward with surgery when it feels right for you. Our practice’s policy is not to treat anyone under the age of 19. Call us to schedule your consultation on or after your 19th birthday.

Will I be able to feel sexual pleasure?

Many patients report tactile and erogenous sensation, especially when nerve connections are successfully made. Sensation develops gradually, and it may take time for the penis to fully regain feeling, but the goal is to achieve meaningful sensation by the end of recovery.

Can I have bottom surgery without phalloplasty?

Yes. Metoidioplasty is a good standalone option. Your care team will help you choose what’s right for you.

How long is the recovery time after bottom surgery?

Recovery can vary depending on the procedure. Most patients need 6–12 weeks off for phalloplasty or metoidioplasty, with full activity resuming after several months. Our team provides a personalized recovery plan and ongoing support throughout the process.

What if I’ve had complications from a previous surgery elsewhere?

You’re not alone. Our team specializes in complex revision work, including fistula repair, nerve restoration, flap salvage, urethral stricture management, aesthetic revision, and prosthetic troubleshooting. We provide second-opinion consultations and trauma-informed care pathways to ensure you feel safe, supported, and understood throughout the process.