FTM Bottom Surgery Guide 2026: Metoidioplasty vs Phalloplasty, Costs & Recovery

FTM bottom surgery encompasses a range of gender-affirming procedures designed to create masculine-appearing genital anatomy, with metoidioplasty and phalloplasty being the two main approaches to penile reconstruction. 

Metoidioplasty uses existing genital tissue to create a smaller phallus, while phalloplasty constructs a larger penis using tissue from another part of the body and is commonly performed in stages. Additional procedures such as urethral lengthening, scrotoplasty, and vaginectomy may be included according to individual goals. 

Understanding the surgical options, potential complications, recovery, and costs can help patients make informed decisions with an experienced gender-affirming surgeon.

Key Takeaways

• Metoidioplasty creates a smaller phallus using existing genital tissue.

• Phalloplasty creates a larger penis using tissue transferred from another body area.

• Both procedures can include urethral lengthening and scrotoplasty.

• Phalloplasty is generally performed in multiple stages.

• Recovery time varies according to the technique and number of procedures.

• FTM surgery costs depend on the surgical approach, hospital, surgeon, number of stages, and additional procedures.

What Is FTM Bottom Surgery?

FTM bottom surgery, also known as genital masculinization surgery, is a broad term for surgical procedures that masculinize the genital anatomy. Rather than describing one standardized operation, FTM genital surgery encompasses several possible procedures that can be tailored to a person’s gender-affirming goals.

The surgical plan may involve penile construction alone or a combination of different procedures addressing the urethra, scrotum, vagina, uterus, or ovaries. 

Not every person pursuing gender affirmation chooses genital surgery, and not every person requires the same combination of procedures.

Common Components of Gender-Affirming Bottom Surgery

The exact combination depends on the individual's goals and surgical assessment. Common components include:

• Metoidioplasty

• Phalloplasty

• Urethral lengthening

• Scrotoplasty

• Testicular implants

• Hysterectomy or oophorectomy

• Vaginectomy or vaginal closure

Metoidioplasty Procedure

A metoidioplasty procedure uses tissue that has enlarged through testosterone therapy to create a smaller phallus. Since the procedure depends on existing genital tissue rather than a free flap from the arm or thigh, it can involve fewer surgical stages than phalloplasty.

The resulting phallus is typically smaller than one created through phalloplasty, but the approach can preserve erectile tissue and sensation.

Additionally, depending on the surgical plan, metoidioplasty can involve:

• Release of the clitoral ligaments to increase visible length

• Urethral lengthening

• Scrotum creation

• Testicular implants at a later stage

• Vaginectomy

• Hysterectomy or oophorectomy

Phalloplasty Procedure

A phalloplasty procedure constructs a penis using tissue taken from most commonly the forearm and thigh, although the specific technique varies between surgical teams.

Phalloplasty can provide greater penile length and girth than metoidioplasty, but it is more complex and commonly requires multiple stages. Urethral reconstruction, scrotoplasty, glans creation, and erectile implants may be incorporated at different points in the treatment plan.

Phalloplasty Techniques

The phalloplasty technique is selected according to anatomy, desired results, donor-site considerations, and the surgeon’s experience.

Common approaches include:

• Radial forearm free-flap phalloplasty

• Anterolateral thigh phalloplasty

• Other individualized flap techniques

Because tissue is taken from a donor site, phalloplasty also introduces considerations such as scarring, wound healing, and changes in sensation at that location.

Metoidioplasty vs Phalloplasty

Choosing between the two approaches is primarily a question of priorities rather than determining which operation is objectively superior. Factors such as desired size, urinary function, sensation, donor-site scarring, and willingness to undergo multiple procedures can all influence the decision.

The most important comparison is therefore how each approach aligns with the individual's desired function and appearance rather than focusing on size alone.

FTM Surgery Cost: What Affects the Price?

FTM bottom surgery cost is mainly affected by the surgical technique, procedure complexity, number of stages, and additional procedures required. Because treatment is highly individualized, a quoted surgical price may cover only one stage or may form part of a broader treatment package.

Before comparing prices, it is important to determine exactly what each quote includes. Key cost factors include:

• Surgical technique and complexity

• Number of planned stages

• Surgeon and hospital fees

• Anesthesia and inpatient care

• Urethral reconstruction

• Scrotoplasty and implants

• Donor-site management

• Follow-up appointments

• Treatment of potential complications

For international patients, travel, accommodation, and extended stays can also affect the overall budget. A lower initial surgical quote should therefore not automatically be interpreted as a lower total treatment cost, particularly when additional stages, procedures, or follow-up care are priced separately.

Bottom Surgery Recovery Time

Bottom surgery recovery time depends heavily on whether the procedure is metoidioplasty or phalloplasty and whether additional procedures are performed simultaneously. Phalloplasty generally requires a longer and more involved recovery because it involves tissue transfer and staged reconstruction.

During recovery, patients may need to manage:

• Catheters or urinary drainage devices

• Incision and wound care

• Temporary activity restrictions

• Follow-up examinations

• Monitoring for urethral or wound complications

• Additional procedures before the reconstruction is considered complete

Recovery milestones should always be based on the operating surgeon's instructions rather than a fixed timeline.

Risks and Potential Complications

As with any major operation, gender-affirming bottom surgery carries risks. The specific complications depend on the technique and the procedures included in the surgical plan.

Urethral complications are particularly important to discuss when urethral lengthening is performed. These can include strictures and fistulas, while phalloplasty may also involve flap-related and donor-site complications.

Potential complications include:

• Infection

• Bleeding or hematoma

• Wound healing problems

• Urethral stricture or fistula

• Changes in sensation

• Donor-site scarring or complications

• Need for revision surgery

• Implant-related complications

How to Choose the Right FTM Bottom Surgery

The best approach depends on what the individual considers most important from both a functional and aesthetic perspective. A consultation with a surgeon experienced in transmasculine genital reconstruction should involve a detailed discussion of realistic outcomes, complications, staging, and long-term care.

Important questions to discuss include:

• Is standing urination a priority?

• Is penile size or sensation more important?

• How much donor-site scarring is acceptable?

• Is penetrative sexual function a priority?

• How many procedures are realistic?

• What happens if a complication requires revision?

Frequently Asked Questions

Can metoidioplasty allow standing urination?

It can in some patients when urethral lengthening is performed, although the outcome varies according to anatomy and healing.

Is sensation possible after phalloplasty?

Sensation can develop as nerves regenerate, but the timing and degree of sensation vary considerably between individuals, and sensation is not guaranteed.

Does bottom surgery have to include every available procedure?

No. Gender-affirming surgery is individualized, and people may choose different combinations of procedures according to their goals.