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What Is a Phalloplasty?
A phalloplasty is a gender-affirming surgery that creates a phallus (penis). For trans men and transmasculine people with gender dysphoria, it can be an important step in aligning their body with their gender identity. Bottom surgery is an extensive undertaking that normally involves taking a flap of tissue from another part of your body (such as the forearm or thigh) and shaping it into a phallus.
Phalloplasty may take one or more procedures. The tissue used to create the phallus (a flap) is usually taken from the forearm, thigh, or back, and the donor site may need a skin graft to close it. Each location has pros and cons for scarring, sensation, and healing. Bottom surgery for trans men is less common than top surgery. Some of the reasons for this include:
- The financial burden it places on you and your family
- Lack of resources to help you recover successfully
- Uncertainty of the outcome
Today, more resources and doctors experienced in gender-affirming care are available to support you. In Midtown Manhattan, Dr. David Shokrian at Millennial Plastic Surgery offers consultations to help you explore your options and decide what is right for you.
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Clients’ Testimonials
Had a procedure done a few days ago by Dr. Shokrian and he was so kind, professional & efficient! So far I am LOVING my results! And as for the staff, everyone was very polite and attentive. I am so happy I chose Millennial Plastic Surgery.
What Are the Types of Female-to-Male Bottom Surgery?
As a transgender man or transmasculine individual pursuing gender alignment, you can opt for much more in your transformation than just fashioning and attaching a penis. How much you want to get done is your choice, but it depends on your resources, where you are in the process and what your skilled surgeon recommends. The options for FTM bottom surgeries include a:
- Hysterectomy, which removes your uterus
- Vaginectomy that removes your vagina and seals the opening
- Oophorectomy, which removes your ovaries
- Phalloplasty, to create a phallus
- Metoidioplasty, which releases the clitoris (enlarged by testosterone therapy) so it extends forward, creating a smaller phallus, usually with a better chance of preserving sensation. It may be combined with urethral lengthening (to urinate standing up) and scrotoplasty.
Transgender men may have one or more of these procedures done at the same time or at different times. Some trans men start their gender reassignment process with an easier surgical option, like breast reduction or female-to-male top surgery.
The surgery can last from two to 10 hours, depending on what you want done. The recovery can take a week to several weeks. With a phalloplasty, you need two or more procedures, each with its own recovery time. Make sure you have a plan in place for a smooth recuperation.
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What’s the Process for Getting FTM Bottom Surgery?
For most trans men, bottom surgery is one of the last details to consider. Many trans men choose not to get it done at all. It’s a humongous undertaking physically, emotionally and mentally. The basic process includes:
- Evaluation by your NYC doctor
- Removal of pubic hair
- Tests, X-rays and other examinations
- No more blood thinning medication, including over-the-counter, prescribed or herbal
- Guidance and a written recommendation from your therapist
- Instructions from your surgeon to stop smoking and lose weight
What Are the Results of FTM Bottom Surgery?
As a result of a phalloplasty, you’ll have a penis that looks real. Your surgeon lengthens the urethra so you can urinate standing up. You’ll have a scrotal sac. Usually, it takes another surgery to insert testicles and possibly a third to add a prosthesis to aid in erection. Some options to consider for recovery include:
- Scheduling time off from work or school
- Asking a friend or family member to take you home after the procedure
- Trying to get as much support as possible from friends and family — it takes four to six weeks to recuperate and you may need help with household tasks
What Are the Risks and Complications Associated with FTM Bottom Surgery?
Like any surgery, FTM bottom surgery carries general risks. It also has risks specific to the procedure, and phalloplasty in particular is a complex, often multi-stage operation. Choosing an experienced plastic surgeon in NYC who works in an accredited facility can help lower these risks, but it cannot eliminate them. Because tissue is taken from a donor site (such as the forearm or thigh), you have two surgical sites. Difficulties may include:
- Bleeding
- A bad response to anesthesia
- Dissatisfaction with the results
- Infection
- Urethral complications, such as fistulas
- Scarring, numbness, or reduced function at the donor site
- Changes in sensation
There are other types of bottom surgery that a trans man may have that only requires one surgical procedure, such as a metoidioplasty that turns the genital tissue you have into a defined penis. Each surgery has its own set of risks and outcomes. It’s between you and your physician to decide what’s right for you in your transformation.
How Much Does FTM Bottom Surgery Cost?
The cost depends on the procedure (metoidioplasty or phalloplasty), the number of stages, and the techniques used. Pricing is provided after your consultation. In addition to the surgery itself, other expenses include:
- Hospital or facility fee
- Anesthesiologist fee
- Prescription medications
- Specialized post-surgical garments
Follow-up visits and revision procedures, if needed.
Coverage varies by insurance plan. See the section below on insurance coverage, or contact our office to discuss financing options.
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Is FTM Bottom Surgery Covered by Insurance?
It’s against the law for insurance companies to discriminate based on your gender or sexual identity. But it depends on your insurance coverage. It may be up to you and your doctors to convince the insurance company that this is a necessary medical procedure. Pre-requisites may include:
- Living as a man for at least one year
- Hormone therapy
- A letter from your therapist stating that you’re mentally ready for this procedure
You are, of course, responsible for any co-pays or deductibles. It’s becoming easier for the LGBTQ+ community to have access to medical personnel who understand their needs and concerns, but it’s more important to be comfortable with your plastic surgeon than worried about the cost. For a private consultation, contact Dr. David Shokrian at Millennial Plastic Surgery. He’s the compassionate doctor you’re looking for in New York City.