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What Is MTF Bottom Surgery?
MTF bottom surgery is a gender-affirming procedure that creates female genitalia, helping trans women and transfeminine patients align their bodies with their gender identity. It reshapes existing genital tissue to create a vulva and, in a vaginoplasty, a vaginal canal, and usually includes removal of the testicles (orchiectomy). Other procedures that may be performed as part of your transition before or after bottom surgery include:
- Facial feminization
- Breast plastic surgery with breast implants, or a MTF top surgery
- Tracheal shave
In most instances, the top surgeries are taken care of before the bottom. This is largely due to an easier recovery and lesser financial burden. At the same time, transgender women may or may not have any surgery, but they still live their lives as women.
Bottom surgery is a major, life-changing step. It’s important to choose a plastic surgeon who understands the LGBTQ+ community and is willing to meet your needs. Dr. David Shokrian and the staff at Millennial Plastic Surgery in Midtown Manhattan offer experienced, respectful care to help you feel understood and supported.
*results may vary
Clients’ Testimonials
My surgery was exceptionally amazing. I'm so grateful. Dr. Shokrian understood exactly what I wanted. Post-op care was wonderful. I'm going to book again for another procedure.
Who’s a Good Candidate for Male to Female Bottom Surgery?
If you’re planning on getting this done, you should be in good physical shape to start with. Your doctor may have you take steps to prepare that might include:
- Exercising regularly
- Quitting smoking
- Losing weight
- Getting any conditions that you aren’t managing well under control, like diabetes or high blood pressure
- Living as a woman for at least a year
- Going into therapy for a short time to firm up your expectations
Have an open and honest discussion with your doctor about how you feel, what expectations you have about the procedure and what lifestyle changes you’re willing to make. You and your doctor discuss exactly what’s being done and what outcome you can expect because this is perhaps the biggest transformation of your life.
Are There Any Prerequisites for Getting MTF Bottom Surgery?
As with most gender-affirming surgeries, you need to be under the care of a licensed therapist. Your physician and sometimes insurance companies need a written assessment from a licensed mental health professional. You may also need:
- Lab tests and possibly x-rays
- New medications or have old ones adjusted
- Genital hair removal, which may start up to nine months before the surgery
This can be a lengthy and complex procedure. Combine this with the aftercare, and it becomes at least a two- year metamorphosis. This is why you need a strong mind, body and soul, as well as a group of family and friends that you can rely on to support your decisions.
What’s the Procedure for Male-to-Female Bottom Surgery?
There are two basic types of MTF bottom surgeries. A vulvoplasty involves removing the testicles and scrotum and reshaping existing genital tissue to create a clitoris, labia, and a repositioned urethral opening, without creating a vaginal canal. A vaginoplasty does the same and also creates a vaginal canal (neovagina), most commonly using penile skin (penile inversion technique). A vulvoplasty is an option for those who:
- Don’t want to have penetrative sex
- Have medical conditions that make a longer, more complex surgery riskier
- Don’t want to keep up with the lifelong dilation procedures
- Prefer a shorter surgery and recovery
- Want to avoid the more extensive hair removal that a vaginoplasty may require
How Much Does MTF Bottom Surgery Cost?
The cost depends on what procedures you plan to have done and the doctor you decide on. Other costs involved in transgender surgery, male-to-female, include:
- Facility fees
- Anesthesiologist’s fee
- Pubic hair removal, in some cases
- Aftercare medical supplies and medicine
There may also be financial ramifications of taking time off from work or school — ask your employer about FMLA and short-term disability. Your insurance may cover part of these costs, but if they consider it elective surgery, it’s not covered. Other options include a personal loan or using an HSA account. Financing options may be available at Millennial Plastic Surgery.
I couldn't be happier with the level of service provided.
What Are the Risks and Complications of MTF Bottom Surgery?
Like any surgery, MTF bottom surgery carries general risks such as bleeding, infection, and reactions to anesthesia. It also has risks specific to the procedure, including poor wound healing or partial tissue loss, narrowing of the vaginal canal or urethral opening, fistulas (an abnormal connection between the vagina and the bladder or rectum), changes in sensation, and the possibility of needing a revision surgery. Relying on an experienced plastic surgeon in NYC can lower these risks, but it cannot eliminate them. Dissatisfaction with the results is also possible, which is why you must talk it over with your therapist and doctor before you undergo vaginoplasty.
Some people experience urinary changes, such as spraying or mild incontinence, that often improve with time. The most effective thing you can do to minimize these difficulties is to prepare and strictly follow your plastic surgeon’s post-op instructions that may include:
- Spending several days in the hospital (your surgeon will confirm the exact length)
- Buying a donut cushion as it will be painful to sit for a time
- Taking antibiotics and other medications as prescribed
- Using ice packs to reduce pain and swelling
- Sticking to a strict schedule for dilation treatment
Contact your surgeon right away if you develop a fever, heavy bleeding, severe or worsening pain, or signs of infection.
Recovery time depends on exactly what procedures you have performed. Total recovery lasts at least a year. The better shape you’re in, the easier your recovery will be. A vaginoplasty is a tremendous surgery, so you should be completely ready physically and emotionally to take on such a monumental task. You will have to plan well and enlist the help of your family and close friends to aid you in your recovery.
Read more: Post-Op Transgender Genitals, What You Can Expect Post-Op Bottom Surgery?
56 West 45th Street, 4th floor New York, NY 10036 1000 Northern Blvd Suite 165
Great Neck, NY 11020
What Are the Results of MTF Bottom Surgery?
Vaginoplasty results in a functional vagina. The physical results take time, but after a few weeks, the swelling goes down and the scars diminish. The results include:
- Strengthened gender validation
- Lessened gender dysphoria
While many trans women have top surgery, few have bottom surgery. It’s an expensive and difficult procedure, as well as a long and arduous recovery period. You need an exemplary plastic surgeon who has the skills — both in surgery and with his bedside manner — to care for you properly. To receive that compassionate care, contact Dr. David Shokrian at Millennial Plastic Surgery, the physician you want to make your dreams a reality.