The Question of The Nads
What is Bottom Surgery
The goal of transmasculine bottom surgery is to transform the female genitalia and reconstruct it into that of a male. Transmasculine bottom surgery is typically performed as a multiple stage procedure. There are many techniques used to perform bottom surgery, and the most appropriate technique for you will depend on your surgeon's preference as well as your personal goals.
A surgeon's cost for transmasculine bottom surgery may vary based on his or her experience as well as geographic location. Many plastic surgeons offer patient financing plans for transmasculine bottom surgery, so be sure to ask.
Transmasculine bottom surgery costs may include:
- Surgeon's fee
- Hospital or surgical facility costs
- Anesthesia fees
- Prescriptions for medication
- Post-surgery garments
- Medical tests and x-rays
When choosing a board-certified plastic surgeon for transmasculine bottom surgery, remember that the surgeon's experience and your comfort with him or her are just as important as the final cost of the surgery.
Transmasculine bottom surgery is considered a reconstructive procedure. In some instances, it can be covered by health insurance. However, your coverage may only provide a small part of the total fee.
Bottom Surgery Candidate
Transmasculine bottom surgery is a highly individualized procedure. You should do it for yourself, not to fulfill someone else's desires or to try to fit any sort of ideal image.
Transmasculine bottom surgery is a good option for you if:
- You have been diagnosed with persistent gender dysphoria
- You have been under the care of two mental health professionals who can each provide a letter of recommendation supporting your decision to undergo surgery
- You have been living as a member of your desired sex
- You are of the age to make consent
- You have a positive outlook and realistic expectations
- If significant medical or mental health concerns exist, they must be reasonably well-controlled.
Following your bottom surgery, gauze or bandages may be applied to your incisions. A support garment may be used to maintain the position of the penis and to prevent excessive movement while the tissues heal.
You will be given specific instructions that may include: How to care for your surgical site(s) following surgery, medications to apply or take orally to aid healing and reduce the risk of infection, specific concerns to look for at the surgical site or in your general health, and when to follow up with your plastic surgeon.
Be sure to ask your plastic surgeon specific questions about what you can expect during your individual recovery period.
- Where will I be taken after my surgery is complete?
- What medication will I be given or prescribed after surgery?
- Will I have dressings/bandages after surgery? When will they be removed?
- Will there be drains? For how long?
- When can I bathe or shower?
- When can I resume normal activity and exercise?
- When do I return for follow-up care?
Healing will continue for several months as swelling decreases. Continue to follow your plastic surgeon's instructions and attend follow-up visits as scheduled.
The final results of transmasculine bottom surgery can help alleviate the feelings of gender dysphoria that some individuals may experience.
Over time, the new penis will settle into position and the scar lines will improve, although they'll never disappear completely. There are trade-offs, but most transmen feel these are small compared to the large improvement in their quality of life and the ability to look and feel like a man.
Although most transmen choose to have their ovaries removed, some do not. The amount of ovarian growth as a result of testosterone therapy is small, the risk of developing ovarian cancer is not zero. Careful monitoring of ovarian health through exam is essential to your long-term health.
A prosthesis is usually placed in the penile tissues at a later date to provide rigidity to the tissues.
When you go home, if you experience shortness of breath, chest pains, or unusual heartbeats, seek medical attention immediately. Should any of these complications occur, you may require hospitalization and additional treatment.
The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure and another surgery may be necessary.
Following your physician's instructions is key to the success of your surgery. It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. Your doctor will give you specific instructions on how to care for yourself.
Risk & Safety
The decision to have bottom surgery is extremely personal. You'll have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable. Many individuals view this procedure as a necessary step toward alleviating their gender dysphoria.
Your plastic surgeon and/or staff will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedures you will undergo and any risks or potential complications.
The possible risks of transmasculine bottom surgery include, but are not limited to, bleeding, infection, poor healing of incisions, hematoma, nerve injury, failure of the transplanted tissues to survive, unsightly scars, exposure of the prosthesis, injury to the urinary tract, abnormal connections between the urethra and the skin, painful intercourse and anesthesia risks.
During your transmasculine bottom surgery consultation be prepared to discuss:
- Your transition process
- Your surgical goals
- Medical conditions, drug allergies and medical treatments
- Current medications, vitamins, herbal supplements, alcohol, tobacco and drug use
- Previous surgeries
Your surgeon will also:
- Evaluate your general health status and any pre-existing health conditions or risk factors
- Examine your genitalia
- Examine donor sites
- Take photographs
- Discuss your options and recommend a course of treatment
- Discuss likely outcomes of bottom surgery and any risks or potential complications
Be sure to ask your plastic surgeon questions. It's very important to understand all aspects of your bottom surgery. To help, we have prepared a checklist of questions to ask your plastic surgeon that you can take with you to your consultation.
It's natural to feel some anxiety, whether it's excitement for your anticipated new look or a bit of preoperative stress. Don't be shy about discussing these feelings with your plastic surgeon.
In preparing for transmasculine bottom surgery, you may be asked to:
- Get lab testing or a medical evaluation
- Provide two letters of recommendation from two therapists
- Take certain medications or adjust your current medications
- Stop smoking
- Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding
Transmasculine bottom surgery is typically performed in a hospital setting, and will likely use general anesthesia. Some follow-up procedures may be performed on an outpatient basis, and often multiple procedures are required until the final stage. These decisions will be based on the requirements of your specific procedure and in consideration of your preferences and your doctor's best judgment.
Words To Know
- A term for the tissues that will be used to create the new penis.
- General anesthesia
- Drugs and/or gases used during an operation to relieve pain and alter consciousness.
- Blood pooling beneath the skin.
- A female-to-male surgery to reconstruct the penis using an enlarged clitoris.
- A female-to-male surgery to reconstruct the penis using tissues from various parts of the body.
- A procedure that reconstructs the urethra.
- A procedure that removes the inner lining of the vagina and closes off the space prior to the penile reconstruction.
Use this checklist as a guide during your transmasculine bottom surgery consultation:
- Are you certified by the American Board of Plastic Surgery?
- Were you trained specifically in the field of plastic surgery?
- How many years of plastic surgery training have you had?
- Are you a member of the World Professional Association for Transgender Health?
- What specific training do you have in transmasculine bottom surgery techniques?
- Do you have hospital privileges to perform this procedure? If so, at which hospitals?
- Is the office-based surgical facility accredited by a nationally- or state-recognized accrediting agency, or is it state-licensed or Medicare-certified?
- Am I a good candidate for this procedure?
- What will be expected of me to get the best results?
- Where and how will you perform my procedure?
- What surgical technique is recommended for me?
- How long of a recovery period can I expect, and what kind of help will I need during my recovery?
- What are the risks and complications associated with my procedure?
- How are complications handled?
- What are my options if I am dissatisfied with the outcome?
- Do you have before-and-after photos I can look at for this procedure and what results are reasonable for me?