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Female-To-Male (FTM) Bottom Surgery

Female-To-Male Bottom Surgery

Female-to-Male (FTM) bottom surgery is a significant and life-changing procedure for transmasculine individuals, greatly enhancing the alignment of their physical appearance with their true gender identity. At East Coast Advanced Plastic Surgery, we are dedicated to providing compassionate, expert care, ensuring that our patients feel supported, informed, and empowered at every stage of their journey. Dr. Marano and Dr. Keith have assembled a world-class team of health professionals to perform gender-affirming genital masculinizing surgery with the use of microsurgical technique. In addition to the expert surgeons of ECAPS, Dr. Keith and Dr. Marano routinely work with board-certified experts from urology and gynecology to safely perform these procedures. In 2018, Dr. Keith performed the first phalloplasty in the state of New Jersey.

MTF-what is

WHAT IS PHALLOPLASTY

A phalloplasty is a surgical procedure in which a male-anatomic appearing penis is constructed using autologous tissue (your own tissue from another part of your body). Phalloplasty is a multi-staged procedure, with the combination of stages taking place over at least one year. Each patient’s surgical plan is unique depending on their particular goals.

Phalloplasty Donor Sites

Radial forearm free flap phalloplasty (RFFF)
Anterolateral thigh flap phalloplasty (ALT) – A flap is tissue, in this case skin and fat, taken with its own blood/nerve supply and transported to a different part of the body. This hyper-complex procedure is used to create a phallus while preserving erogenous sensation. Dr. Keith and his team will work to determine the best donor site for you. At your first consultation with us, we will examine both donor sites to determine your specific anatomy, as well as review each donor site option at length.

What Are The Stages Of Phalloplasty

In order to perform surgery safely with the goal of achieving the best aesthetic and functional results with the least complications, phalloplasty is performed in various stages. Dr. Keith, Dr. Marano, and their team will work with each patient individually to establish patient-specific goals, a surgical timeline as well as ongoing support as you move through this process. Below is an example of the various stages (remember, each patient’s surgical plan varies)

transgender person looking at files while at work

STAGE 1: VAGINECTOMY AND HYSTERECTOMY (REQUIRED IF ONE OF YOUR GOALS IS STANDING TO URINATE)

  • A gynecologist will remove the vagina, as well as the uterus.

STAGE 2: CREATION OF THE PHALLUS, URETHROPLASTY, AND SCROTOPLASTY

  • During this stage, Dr. Marano and Dr. Keith create the phallus using you chosen donor site, creates a neo-urethra (new urethra) inside that phallus, and creates a scrotum using your existing tissue.
  • It is important to note that the neo-urethra (tubular structure within the phallus to eventually allow urine to exit from the bladder) takes time to heal. The new urethra is not connected to your native urethra until the next stage. While healing of the neo-urethra takes place, you will still urinate out of your existing, native urethra.

STAGE 3: URETHRAL HOOKUP

  • During this stage, our team works with a board-certified urologist to connect the new urethra in your phallus to your native urethra, in order for you to stand to urinate.

STAGE 4: TESTICULAR IMPLANTS AND GLANSPLASTY

  • Prosthetic saline-filled testicles placed into the scrotum
  • A glansplasty is the surgical creation of the glans penis, creating the appearance of a circumcised penis

STAGE 5: PENILE PROSTHESIS

  • This is typically the final stage of phalloplasty
  • A prosthesis is placed inside the phallus in order to achieve the ability to have an erection and have penetrative intercourse with a partner

HAIR REMOVAL

If one of your goals is to stand while urinating, hair removal from the donor site is critical before phalloplasty. Hair growth within your neo-urethra can lead to severe complications, such as stricture (narrowing of the urethra) and fistula formation (abnormal connections between organs). These complications can cause significant pain, infections, and may require additional surgeries to correct. Hair removal is essential for ensuring a smooth and functional neo-urethra.

Typically performed through laser or electrolysis, this process generally takes between 6-9 months to complete. Proper and thorough hair removal minimizes the risk of complications and contributes to the overall success of your surgery. We currently perform laser hair removal at our Manhattan office. If this location is not convenient for you, we will assist in finding a hair removal provider closer to your home, ensuring you receive the necessary treatment to prepare for your surgery.

recovery

Male-to-Female (MTF) Bottom Surgery Recovery

Phalloplasty is a rewarding but time-consuming commitment. Healing between each stage is very important and crucial to the success of the next stage. Frequent visits with our team as well as with the urologist are necessary throughout the process. Our entire office staff is well-educated to provide quality and individualized postoperative care. Initial Recovery Week 1-2:

  • Hospital Stay: Patients typically stay in the hospital for 5-7 days post-surgery. During this time, pain management is a priority, with medications provided to control discomfort.
  • Mobility: Limited movement is recommended to promote healing. Patients are encouraged to walk short distances to prevent blood clots.
  • Wound Care: Proper wound care is essential to prevent infection. Our team will provide instructions on how to clean and dress the surgical sites.

Week 3-4:

  • Pain Management: Pain should gradually decrease, but patients may still require pain medication. Over-the-counter pain relievers can be used as needed.
  • Mobility: Patients can slowly increase their activity levels but should avoid strenuous activities. Light walking is encouraged.
  • Wound Care: Continued attention to wound care is crucial. Any signs of infection, such as redness, swelling, or discharge, should be reported to our team immediately.

Long-Term Care Month 2-3:

  • Complication Monitoring: Regular follow-up appointments are essential to monitor for complications such as fistulas or strictures. Any unusual symptoms should be reported to our team promptly.
  • Scar Management: Techniques such as massage, silicone sheets, or prescribed ointments can help manage scar tissue.
  • Mobility: Patients can begin to resume more normal activities but should still avoid heavy lifting or intense exercise.

Month 4-6:

  • Follow-Up Appointments: Continued follow-up visits help ensure proper healing and address any complications.
  • Scar Management: Ongoing management of scar tissue is important for optimal healing.
  • Mobility: Patients can typically return to most normal activities, but it’s important to listen to your body and avoid overexertion.

WHAT IS METOIDIOPLASTY

A metoidioplasty is a surgical procedure in which your own, existing genital tissue is used to create a neo-phallus (new-penis). Special care is used to preserve erogenous sensation. This procedure can be performed with OR without urethral lengthening (urethral lengthening allows for the ability to eventually stand to urinate). It is important to note that the neo-phallus created during metoidioplasty typically cannot be used for penetrative intercourse. Metoidioplasty itself is a one-stage procedure, however, various additional procedures can be done either in conjunction with, before or after metoidioplasty, potentially making it a multi-stage process.

WHAT IS GLANSPLASTY

Glansplasty is a surgical procedure that is performed when a patient desires the appearance of a circumcised phallus. The glans penis is the tip of the phallus and consists of a coronal sulcus and coronal ridge. The creation of an aesthetically pleasing and anatomically-male glans penis requires experience and acute attention to detail. Dr. Marano and Dr. Keith use the modified Norfolk glansplasty technique. A skin flap is created at the tip of the phallus, which is rolled to create a coronal ridge. The area where the skin flap was taken from to create the ridge is then covered with a split-thickness skin graft. The skin graft is typically harvested from the thigh.

OPTIONAL ADDITIONAL PROCEDURES

Scrotoplasty

The creation of the scrotal sac using the labia Placement of testicular Implants – Prosthetic saline-filled testicles placed into the scrotu Monsplasty – An incision is made across the lower abdomen to lift and tighten the mons pubis (tissue and skin covering the pelvic bone). This helps with the position of the neo-phallus and neo-scrotum.

How Much Does Phalloplasty Surgey Cost in New Jersey?

Many insurance plans cover gender affirmation surgeries. Our team can assist in navigating insurance policies and obtaining coverage.

Why Choose East Coast Advanced Plastic Surgery?

At East Coast Advanced Plastic Surgery (ECAPS), our multidisciplinary approach ensures comprehensive and high-quality care for our patients. Dr. Marano and Dr. Keith have assembled a world-class team of health professionals, including board-certified experts from urology and gynecology, to provide exceptional gender-affirming surgeries. This collaboration allows us to address the complex needs of our patients with precision and care. For example, during the multi-stage phalloplasty, our team of specialists works together to ensure the best possible outcomes, from the initial creation of the phallus to urethral hook-up and beyond.

Female-To-Male Bottom Surgery FAQ’S

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Take the first step toward your transformative journey with East Coast Advanced Plastic Surgery. Contact us today and let’s begin your journey together. Our team is ready to provide you with the compassionate, expert care you deserve. Our specialists are here to support you every step of the way.

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