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Female-to-male FTM surgery ( also known as FTM gender reassignment surgery)is a type of sex reassignment surgery, which is also called gender affirmation surgery or gender-affirming surgery.
Examples of FTM surgery include:
removal of the uterus, known as a hysterectomy
removal of the vagina, known as a vaginectomy
construction of a penis through metoidioplasty or phalloplasty
Before having female to male ftm gender-affirming surgery, a person will receive testosterone replacement therapy.
They may then undergo one or more of the following types of procedure.
A person undergoing surgery to transition from female to male typically has a subcutaneous mastectomy to remove breast tissue. The surgeon will also make alterations to the appearance and position of the nipples.
Meanwhile, testosterone therapy will stimulate the growth of chest hair.
A person may wish to undergo this type of surgery if they are uncomfortable having a uterus, ovaries, or fallopian tubes, or if hormone therapy does not stop menstruation.
In a partial hysterectomy, a FTM surgeon will remove only the uterus.
In a total hysterectomy, they will also remove the cervix.
A bilateral salpingo-oophorectomy, or BSO, involves the removal of the right and left fallopian tubes and ovaries.
A metoidioplasty is a method of constructing a new penis, or neopenis.
It involves changing the clitoris into a penis. A person will receive hormone therapy before the surgery to enlarge the clitoris for this purpose.
During the procedure, the surgeon also removes the vagina, in a vaginectomy.
In addition, they lengthen the urethra and position it through the neopenis. To achieve the lengthening, the surgeon uses tissues from the cheek, labia minora, or other parts of the vagina. The aim of this is to allow the person to urinate while standing.
Another option is a Centurion procedure, which involves repositioning round ligaments under the clitoris to increase the girth of the penis.
A metoidioplasty typically takes 2–5 hours. After the initial surgery, additional procedures may be necessary.
A Centurion procedure takes approximately 2.5 hours, and removing the female reproductive organs will add to this time.
An advantage of a metoidioplasty is that the neopenis may become erect, due to the erectile abilities of clitoral tissue.
However, a neopenis resulting from a metoidioplasty is often too small for penetrative sex.
A phalloplasty uses grafted skin — usually from the arm, thigh, back, or abdomen — to form a neopenis. Doctors consider taking skin from the forearm to be the best optionTrusted Source in penile construction.
Compared with a metoidioplasty, a phalloplasty results in a larger penis. However, this neopenis cannot become erect on its own.
After a period of recovery, a person can have a penile implant. This can allow them to get and maintain erections and have penetrative sex.
During a phalloplasty, the surgeon performs a vaginectomy and lengthens the urethra to allow for urination through the penis.
Disadvantages of a phalloplasty include the number of surgical visits and revisions that may be necessary, as well as the cost, which is typically higher than that of a metoidioplasty.
A person may decide to have a scrotoplasty — the creation of a scrotum — alongside a metoidioplasty or phalloplasty.
In a scrotoplasty, a surgeon hollows out and repositions the labia majora to form a scrotum and inserts silicone testicular implants.
The recovery time from female to male FTM surgery varies, depending on the type of procedure and factors such as the person’s overall health and lifestyle choices.
For example, smoking slows down recovery and increases the risk of complications following surgery. If a person smokes, vapes, or uses any substance with nicotine, a medical team may consider them less eligible for this type of surgery.
Following gender-affirming surgery, most people need to stay in the hospital for at least a couple of days.
After leaving the hospital, the person needs to rest and only engage in very limited activities for about 6 weeks or longer.
Also, when a person has had a urethral extension, they need to use a catheter for 3–4 weeks.
Some complications of a metoidioplasty or phalloplasty include:
A person who has had a phalloplasty may experience:
Risks of a scrotoplasty include rejection of the testicular implants.
All gender-affirming surgeries carry a risk of:
A person who undergoes a metoidioplasty may have erections and enjoy more sensation in their neopenis. However, the penis will be relatively small in size.
A neopenis that results from a phalloplasty is usually larger, though it may be less sensitive. To have erections, a person will need a penile implant.
If a person has urethral extension, the goal is to be able to urinate while standing after a full recovery from the procedure. Some studiesTrusted Source report a high number of urological complications following phalloplasties. It is important to attend regular follow-ups with a urologist.
A 2005 study of 55 people who underwent gender-affirming surgery — including 23 female-to-male participants — notes that 80% of all participants reported “improvement of their sexuality” following surgery.
Transgender men tended to report more frequent masturbation, sexual satisfaction, and sexual excitement than transgender women. They also reported reaching orgasms more easily than they had before surgery and a tendency toward “more powerful and shorter” orgasms.
Transgender men with penile implants for erections experienced pain more frequently during sex than those without implants. However, they also reported that their sexual expectations were more fully realized, compared with participants who had not received implants.
A 2018 studyTrusted Source found that 94–100% of participants who had undergone gender-affirming surgery reported satisfaction with the surgical results, with the variance depending on the type of procedure.
The 6% of people who reported dissatisfaction or regret did so as a result of preoperative psychological symptoms or complications following the procedures.
The outlook for female-to-male surgery depends on the type of surgery, the person’s health, and other factors. Most people report satisfaction following the procedure.
However, the complication rate is relatively highTrusted Source, especially in relation to urinary health.
Therefore, it is important to work closely with a qualified plastic surgeon, urologist, gynecologist, and mental health professional to ensure the best outcome.
It is also essential to follow recovery guidelines and attend all follow-up appointments.
You can find information specific to your province in the Being Trans section of our website or of your provincial government.
According to WPATH’s Standards of Care, an individual must be of the age of majority in the country of reference to be allowed to undergo gender reassignment surgery. Therefore, the required age for genital reconstructive surgery is 18 years of age and 16 for masculinization of the torso surgery (mastectomy).
The documents required are the same set out by WPATH’s Standards of Care. GRS Montréal surgeons may ask you for additional documentation and/or test results in order to ensure safe surgical proceedings.
Once your preoperative medical file has been confirmed, a staff member will contact you to provide you with a preliminary surgery date, taking into account your own availability and that of the operating room.
GRS Montréal must receive your results 2 months before your surgery date in order to confirm this date and avoid a postponement.
It is important to keep in mind that complications rarely occur. Generally, minor problems are the most common. Complications may make recovery time longer, but they do not necessarily affect final results.
While risk is involved in all surgeries, GRS Montréal physicians work continually to prevent them through the development and maintenance of safe surgical practices. Additionally, pre and postoperative treatment and follow-up plans allow for early detection and management of complications that may arise. In the case of complications, our doctors will provide you with all of the necessary information to help you eliminate all problems as quickly as possible.
The majority of patients retain their ability to achieve orgasm after surgery, but there is still a risk that sexual function or the ability to have an orgasm will be affected. GRS Montréal surgeons are very experienced and use techniques that allow the patient to retain her or his sensations of sexual pleasure. Your health history (smoking, diet, alcohol, etc.) can also affect healing and, in this way, alter the sensitivity of your genitals.
You can contact us at any time in order to communicate confidentially with a member of the GRS team. Once your file is complete, a member of the nursing staff in the preoperative clinic will contact you.
Yes, it is possible to have surgery as HIV is not a contraindication to surgery. However, it is important to mention your infection to us and to provide us with the results of your viral load when you want to plan your surgery. Your viral load lab results must be labelled “undetectable”. Antivirals are the only way to achieve this label.
Yes, surgery is possible even if you have contracted an STI in the past. However, if you currently have an STI, it is recommended you be healed before having surgery. Your symptoms must be treated. if a fever is present, surgery will be postponed.
After surgery, you remain at risk of contracting or transmitting infections transmitted sexually and by blood. Consult your family doctor for information about available contraception.
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The initial metoidioplasty surgery can take anywhere from 2.5 to 5 hours depending on the surgeon and on which procedures you choose to have as part of your metoidioplasty.
If you’re seeking out simple meta only, you’ll likely be placed under a conscious sedation, meaning that you’ll be awake but mostly unaware during the surgery. If you’re having a urethral lengthening, hysterectomy, or vaginectomy performed as well, you’ll be placed under general anesthesia.
If you choose to have scrotoplasty, the doctor may insert what are known as tissue expanders into the labia during the first procedure in order to prepare the tissue to accept the larger testicle implants during a follow-up procedure. Most surgeons wait three to six months to perform the second surgery.
Most doctors perform metoidioplasty as an outpatient surgery, meaning you’ll be able to leave the hospital on the same day that you have the procedure. Some doctors may request that you stay overnight following your surgery.
As with any surgery, the recovery process will vary from person to person and from procedure to procedure.
While recovery times vary somewhat, you’re likely to be out of work for at least the first two weeks. As well, it’s generally recommended that you don’t do any heavy lifting for the first two to four weeks following surgery.
In general, doctors typically advise against travel between 10 days to three weeks after the procedure.
Apart from the standard issues that may arise from having surgery, there are a few potential complications you may experience with metoidioplasty. One is called a urinary fistula, a hole in the urethra that can cause leakage of urine. This can be repaired surgically and in some instances may heal itself without intervention.
The other potential complication if you’ve chosen scrotoplasty is that your body may reject the silicone implants, which may result in needing to have another surgery.
There are several procedures that can be performed as a part of metoidioplasty, all of which are completely optional. describes these procedures as follows:
The ligament, the tough connective tissue that holds the clitoris to the pubic bone, is cut and the neophallus is released from the clitoral hood. This frees it from the surrounding tissue, increasing the length and the exposure of the new penis.
The vaginal cavity is removed, and the opening to the vagina is closed.
This procedure reroutes the urethra up through the neophallus, allowing you to urinate from the neophallus, ideally while standing up.
Small silicone implants are inserted into the labia to achieve the look and feel of testicles. Surgeons may or may not suture the skin from the two labia together to form a joined testicular sac.
A portion of the skin from the mons pubis, the mound just above the penis, and some of the fatty tissue from the mons are removed. The skin is then pulled upward to shift the penis and, if you choose to have scrotoplasty, the testicles further forward, increasing the visibility of and access to the penis.
It’s entirely up to you to decide which, if any, of these procedures you would like to have as a part of your metoidioplasty. For instance, you may wish to have all of the procedures performed, or you may wish to undergo the clitoral release and urethroplasty, but retain your vagina. It’s all about making your body align best with your sense of self.
A phalloplasty is the construction or reconstruction of a penis. The phalloplasty is a common surgical choice for transgender and nonbinary people interested in gender confirmation surgery. It’s also used to reconstruct the penis in cases of trauma, cancer, or congenital defect.
The goal of a phalloplasty is to build a cosmetically appealing penis of sufficient size that is capable of feeling sensations and releasing urine from a standing position. It’s a complex procedure that often involves more than one surgery.
Phalloplasty techniques continue to evolve with the fields of plastic surgery and urology. Currently, the gold standard phalloplasty procedure is known as a radial forearm free-flap (RFF) phalloplasty. During this procedure, surgeons use a flap of skin from your forearm to build the shaft of the penis.
During a phalloplasty, doctors remove a flap of skin from a donor area of your body. They might remove this flap entirely or leave it partially attached. This tissue is used to make both the urethra and the shaft of the penis, in a tube-within-a-tube structure. The larger tube is basically rolled up around the inside tube. Skin grafts are then taken from inconspicuous areas of the body, where they will leave no visible scars, and grafted on to the donation site.
The female urethra is shorter than the male urethra. Surgeons can lengthen the urethra and attach it to the female urethra so that urine will flow from the tip of the penis. The clitoris is usually left in place near the base of the penis, where it can still be stimulated. People who can achieve orgasm before their surgery can usually still do so after their surgery.
A phalloplasty, specifically, is when surgeons turn a flap of donor skin into a phallus. But generally, it refers to a number of separate procedures that are often done in tandem. These procedures include:
There is no single order or timeline for these procedures. Many people do not do all of them. Some people do some of them together, while others spread them out over many years. These procedures require surgeons from three different specialties: gynecology, urology, and plastic surgery.
When looking for a surgeon, you may want to look for one with an established team. Before any of these medical interventions, talk to your doctor about fertility preservation and impact on sexual functioning.
The difference between the prevailing phalloplasty techniques is the location from which the donor skin is taken and the way in which it is removed and reattached. Donor sites can include the lower abdomen, groin, torso, or thigh. However, the preferred site of most surgeons is the forearm.
The radial forearm free-flap (RFF or RFFF) phalloplasty is the most recent evolution in genital reconstruction. In a free flap procedure, the tissue is completely removed from the forearm with its blood vessels and nerves intact. These blood vessels and nerves are reattached with microsurgical precision, allowing blood to flow naturally to the new phallus.
This procedure is preferred to other techniques because it provides excellent sensitivity along with good aesthetic results. The urethra can be constructed in a tube-within-a-tube fashion, allowing for standing urination. There is room for the later implantation of an erection rod or inflatable pump.
The chances of mobility damage to the donor-site are also low, however skin grafts to the forearm often leave moderate to severe scarring. This procedure is not ideal for someone worried about visible scars.
The anterior lateral thigh (ALT) pedicled flap phalloplasty is not the leading choice of most surgeons because it results in a much lower level of physical sensitivity in the new penis. In a pedicled flap procedure, the tissue is separated from the blood vessels and nerves. The urethra can be restructured for standing urination, and there is ample room for a penile implant.
Those who have undergone this procedure are generally satisfied, but report low levels of erotic sensitivity. There is a higher rate of urinary and other complicationsTrusted Source with this procedure than with RFF. The skin grafts can leave significant scaring, but in a more discrete place.
The abdominal phalloplasty, also called the supra-pubic phalloplasty, is a good choice for trans men who don’t require a vaginectomy or a restructured urethra. The urethra will not go through the tip of the penis and urination will continue to require a seated position.
Like the ALT, this procedure does not require microsurgery, so it is less expensive. The new phallus will have tactile, but not erotic sensation. But the clitoris, which is preserved in its original location or buried, can still be stimulated, and a penile implant can allow for penetration.
The procedure leaves a horizontal scar stretching from hip to hip. This scar is easily hidden by clothing. Because it does not involve the urethra, it is associated with fewer complications.
A musculocutaneous latissimus dorsi (MLD) flap phalloplasty takes donor tissue from the back muscles underneath the arm. This procedure provides a large flap of donor tissue, which allows surgeons to create a larger penis. It is well-suited for both a restructuring of the urethra and the addition of an erectile device.
The flap of skin includes blood vessels and nerve tissue, but the single motor nerve is less erotically sensitive than the nerves connected with RFF. The donor site heals well and is not nearly as noticeable as other procedures.
Transition takes a long time. It is not done quickly. On average, the minimum time required to change your physical sex is about two years, and that is a best case situation. Often, the process can take three, four, five, or many more years.