Female-to-male surgery or FTM surgery is a type of sex reassignment surgery, which is also called gender-affirming surgery or gender affirmation surgery. This can take different forms, including a mastectomy, the removal of breasts and the altering of the genital region, also known as bottom surgery.
Examples of bottom surgery include the removal of the uterus known as hysterectomy, removal of the vagina known as vaginectomy, construction of a penis through phalloplasty or metoidioplasty.
Surgery
Before having FTM gender-affirming surgery, a person will receive testosterone replacement therapy. They may then undergo one or more of the following types of procedure.
Chest restructuring
Someone undergoing surgery to transition from female to male usually 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.
Removal of the uterus, ovaries, and fallopian tubes
A person may wish to undergo this type of surgery if they are uncomfortable having ovaries, a uterus, or fallopian tubes, or if hormone therapy does not stop menstruation. In a partial hysterectomy, a 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.
Metoidioplasty
A metoidioplasty is a method of constructing a new penis, also known as neopenis. It involves changing the clitoris into a penis. A person will receive hormone therapy before the surgery in order to enlarge the clitoris for this purpose. During the procedure, the surgeon will also remove the vagina, called a vaginectomy.
Also, they lengthen the urethra and position it through the neopenis. To get the exact length, the surgeon uses tissues from the labia minora, the cheek 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 in order to increase the girth of the penis.
A metoidioplasty usually takes 2 to 5 hours. After the initial surgery, additional procedures may be needed. A Centurion procedure takes around 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, because of the erectile abilities of clitoral tissue. However, neopenis resulting from metoidioplasty is usually to small for penetrative sex.
Phalloplasty
A phalloplasty uses grafted skin that is usually from the thigh, arm, abdomen or back, in order to form a neopenis. Doctors consider taking skin from the forearm to be the best option in penile construction. Compared with metoidioplasty, a phalloplasty results in a larger penis. However, this neopenis can't become erect on its own.
After a period of recovery, a person can have a penile implant. This can allow them to get and to maintain erections and have penetrative sex. During a phalloplasty, the surgeon performs a vaginectomy and lengthens the urethra to allow urination through the penis.
The disadvantages of a phalloplasty include the number of surgical visits and revisions that may be needed, as well as the cost, which is usually higher than that of a metoidioplasty.
Scrotoplasty
A person may decide to have a scrotoplasty, which is 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.
