Ftm Bottom Surgery

[Guest Evan_J]

Eeeevery now and then, with all things, it becomes necessary to "go back to the beginning" as far as info and explanations.

Just because a vast majority of a group at a given time may have "already heard it" doesn't mean every one has. There are always new people . Members of our community who deserve that same opportunity to get the information that for some has become "old hat".

This thread is for those people. And (we always hope ) those persons with "new" or little known information thats become available since we last covered this stuff.

This thread will address FtM bottom surgery techniques only.

Definitions and Descriptions.

(written portions taken from transbucket. com with appropriate credits included)

Metoidioplasty

Metoidioplasty, sometimes referred to as meta or meto, involves creation of a penis by extending and repositioning the clitoris that has already been enlarged through testosterone therapy. Clitoral release often involves cutting suspensory ligaments to bring more of the phallus outside the body. Some surgeons increase girth and add support to the penis by bulking it up with other tissue. Resulting length varies widely, but is usually under 10 cm. Scaring tends to be minimal and in almost all cases the penis retains full erotic sensation and the ability to obtain erection naturally.

Metoidioplasty can be performed with or without urethroplasty (urethral extension or "hook up", in order to stand to pee through the penis), vaginectomy/colpocleisis, hysterectomy, and/or scrotoplasty (formation of a scrotum and testicular implants). Depending on the combination of surgeries involved, costs range from roughly $4K to $40K.

Adapted from <http://en.wikipedia.org/wiki/Metoidioplasty>, Nick Gorton's "Medical Therapy and Health Maintenance for Transgender Men", "Metoidioplasty: a variant of phalloplasty in female transsexuals" by Perovic & Djordjevic, and "Metaidoioplasty: An Alternative Phalloplasty Technique in Transsexuals" by Hage. Thanks to Zerk for compiling this data.

Some examples of Metaoidioplasties http://www.marcibowers.com/grs/ftmoutcomes.html#

The Centurion -or "enhanced " Metaoidioplasty- a crossover procedure utilizing characteristics found in phalloplasties. The centurion is a metaoidioplasty that utilizes the round ligaments found in the labia majora to add diameter to the neopenis. If sufficient length has been achieved on hrt, penile erectile prosthesis may also be implanted in this procedure. Typically however erectile prosthesis are not an option because of achieved length. (Thread authors paraphrase of the procedure)

[thread awaiting example link of centurion]

The following example, though it may(uncertainty) differ from the centurion as performed by Raphael (accepted at least in the U.S. for the originator of the technique called the Centurion as he performed it) the below would qualify as a type of centurion since it does utilize other ligaments/tissues in achieving a greater diameter.

http://www.shahryarcohanzad.com/?15#Metoid...%20transsexuals

Phalloplasty

Phalloplasty is a surgery that entails creating a full sized adult male penis through grafting tissues from other areas of the body. The most common donor sites are the forearm, the groin area, and the lower abdomen, although the thigh and back are also used. Many surgeons perform urethral lengthening as part of the phalloplasty, allowing the ability to stand to pee. A vaginectomy (removal/closure of the vagina) is often part of the procedure, and a few surgeons will even simultaneously perform a hysterectomy if the patient hasn't had one prior.

With all types of phalloplasty, the labia are united to form a scrotum, where prosthetic testicles are inserted. An erectile prosthesis can be inserted into the phallus to enable sexual penetration, which is usually done in a separate surgery. There are several types of erectile protheses, ranging from simple rods to elaborate pumping systems. These are the same prostheses that are used for men with erectile dysfunction. However, many men do not opt for erectile implants, as they carry a risk for rejection, and they find other methods (such as self-adhesive wrap with a condom) to be adequate for achieving sexual penetration.

Phalloplasties vary in their cosmetic outcome, with some remaining the same shape and circumference along the entire length (giving more of a "tube" like appearance), while other surgeons are able to create a convincing looking head by creating a glans and coronal ridge. Some patients will pursue electrolysis or laser hair removal either before or after surgery in order to have a hairless penis. Most men who have received phalloplasties would say that they pass the "locker room test" but their penises are able to be distinguished from non-trans male penises when looked at up close.

The major advantage to having a phalloplasty is the result of having a full sized adult male penis, which can be anywhere from 4 to 9 inches long, and 5+ inches in circumference. Erotic sensation in the length of the phallus is variable, depending on the type of phalloplasty performed. However, despite many rumors to the contrary, practically all patients retain the ability to orgasm. The major disadvantages to phalloplasty are the large scars that occur on donor sites, the high cost, and the intensity of the surgery and recovery.

Complications most often occur from urethral lengthening, and they most often include either a fistula (hole in the urethra) or a stricture (blockage of the urethra). Sometimes these complications can resolve on their own, but they commonly require surgery to correct. Other complications include infection, tissue death (either parts of the phallus or the entire phallus itself), unsatisfactory aesthetic result, testicular or erectile implant extrusion, failure to regain sensation, and complications associated with the donor site; all of which can often require further surgery.

written by jakedgreenbeer

Types of FtM Phalloplasty

• Radial Forearm Free Flap
  

This technique involves using a graft of tissue that is taken from most of the circumference of the non-dominant forearm. The tissue is rolled up to form a “tube within a tube,” with the inner part of the forearm forming the new urethra, and the outer forearm forming the outside of the phalloplasty. The forearm donor site is then covered with a skin graft from the upper thigh.

The grafted urethra is connected to the native urethra using tissue from the vaginal wall and/or the inner labia. This is usually done as part of the initial procedure. This technique involves microsurgery, where grafted nerves are connected to the existing clitoris, which results in erotic sensation throughout the length of the entire phallus. It may take up to a year for nerve sensation to regenerate; however, sensation from the buried clitoris is always retained.

The major disadvantage to this procedure is the scar that results on the forearm, which is a deal-breaker for many transmen. It should be noted that one study found no long term functional damage to the forearm in any of the 125 participants who received radial forearm phalloplasties. However, this is the only procedure where one does not have to compromise on full adult size nor erotic sensation. This is usually a two stage surgery; one stage for the creation of the phallus, urethral hook up, vaginectomy, and initial scrotoplasty, and a second stage for the erection implant and permanent testicular implants.

Recently, some radial forearm phalloplasty surgeons have combined forearm flaps with flaps from other areas (such as the thigh or groin) in order to retain erotic sensation while trying to minimize the area of the forearm scar.

written by jakedgreenbeer

Photos of the radial forearm donor site and post-op genitalia.

http://www.thetransitionalmale.com/monstrey.html

• Pedicle Pubic/Groin/Abdominal Flap
  

This procedure creates a tube out of either the suprapubic lower abdominal area, or the hip/flank area adjacent to the native genitals (usually running from the groin to the edge of the pelvic bone). The exact location of the donor site as well as name of procedure varies. However, the main difference between this method and the radial forearm method is that the tissue used to create this type of phallus is never completely detached from the body. A flap of skin and tissue is raised to create a tube that is initially attached on both ends (this procedure was formerly referred to as the “suitcase handle” technique for this reason). This procedure may also utilize grafted skin from the thigh area to wrap around the outside of the pedicle flap, mimicking the loose outer skin of the penis. One end of the flap is detached, swung down and connected to the clitoral area, and finally the other end is detached in order to allow the phallus to hang freely.

A urethral extension may by created using tissue from the labia or vaginal wall, or simply from creating an "inside-out" inner tube from the donor area. The clitoris is left intact, either buried in the base of the phallus, or just below it. This operation is performed in anywhere from one to twelve stages (the latter of which takes over a year to complete).

This method produces a penis that retains tactile, but not erotic sensation, as no microsurgery is performed. The aesthetic appearance of the penis is also sometimes less realistic than radial forearm phalloplasties, however, this varies among surgeons and individual patients, and many pedicle flap phallos are exceedingly good looking. The major advantage to this procedure is an adult sized penis without any major visible scarring, as the scar most often left is usually just a line that is easily hidden below clothing.

written by jakedgreenbeer

• Musculocutaneous Latissimus Dorsi (MLD) Flap
  

This is a relatively new type of phalloplasty, currently performed by only two surgeons. As noted on one of the surgeon’s websites, “The latissimus dorsi used in this phalloplasty is the broadest muscle of the back comprised of a pair of flat, triangular-shaped muscles across the middle and lower back.” This procedure involves a free tissue flap transfer, leaving a long, linear scar which runs from the underarm down to the lower back, which is considered preferable and less conspicuous to many transmen. Microsurgery is performed to connect nerves, and the erotic sensation is generally better than with pedicle flaps, but less than with radial forearm flaps.

written by jakedgreenbeer

Notation: Dr. Perovic has recently passed away (a month or so ago) however the MLD flap procedure was covered extensively on his site. It may be performed by other surgeons certainly and very likely by Djinovic in his practice after parting with Perovic.

Site shows post surgery pics as well as a photo diagraming the donor site. Also included is an illustrative picture of a double rodded erectile implant. One of the types common to FtM phalloplasty.

http://www.medical-tourism-in-thailand.com...oplasty-dr.html

Other peripheral surgeries regarding the penis and scrotal sac

Scrotoplasty [also known as `Oscheoplasty`]

Scrotoplasty is the creation of a scrotum, usually accomplished by hollowing out the labia majora and inserting silicone testicular implants. Often this can result in a single, unified scrotal sac, but occasionally the scrotoplasty results in the appearance of two sacs, each with one implant. Some surgeons will insert testicular expanders; these are ports implanted into the labia majora where saline is injected over a period of time in order to increase the size of the scrotum before implantation of the silicone testicular implants. Complications can sometimes occur where the implants can extrude or sit too high or unevenly in the newly created scrotal sac.

written by jakedgreenbeer

Glansplasty-creation of the penis glans and (depending on surgeon) corona. While some surgeons have accomplished this by what appears as merely "scoring" the area identified as glans, others have/do accomplish this procedure by utilizing grafting of skin from alternate areas of the body to achieve varied pigmentation. Techniques vary surgeon to surgeon.

[glans penis -the conical tip of the penis that covers the end of the corpora cavernosa penis and the corpus spongiosum like a cap. The urethral orifice is normally located at the distal tip of the glans penis. The corona glandis, the widest part of the glans penis, is around the base of the proximal portion. A fold of dark, thin, hairless skin forms the foreskin covering the glans penis.

-Mosby's Medical Dictionary, 8th edition. © 2009, Elsevier.]

Urethral lengthening/extention -The addition of either synthetic material or organic (usually extracted from a strip of the removed vaginal lining tissue in that case) added to the urethra to form an extremely narrow tubular extention that can be run through a phalloplasty or metaoidioplasty enabling the patient to urinate through the neophallus. Urethral lengthing in the U.S. typically prerequisites hysterectomy, oopherectomy, removal of the cervix, and closure of the vaginal canal. Because placement of the extention often obstucts access to the canal, and very often scrotal sacs which would completely cover this area, would make examination and treatment of organs/structures within impossible, doctors in the U.S. (by and large) perform this procedure only after removal of the aforementioned reproductive organs.

Medical tattooing of the neo phallus

It is often remarked by transitioning males that the appearance of the phalloplasty in particular is "monochromatic" or "does not have the appearance of a natal penis" because of the absence in differentiations in pigments and textile topography. This is addressed with the process of medical tattooing, in which detailed and subtle shading, viening, and the appearance of "texturing" can be accomplished. Within the cost framework of phalloplasty however, this optional addition , is often most expensive monetarily and so is often foregone.

Pubis/pubic resection -The removal or repositioning of the fatty tissues of the mons pubis to create a flatter pubic line and allow for the metaoidioplasty to appear more prominantly, or the alteration of the mons pubis to create a more male appearing base for other genital surgery.

Surgeries that may or may not be prerequisite to various FtM SRS techniques

Awesome and informative page discussing/describing hysterectomy, oophorectomy, cervix removal, colpectomy, and colpoclesis (plus a few other things ) http://www.gendercentre.org.au/78article7.htm (good site in general , updates constantly)

Please note: Even if you do not wish to view this site, add the terms colpectomy and colpoclesis to your personal vocabulary as requesting a "vaginectomy" or allowing one in the strictest definition actually involves removing muscle structures that (could you be given this procedure) rendure you unable to control either your urinary or bowel functions and have you on a permanent colostomy bag. What you are seeking is a colpoclesis actually, the closure of the vagina or colpectomy removal of the lining.

Removal of the vaginal lining http://www.iiav.nl/ezines/web/IJT/97-03/nu...vo05no01_02.htm (figure 9)

Colpoclesis: http://www.urogynecology.in/Vault%20Prolapse.asp?sel=VP

**Other suggested and recommended therapies associated with FtM Bottom surgery**

"Pumping"

Whenever the topic of FtM bottom surgeries comes up so do the questions of pumping. -What is it? Is it necessary? Will it benefit me? Where do I get one?

The term pumping in this case is taken from the phrase "penis pumping" and is the practice of using a vacuum pump and cylindar to increase penis size. Several companies at this time market cylindars appropriate in size to accomodate transitioning FtM males. Most noted of these is likely Kaplan (please see "Kaplan Medical Supplies if searching). Several FtM srs surgeons advise that pumping, in conjuction with andro/testosterone cream prescribed specifically for this purpose, and applied directly to the neophallic tissues, be taken up and mantaintained for approximately 3-4 months prior to metaoidioplasty surgery to illicit better results associated with longer phallus. Many transitioning males utilize the practice of pumping without the addition of topical androgens for periods of time far longer and much farther in advance of such surgery. It is recorded that the maximum neophallic length of 5 inches was reached by a transitioning male who regularly practiced this technique over a time period in excess of 4 years prior to metaoidioplasty surgery.

Another pumping system highly recommended by at least one FtM srs surgeon is "the grip" system.

http://www.thegrip.com/

Note: Care and the advice of a medical professional should be undertaken before beginning ANY "enlargement" practice as erroneous executions and weight/vacuum levels can result in permanent damage to the pudendal nerve (The pudendal nerve is responsible for orgasm, urination, and defecation in both sexes. The pudendal nerve innervates the penis and clitoris).

There are certain camps within the transmale community that "doubt" or disregard the idea/practice of pumping as beneficial in any way and so it is a highly individualized decision.

[Guest Evan_J]

And now folks , I gotta take a pause for the cause cuz I've been up since very early and am exhausted. HOWEVER I would like to see whatever folks have to add (do it as a reply on the thread) if you have stuff thats new, left out, or that I just haven't had time to get to (like a site illustrating the scrotoplasty) so that it can be added into the body and maybe we can pin this. A couple of new members would like to be brought up to speed (since its easy to miss whats being talked about in the midst of so many veterans) as well as some of our MtF who would like to be better versed.

[Guest Batsu Maru Otoko Yo!]

Metoidioplasty all the way!

There's also been some research (I'll have to try and find the pages again) into the use of DHT creme (a form of testosterone) on a temporary basis, something like three or four months, to permanently increase the size of the meto microphallus. So far they say there have been no bad side effects for the person being treated, just something like a 150% increase in size, which would hopefully, for the lucky guys, upgrade them to the small end of the normal range.

I hear there are some risks of cross-contamination with the creme, so they suggest the same kinds of precautions be taken as for guys who are taking T as a gel or whatever.

I'm sleepy.

[Guest mrgeof2m1991]

First I want to say thank you for posting this! This was very helpful! I haven't done a lot of research and am glad that I didn't have to look very far. Second the Metoidioplasty surgery sounds like the one that I would get. I haven't been sure if I would yet or not but after reading this and taking a look I have decided that sometime in the future that I will get it.

Thank you once again.

Batsu Maru Otoko Yo! Can you explain more on what you are talking about please? I am interested in knowing more!!!!!!!

[Guest lvmyftm]

What about the centurion surgery?

[Guest Evan_J]

Ok, so its morning and I'm back to adding things.

Batsu and mrgeo, your questions are addressed towards the bottom of the original post. Its being added to as I can either hunt, re-hunt, or (mercifully, and I'm still prayin for stuff) be forwarded stuff.

Things I'd like to see in the post (if any of you have it cuz I know somebody likely has a treasure trove someplace of things )

• a link to an illustration or photo of the scrotoplasty being performed through the labia minora into the majora
  
• link to medical tatooing of a phalloplasty (there was an aaawesome example of a phallo that had it once on transster before it was disbanded, perhaps someone kept a copy or knows where one can be found)
  
• link to a completed centurion
  

[Guest Dman1]

This was extremely helpful. I am leaning more towards Phalloplasty . I just have one question. If someone has the Phalloplasty surgery can they have a natural erection? I would really appreciate knowing the answer to this. Thank you

[Guest MaxTH]

This was extremely helpful. I am leaning more towards Phalloplasty . I just have one question. If someone has the Phalloplasty surgery can they have a natural erection? I would really appreciate knowing the answer to this. Thank you

Surgeons have not found a technique yet to create the spongy tissue of the penis (corpora cavernosa). The erection happens when the spongy tissue is filled with blood. The only way to have something that looks like an erection is to have a penile implant.

I save these interesting links a few months ago:

Dr. Monstrey: http://genderoutlaw.wordpress.com/2008/11/22/why-not-phalloplasty

Australien surgeon. Very graphic photos: http://www.gendercentre.org.au/phalloplasty.htm

[Guest Masculinity]

Phalloplasty all the way...I don't like meta because why would I want a small penis where I can't penetrate or anything. I heard it's impossible to pee standing with meta,because it's so small that it doesn't reach the toilet,also...5 centimeters that only grows to just 2 inches?

Point is,I'd rather have a penis in where I pump it to get erections that can penetrate and looks like a natural one to me depending on the surgeon instead of having a small one that enables penetration,urinating standing and is useless for me..

[Guest Ebany]

Is there any place that shows pictures of donar sites after they have completely healed? I can't seem to get past the massive scars in all of the post op photos I've come across. And I have to admit that it's probably the biggest thing holding me back.

~Dani

[Guest Emily Ray]

I just wanted to comment on masculinity's post if I could. 5 cm is enough for penetration. The vagina is the most sensitive in the first few inches. You also will be able to pee standing up. As a result of HRT mine is now considerably less than 2" and I can still pee standing if I desire. Just trying to add some experience to the post though I am going the opposite direction.

Huggs

Emily

[Guest Strawberie]

I am leaning more towards phalloplasty because I would like to be able to satisfy potential male partners as well, but I would hate to take T in order to achieve this; I enjoy having a very androgynous and pretty-boy face and body. Is it possible to have this surgery without going on T? I would greatly appreciate some feedback because I have yet to find an answer to my dilemma.

[Guest PrinceBell]

I'm also considering phalloplasty, but I feel the same as Strawberie; going on T isn't an option for me. So I'm asking the same question:

Is it possible to get phalloplasty surgery without going on T?

[Guest Socrates101]

Thanks for posting the informative information!

Definitely have my mind set on meta for the near future, then i very well may or may not consider "upgrading" to a more advanced option if science has improved dramatically in the future. Phallo's never been/never will be an option for me. Being naturally asexual also helps in terms of living with a good meta result for the rest of my life would be heaven, and due to my sexuality(or lack of thereof) i have no desire to being able to use it for penetrative sex or have it manipulated by others, having a natural erection/being able to orgasm/peeing while standing on my own will be more than enough to live on. Size doesn't really matter, as long as i have a real penis and can 'get it up' naturally on my own, without need for prosthetic.

I generally consider phallo to be a realistic prosthetic 3 in 1 packer permanently attached to you, definitely not worth the money.

[Guest Socrates101]

I'm also considering phalloplasty, but I feel the same as Strawberie; going on T isn't an option for me. So I'm asking the same question:

Is it possible to get phalloplasty surgery without going on T?

No thats not possible, unless you have your surgery illegally in a different country where they wouldn't care for your safety at all. No doctor will operate on a transgender patient for genital surgery unless that have had at least 1 year on T, and proof of living in their true gender, as well as written recommendation letter from a gender therapist. As well as that, it is also very unsafe to have any sort of genital surgery if you are not producing the right hormones. If you don't get on T, your body will continue to produced estrogen, the female hormone. When you have gential surgery, most operations consist of taking out the female internal organs(uterus, womb etc) to prevent complications. The internal female parts have to be taken out during the surgery because 1) without going on t, you'll still be having monthly period cycles, and if unless you like the thought of bleeding from your penis which could lead to so many different complications, that definitely wont happen. 2)your female hormones will reject your male parts and cause problems.

So taking them(female parts) out isn't a problem, the main problem here arises because you have said that you wont be taking T. Human body cannot survive without hormones, the male and female sexual parts are responsible for producing the male and female hormones. If the uterus/womb gets taken out(which it will have to be in this surgery), you wont be able to produce any more estrogen, and if you're not taking Testosterone by then you basically will be left with no hormone production, which will lead to loss of bone mass, vulnerabilities to all forms of diseases and physical illness and much more.

If you can afford to get such a surgery i fail to understand why you would be unable to afford/get legal access to T? You will be left in the body of a female with a penis(which you will continue to have monthly periods through) and due to lack of testosterone and continued production of estrogen, even after top surgery the estrogen will cause your body to continue to grow breast tissue and after a few years you may end up with a normal female chest and may have to go through top surgery again. I don't think any man would want that.

[Guest Kael147]

Hey Guys, I'm scheduled for a meta in Montreal in February. It was supposed to have been earlier this week, but it got postponed due to some complications from my oopherectomy. I developed a fistula and while it is completely healed now the Montreal docs want me to wait a bit longer to ensure I'm good. I'm a little disappointed, but still looking forward to the surgery. I would have gone for the phallo to have an adult sized penis, but the scars just turned me right off. I'm very lucky that my health care pays for either surgery, but at the end of the day I'm going to have the meta and scrotoplasty. My goal is not penetration, but rather to use the urinals and to not be so self-conscious about changing at the gym and such.

I'll keep you all posted once the surgery is done and let you know how it went. I'm looking forward tot he clitoral release and my bits being in the right place!!!

Keep it real!

Kael

[Guest rufus]

Ebany - I had phaloplasty surgery by Dr. Crane in San Francisco January 24, 2014. I am very pleased with the results. If you go to his website you will see many after pictures in many stages of healing, from 1 day to 1 year.

Rufus

[DuncanCathar]

Thanks for sharing this article it was very informative. I have a lot to think about at this time.

[Alexis MR]

Hello everyone! 
Thanks for the info. I made this account hoping someone can help me know my options. I'll explain my case, any advices are really appreciated. 

I'm from Spain, and here we are covered for the trasgender treatment. On the unit there were 2 options for FTM botom surgeries, metoidioplasty and phalloplasty (using leg or arm tissue). However, they were giving lots of complications and were suppresed. My doctor has told me I have no viable options in my country. 
So, I thought I should save some money in case there are any options elsewhere. I'm not too interested in metoidoplasty, I've seen some results and they are not suitable for intercourse. But as far as I know, the phalloplasties here were awful, the tissue could die and fall, no sensation whatsoever... a disaster. 
I had never heard of the radial forearm option, it says the nerves are connected and such... I'm very interested in knowing any life experiences, if anyone has had a successful phalloplasty (able to perform and to feel), in which country, what clinnic, things like that. I'm quite lost on the subject, since I was told years ago the surgeries were giving bad results. I'm 32 know, I've been using testosterone and living as a man since 18, but I still have disphoria. Oh, and I already had the ovaries and the other stuff removed, that surgerie is available here and it went fantastic. 

Thanks for any advice =]

[Gizmo]

I had my surgery done by Dr. Liedl in Munich, Germany. He only uses the forearm method. I`m really satisfied with the result, it looks great and I`m so happy to have it! I refer to it as my penis, or dick.

 

Had a friend, who didn`t want the scar on the forearm, and who had the surgery done by Perovic in Belgrade, Serbia. He thought he would only have a small scar, but it looks like he was bitten by a shark. The penis would need to be thinned out, only he doesn`t have the money to afford it. He tried to get it done by Dr. Liedl, but the insurance refused to pay for it, because he had the phalloplasty inb Serbia. They only pay for surgeries you get done in Germany. So, now he has that unfinished project between his legs, and doesn`t know if he can ever proceed with it.

 

Before I got my surgery, I thought about that method, too, and I asked Dr. Liedl, why no surgeon, except Perovic, used it. He said, that the risk would be much higher than with the forearm flap. 

[Maric]

Has anyone has the radial free arm flap? that's the one I want. I'm willing to wait a year for sex to have full sensation.If anyone's had it, how does it feel? Any success stories of sensation coming back earlier than normal?

[serpentil1]

Did bottom surgery with M. Djorjevic in Belgrade. Meta even though I wanted phallo, but they said they'd only give me meta, dunno why. Was desperate so I did meta anyway. Esthetically pleasing, looks like a normal penis albeit small, cis people couldn't tell the difference I'm sure. Lost sensation 1 year post surgery and it's downgraded ever since, can't fap anymore even if I'm -excited- as hell. Barely have any kind of sensation left. It's been about 4 years. Just wanna let people know that this could happen as well - even with meta.