Is MTF Bottom Surgery Worth It?

For many trans women, transfeminine bottom surgery, also called male-to-female bottom (MTF) surgery or vaginoplasty, is a life-changing experience. This complex surgery involves turning male genitalia into female genitalia, with both functional and aesthetic results. But what is MTF bottom surgery all about? This blog reviews what MTF bottom surgery is and the factors that can influence the decision whether or not to undergo the surgery by looking at the physical, emotional, financial, and social impact.

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What Is MTF Bottom Surgery?

The gender-affirming series of procedures involved in MTF bottom surgery is designed to create female genitalia from male anatomy. The most common type of MTF bottom surgery is vaginoplasty, which involves creating a neovagina, clitoris, and labia. Often preferred by trans women, vaginoplasty can more fully align their physical body with their gender identity and alleviates gender dysphoria for many patients. Doctors John L. Whitehead and Alain Ramirez at Restore Medical Center specialize in this delicate surgery while supporting each patient fully in their transgender journey.

What Does Vaginoplasty Involve?

Vaginoplasty is a surgery designed to create a vagina and typically includes these four steps:

1. Orchiectomy (Testicle Removal): If this procedure has not already been performed, the testicles will be removed during vaginoplasty.
2. Penile Inversion: The penile skin is inverted to create the vaginal canal.
3. Clitoroplasty: Formation of a clitoris using glans tissue to ensure sensitivity.
4. Labiaplasty: Creation of labia minora and majora to complete the female genitalia.
5. Urethroplasty: Creation of a shortened urethra, more true to cis female gender anatomy.

Who Will MTF Bottom Surgery Benefit Most?

Candidates for MTF bottom surgery are those who desire the full set of procedures and meet the following criteria:

• 18 years or older, with some exceptions made on a case-by-case basis
• A diagnosis of gender dysphoria
• One year of continuous hormone replacement therapy (HRT)
• Sufficient psychological evaluation to solidify their decision
• A set period of real-life experience living as their identified gender
• Good physical health

Physical, Emotional, and Aesthetic Benefits of MTF Bottom Surgery

The main goal of transfeminine bottom surgery is to create functional and aesthetic female genitalia. Most patients are satisfied and gratified by their vaginoplasty results and feel their body now reflects their gender identity. The surgery can improve quality of life and alleviate or even eliminate gender dysphoria for many.

Functional Benefits

The neovagina is designed to function like a fully functional and biological vagina:

• Sexual Function: The neovagina can have penetrative sex, and the neoclitoris is sensitive to sexual pleasure.
• Urination: The urethra is shortened and re-oriented, allowing patients to pee sitting down.

Emotional and Social Benefits

The emotional and psychological benefits of male-to-female bottom surgery can be huge, and social interactions can also improve as a result. Many trans women find more acceptance and understanding from family, friends, and society. This acceptance can lead to:

• Relief From Gender Dysphoria: The surgery can alleviate the mental distress of having a body that doesn’t match your gender identity.
• Improved Mental Health: After surgery, patients often report less anxiety and depression.
• Higher Self-Esteem: Having a body that matches your gender identity can boost self-confidence and self-worth.
• Better Social Integration: Many patients can feel more comfortable and safe in social situations.
• Closer Relationships: After the procedure, patients can feel more intimacy and connection with partners.
• Safety: There can be less risk of discrimination and violence when your physical body matches your gender identity.

Other Considerations of MTF Bottom Surgery

While MTF bottom surgery has many benefits, possible challenges and risks can arise. Every patient’s situation is different, and these factors should be carefully considered when making a decision.

Cost of MTF Bottom Surgery and Aftercare

The cost of male-to-female bottom surgery is high, and insurance coverage varies. Patients should consider:

• Surgery Cost: Surgical costs typically consist of three main types: surgeon fee, anesthesia fee, and facility fee. The facility fees cover such things as medications, instruments/materials/sutures, nursing, operative assistants, etc. The overall cost of this procedure depends on the facility where it is done and the approach to the vaginoplasty (i.e. robotic/peritoneal flap vaginoplasty will be more expensive than penile inversion vaginoplasty). Ask your surgeon if your quote is all-inclusive of these items or if you will receive separate bills from different departments.
• Extra Expenses: Unfortunately there are not experienced surgeons everywhere. Most people will have to travel to a qualified surgeon. Travel, food, lodging, medications, and post-operative supplies, such as dressings, dilators, lubrication, etc, should all be considered before you schedule your surgery. You need to be able to afford everything necessary to make your surgery a success, or surgery may fail.
• Insurance Coverage: Check with insurance providers about coverage and out-of-pocket costs.

Transfeminine Surgical Risks and Complications

As with any surgery, male-to-female bottom surgery has risks. All patients considering this surgery should be well-informed and aware of potential risks, which can include:

• Infection: Post-op infections can occur and need to be treated promptly.
• Bleeding: Excessive bleeding during or after surgery.
• Scars: Scarring at the surgical site can affect aesthetics and function.
• Stenosis: The neovagina may try to heal closed. To prevent this, patients need to dilate the neovaginal canal regularly in order to maintain its depth and width.

The procedure is quite complex; be sure to choose a surgeon who has great case numbers of experience. Beware of a surgeon who does not have extensive experience with this procedure. At Restore Medical Center, Drs. Whitehead and Ramirez specialize in gender affirmation surgery, which means you’re working with surgeons who have extensive experience and skill in performing male-to-female bottom surgery. Any questions, concerns, or complications post-op should be brought up to Dr. Whitehead or Dr. Ramirez as soon as possible.

Male-to-Female Recovery and Aftercare

Recovery from MTF bottom surgery can be extensive, and many patients require a lot of aftercare:

• Initial Recovery: Patients stay in the hospital, hotel, or recovery house for about a week after surgery. The results typically do not look appealing at this stage, as there is typically some swelling and congestion, which resolves over the next several weeks.
• Long-term Healing: Full recovery can take several months with continued improvement in aesthetics and function.
• Dilation and Maintenance: Dilation is necessary (either with a dilator or through actual penetrative sex once healed) to prevent the neovagina from closing.

Is MTF Bottom Surgery Right for Me?

There are many physical, financial, and emotional factors that can influence the decision to choose transfeminine bottom surgery. It’s all about weighing the benefits against the challenges and risks. Here are some things to consider:

What Are Your Personal Goals and Expectations?

Consider these questions when evaluating MTF bottom surgery:

• Why do you want surgery? During your initial consultation, be clear with your gender-affirming surgeon about your reasons for surgery.
• What are your expectations? It’s important to have realistic expectations about the results and the healing process. It is important to know that no surgery is likely to achieve your idea of perfection. Surgery should be aimed at reducing overall dysphoria.
• Are you ready for the commitment? MTF bottom surgery can be a life-changing decision. Consider the time, effort, and financial investment and if you feel ready to take this step in your gender journey. Arrange your surgery only when you have sufficient funds, emotional support, and healing time.

Support During Your Transfeminine Bottom Surgery

Having a good support system can make a big difference in the decision and recovery process:

• Emotional Support: Friends, family, and support groups can make an enormous difference in your recovery by providing direct and emotional assistance.
• Medical Support: Access to experienced surgeons and medical professionals can improve a patient’s overall experience. Doctors Whitehead and Ramirez are with you every step of the way, from the initial private consultation to post-operative care.

Long-Term Considerations of MTF Bottom Surgery

• Long-term Health: Understand the long-term health implications and medical follow-ups.
• Quality of Life: Consider the benefits and risks of surgery and how you anticipate the surgery will affect your overall quality of life.

Your Miami, Florida, MTF Bottom Surgery Experts

Our board-certified surgeon Dr. John L. Whitehead and board-certified anesthesiologist Dr. Alain Ramirez have unrivaled skills and years of experience necessary to deliver satisfying transfeminine surgery results. At Restore Medical Center in Bay Harbor Islands, all we do is gender affirmation surgery. Our surgical center is American Association for Accreditation of Ambulatory Surgical Facilities (AAAASF) accredited, and our entire team is made up of LGBTQ+ allies committed to serving trans men and women, non-binary individuals in Miami, Florida, and those traveling to Miami for their male-to-female bottom surgery.

Check out our male-to-female bottom surgery pictures and call 305.865.2000 to schedule your MTF bottom surgery consultation.