A Comprehensive Guide to Bottom Surgery Costs Medically reviewed by Nicole M, RN on October 15, 2024. Bottom surgery refers to procedures that reconstruct an individual’s natal genital tissue to relieve gender dysphoria and allow them to experience greater gender congruence. The overall costs of surgery––the procedure itself, the preparations for surgery, the time off work needed to recover and more––often comprise the greatest barrier to medically necessary gender-affirming surgery. This guide gives a comprehensive overview of the costs of what some call FTM bottom surgery (metoidioplasty, phalloplasty, etc.) and MTF bottom surgery (vaginoplasty, vulvaplasty and labiaplasty), insurance coverage, as well as grant and financing resources. What influences the cost …