A Comprehensive Guide to MTF Bottom Surgery Medically reviewed by Jennifer Richman on April 30, 2024. What is MTF Bottom Surgery? Male-to-female (MTF) bottom surgery is a term that refers to a series of gender-affirming genital reconstruction procedures that remove natal genital tissue, such as the testicles and penis, and those that construct organs such as a vulva and/or vagina. “MTF” is widely considered an outdated term because surgeries like vaginoplasty do not make someone turn from male to female. Rather, bottom surgery is meant to allow patients to feel in greater alignment with their body. After all, MTF bottom surgery is not prescriptive: there is no one correct way …