As a former patient herself, Dr. Ley has an insider’s perspective on the importance of getting your bottom surgery results right. She is sought after in the transgender community to revise bottom surgeries for medical complications and/or aesthetic motives. If you are interested in undergoing surgery with Dr. Ley, you can schedule a free, virtual consultation with her here. The most common complications associated with these procedures–like urinary fistulas and wound opening–will resolve on their own with at-home treatments. Frustratingly, they may delay the amount of time required to heal.

With both surgeries, a patient can undergo a variety of additional procedures. For example, you can get a mons resection and/or panniculectomy to remove excess fat and skin in the upper pubic area, making the penis more visually apparent. Likewise, Dr. Ley can construct a scrotum and insert silicone testicular implants if a patient would like.

If maximizing the size and girth of the penis is a priority for the patient, the forearm flap and thigh flap phalloplasties have the greatest potential. Groin flap phalloplasties usually create a penis in the range of 3-5 inches of length. Metoidioplasty results are comparatively smaller because the natal penis (or clitoris) is merely released.

Some metoidioplasty patients report that they are able to have penetrative sex with their penis. Many of these patients will use a penis pump to enlarge their results and facilitate penetrative sex. Patients should wait at least 3 months after surgery before using a penis pump.

For both procedures, we recommend that patients wait at least three months before they try to stimulate (orally or manually) their penis, especially if a urethral lengthening is performed. By this time, you can begin exploring your new genitals to see how you can reach an orgasm. A metoidioplasty simply releases the natal penis (or clitoris) from its surrounding ligaments. This means there is virtually no risk of sensation loss since the nerves will not be touched during surgery. A groin flap phalloplasty gives the penis a regular tactile sensation as opposed to heightened, erotic sensation. With both a forearm and thigh flap phalloplasty, the nerve of the donor site can be …

For both metoidioplasty and phalloplasty, it is a patient’s choice as to whether or not they undergo urethral lengthening. This is the procedure that extends the urethra to the tip of the penis, which facilitates peeing standing up. That said, a vaginectomy is required to extend the urethra to prevent medical complications.

Generally speaking, phalloplasties are more taxing surgeries that have a more difficult recovery process than metoidioplasty. Some phalloplasties require multiple surgeries to construct the penis. You can learn more about recovery from a phalloplasty here. A metoidioplasty leaves virtually no visible scarring. A groin flap phalloplasty leaves a very concealable scar on the groin, a thigh flap phalloplasty leaves a large scar that can be covered up by shorts, whereas a forearm flap phalloplasty leaves a large scar across the forearm.