FTM Surgery
Elective bilateral mastectomy
Elective bilateral mastectomy (FTM), the removal or reduction of the breasts (also called reduction mammoplasty, or "top surgery"), involves making a small incision near the nipple and removing most of the tissue and fat from under the skin. This results in a chest shape that appears more masculine. Some people also choose to have skin grafted from the existing nipple to create a new male-like nipple. The procedure has relatively few complications. The length of the hospital stay is dependent on the patient. Reduction mammoplasty is often all a FTM needs to comfortably assume a new gender role and pass in society.
Metoidioplasty
Metoidioplasty (FTM) is the creation of a penis by extending the clitoris that has been significantly enlarged by testosterone hormone use. The skin around the clitoris is removed so that the clitoris can extend from the pubic region and appear as a penis. The resulting penis is smaller than the average size of an adult male penis and its use in sexual intercourse is limited. Some people also have the urethra lengthened, which makes it possible to urinate while standing. This requires removal of the vagina. The fat of the pubic area is typically removed and the skin pulled tighter around the area, creating a more male-like appearance. The vaginal opening is closed and the skin of the vaginal labia (lips) is used to create a scrotum. Inflatable expanders are placed in the scrotum either during or after surgery in order to expand the skin of the newly created scrotum. Once expanded, the scrotum can accommodate testicle implants.
Phalloplasty
Phalloplasty involves constructing a penis from the inner forearm skin (nondominant side) and vaginal tissue and attaching it to the vaginal area. This is also known as a free flap phalloplasty. The forearm skin is grafted along with its nerves, arteries, and veins and formed around a plastic catheter tube, which will serve as the urethra and allow for urination once connected to the female urethra. The forearm skin is used to create the shaft, glans (head), and urethra. The nerves of the clitoris are attached to the grafted nerves and will grow into the penis after surgery. The skin and tissue of the vaginal labia is used to create a scrotum. The procedure may take 3 hours or more. After 6 to 9 months of healthy recovery, cosmetic testicle implants can be inserted in the scrotum. Erectile implants, those used in men with impotence, can be added to achieve erection in the new penis. Hardening of the urinary tract and tissue death in the new penis are complications of phalloplasty.