A Comprehensive Guide to MTF Bottom Surgery Medically reviewed by Dr. Zara Ley on Oct 30, 2025. 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 construct organs such as a vulva and/or vagina. Feminizing bottom surgery can include an orchiectomy, vaginoplasty, vulvaplasty or vulvoplasty, and labiaplasty, amongst other procedures. What can MTF Bottom Surgery Accomplish? The primary goals of what is called feminizing or MTF bottom surgery can be any of the following: Remove the testicles, the body’s main source of testosterone production, eliminating …