Female to Male (FTM) Gender-Affirming Surgery for Transmasculine Patients

Medically reviewed by Jennifer Richman on August 26, 2025.

FTM Transition Surgery Explained

Masculinizing surgeries include a number of procedures ––such as top surgery, bottom surgery, body contouring and facial surgery–– that are designed to alleviate a patient’s gender dysphoria. There is no one right way to transition; there is not a certain number or type of surgeries that trans men or transmasculine non-binary patients must undergo to “complete” their transition. Rather, FTM surgery is meant to target a patient’s unique needs to help them experience greater gender alignment.

If you would like to make a unique surgical plan for your gender journey, you can solicit a free consultation with any of our board-certified surgeons.

Chest Reconstruction Top Surgery

Chest reconstruction top surgery can involve removing chest tissue, excising any unwanted skin overhang to create a tighter chest, as well as resizing and repositioning the areolas and nipples. Bringing in pictures of what you would like your chest to look like after surgery can help your surgeon create a surgical plan most suited to you.

• Patients who have a large amount of chest tissue to remove often undergo a double incision procedure or an inverted-T technique.
• Patients with a medium amount of chest tissue to remove often undergo a double incision procedure, a periareolar incision, an inverted-T technique, a buttonhole incision or a fishmouth incision.
• Patients with a minimal amount of chest tissue and minimal to no skin overhang often undergo a periareolar incision, a keyhole incision or a lollipop incision procedure.
• Patients who are interested in maintaining heightened, erogenous sensitivity in their nipples can undergo a nerve preservation top surgery, inverted-T or buttonhole technique.

Masculinizing Bottom Surgery

Patients can choose from the following surgical options, depending on your unique needs and if you meet the eligibility requirements:

• Hysterectomy, oophorectomy and vaginectomy: Patients can have their vaginal canal, uterus, and/or one or both of their ovaries removed. Hysterectomy and oophorectomy can only be performed by a board-certified gynecological surgeon.

• Metoidioplasty: A metoidioplasty involves releasing erectile tissue (sometimes called the clitoris) from its surrounding ligaments, giving it a more forward and elevated position. Patients can opt for a urethral lengthening procedure if they would like to be able to urinate while standing up.
• Phalloplasty: This surgery involves the creation of a penis using a tissue flap from the patient’s groin, outer thigh, or forearm. Phalloplasty often requires multiple stages of surgery to meet a patient’s goals.

Simple Metoidioplasty vs Complex Metoidioplasty with Urethral Lengthening, Vaginectomy and Scrotoplasty

Body Masculinization Surgery

FTM body contouring has recently become one of the most solicited procedures by trans men. Body masculinization can often be performed alongside top surgery to help reduce the gender dysphoria that a patient may experience from the frame or shape of their body. It most often involves liposuction or abdominoplasty procedures. Patients can solicit liposuction in any of the following areas:

• Upper arms
• Inner and outer thighs
• Abdomen
• Flanks
• Back
• Mons or upper pubic region

Facial Masculinization Surgery

Facial Masculinization Surgery (FMS) offers a wide selection of procedures that patients can choose from to imitate the effects that a first, testosterone-dominant puberty would have had on their facial structure. They include:

• Brow bone augmentation
• Blepharoplasty (eyelid surgery)
• Rhinoplasty (nose reshaping)
• Jawline augmentation
• Genioplasty (chin reshaping or augmentation)
• Tracheal augmentation (Adam’s Apple implant)
• Buccal fat removal

Insurance Requirements & Costs

Patients with insurance plans that include benefits for gender-affirming care may be able to get coverage for masculinizing gender-affirming surgery when they provide the proper documentation. Most insurance providers will require that patients be on at least 12 months of continuous testosterone hormone replacement therapy (HRT) to qualify for coverage, unless the patient has a medical contradiction. Some surgical procedures like phalloplasty can only be performed on patients with insurance coverage due to hospital requirements.