Phalloplasty Surgery in San Francisco

Medically reviewed by Lin-Lin Liu, PA on July 31, 2026.

For many transmasculine and nonbinary individuals, phalloplasty represents a life-changing step toward gender congruence: aligning body and identity. It involves the creation of a phallus using a donor flap of tissue elsewhere on the body. These include the radial forearm flap (RFF), anterolateral thigh flap (ALT), groin flap techniques, and related procedures.

San Francisco is home to some of the most renowned and experienced phalloplasty surgeons in the world. Under the leadership of Dr. Zara Ley (she/her/they)––a board-certified surgeon, trans woman and former patient herself––the Gender Confirmation Center in San Francisco offers a variety of phalloplasty techniques. Dr. Ley is highly experienced and trained in advanced microsurgical techniques. Her and her team have been accompanying trans and non-binary patients for years through their bottom surgery journeys, refining their patient-centered care model.

What is Phalloplasty? Understanding the Procedure

Phalloplasty procedures construct a phallus over multiple stages of surgery, primarily through the use of a donor tissue flap from the patient’s groin, forearm or outer thigh. Each phalloplasty surgical plan is tailored to an individual’s unique goals, anatomy and medical history. For example, some phalloplasty procedures may involve a vaginectomy (surgical removal of the vaginal canal), nerve innervation microsurgery (to connect the phallus to nerves in the patient’s clitoris), or the insertion of an erectile device.

Phalloplasty may sometimes be an appropriate surgical intervention for cisgender male patients after trauma or congenital conditions.

Metoidioplasty vs Phalloplasty: Which Is Right for You?

When it comes to transmasculine bottom surgery, patients most often are curious about the comparison between metoidioplasty and phalloplasty procedures. The chart below gives a general overview of some of the key factors:

Phalloplasty Techniques and Options

The following chart compares the three major types of phalloplasty procedures. Please note that to determine your eligibility for these different techniques, you will need to come in-person to our San Francisco office for a medical evaluation during your free consultation.

*Please note that other stages of surgery will be required for patients who may want any of the following: primary urethral lengthening, a glansplasty (construction of the glans of the penis), a scrotoplasty with or without testicular implants, and/or an erectile device.

Successful Phalloplasty Results and Patient Satisfaction

Overall, while phalloplasty is a procedure that has relatively higher complication rates than other gender-affirming surgeries, patient satisfaction rates have been reportedly high––in the 78% and 90% ranges, depending on the study.

For these reasons, we emphasize the importance of an active support network (of loved ones and mental health professionals), financial preparedness, realistic expectations going into surgery.

Patient Testimonial

The following testimonial is from a patient of Dr. Ley who started undergoing groin-flap phalloplasty with her in 2026:

Dr. Ley is amazing. I feel really lucky that I could find a competent and attentive surgeon who performs groin flap, especially since it isn’t as common as other techniques. Dr. Ley keeps it real and answers any questions honestly and directly. The team is also friendly, cheerful and open. Dr. Ley has also been very accommodating with my requests when possible. She even gave good advice about which of my tattoos would transfer best to the groin. I really enjoy that she has tattoos and piercings as well, because I knew I wouldn’t have to worry about experiencing stigma and stereotyping like I often have in medical environments. An additional benefit of working with Dr. Ley, is that as a trans person herself, she personally understands the perspective of patients undergoing gender-affirming surgery and can relate to their concerns authentically. That’s a rare opportunity to have as a patient.  I would absolutely recommend Dr. Ley for phalloplasty and I’m very happy to be in her care.

Your Phalloplasty Journey at Gender Confirmation Center

The following is a general overview of the steps patients will need to take to undergo a phalloplasty with Dr. Zara Ley.

Pre-Operative Medical Requirements

Patients will likely need to take the following steps to get a surgery date scheduled for phalloplasty:

• Requesting a free, in-person consultation: The first step in any patient’s journey is to request a free surgical consultation. For phalloplasty in particular, Dr. Ley requires consultations to be in-person in their San Francisco office. This is because Dr. Ley and her care team will need to conduct an in-person evaluation of your anatomy to assess which type of phalloplasty procedure you are eligible for.

• Letter of support: To undergo bottom surgery with Dr. Ley, she requires that patients present a letter of support from a gender care health professional––such as an endocrinologist or licensed mental health professional––continuously for at least 9 months.

• Medical clearance: For safety reasons, patients will need to disclose their full medical history. This includes pre-existing medical conditions, medications and supplements you are taking, as well as lifestyle habits such as smoking and exercise. From there, we will likely work with your primary health provider and/or solicit that you undergo certain medical exams to inform our design of your personalized surgical plan.

• Hysterectomy: Patients who would like to undergo a vaginectomy (removal of the vaginal canal) will need to undergo a hysterectomy at least 8-12 weeks prior with another provider. At this time, the GCC does not have a gynecological surgeon in-house that can perform this procedure.

• Hair removal: Some patients may need to undergo laser hair removal and/or electrolysis on their forearm prior to surgery, depending on their surgical plan. Dr. Ley will clarify this for you in your free consultation. The medical illustration below demonstrates which areas of the forearm may need to undergo hair removal for an RFF flap phalloplasty and/or urethral lengthening procedure that uses a skin flap from the forearm:

Insurance Pre-Approval

Unlike other forms of gender-affirming surgery, insurance coverage is a requirement by the hospitals we work with for undergoing surgery. As a result, patients will need to do the following:

• Assess your provider’s coverage requirements: Patients should look into whether their insurance plan(s) have “transgender benefits.” If so, you can look up the specific clinical guidelines they have for “gender reassignment surgery,” “bottom surgery,” or “phalloplasty.” Looking up your plan name with these keywords in your trusted search engine, or calling your insurance’s customer service line, can help you find this information.

• Acquire supporting documentation: Patients will need to provide 1-2 letters of support, depending on your insurance provider’s requirements. Be sure to check what credentials are needed; for example, some insurance plans require that the letter-writer have at least a doctorate. After you’ve solicited a consultation, our insurance concierge team can give you guidance on what the letters should contain.

Undergoing Surgery

Once you have a date for surgery, your care team will send you a pre-operative packet with everything you will need to prepare for surgery. On the day of surgery itself, you will be admitted to the hospital and be under general anesthesia––meaning that you will be entirely asleep––for the duration of the procedure. Patients should expect to stay in the hospital for a few nights after the initial surgery for close monitoring.

Phalloplasty Recovery: Timeline and What to Expect

Recovery from phalloplasty can be particularly difficult for patients, especially when their surgical plan involves multiple stages of surgery. You can read more in-depth information on this topic here. Otherwise, here are some general guidelines:

Hospital Stay

After a microsurgical RFF or ALT phalloplasty, patients can expect to stay in the hospital for six nights. After the first stage of a groin flap phalloplasty, patients can expect to stay 2 nights in the hospital. This is when the most amount of pain, inflammation, and bruising will be experienced.

Urethral Catheder

A urinary catheter will be required for bottom surgery that involves the urethra. The catheter will stay in place for 2-3 weeks to drain any urine from the bladder to allow the lengthened urethra to heal. While an indwelling catheter is not painful, it may be unusual for patients to adjust to. Bladder spasms may be experienced and can be a source of discomfort that can be managed with certain medications.

Limitations on Physical Activity

The following are general guidelines that your care team will confirm with you as they vary from patient to patient. We advise patients to go on light walks to help prevent blood clots after they have been discharged from the hospital. Patients should not lift more than 10 pounds during the first 4 weeks. Exercise and more rigorous activity such as jogging or yard work can be introduced slowly and progressively after about 8-12 weeks.

Limitations on Sexual Activity

We ask patients who undergo phalloplasty to completely avoid manual or oral stimulation for at least 3-4 months (or longer depending on your healing). Your phallus is still healing and at a higher risk of infection. Patients should get their surgeon’s approval after 3-4 months before engaging in manual or oral stimulation of the phallus.

FAQs

How much does phalloplasty surgery cost in San Francisco in 2026?

Exact price estimates for phalloplasty surgery cannot be given because costs vary greatly from patient-to-patient based on insurance coverage. This is because insurance pre-approval is a hospital requirement for patients to undergo phalloplasty. As a result, the patient share of costs for surgery and related services (such as physical therapy during recovery) will be determined by your insurance provider(s).

What is the difference between metoidioplasty and phalloplasty?

Metodioplasty is generally a less invasive surgical procedure that tends to involve less stages of surgery and a less intense recovery process. Metiodioplasty tends to produce smaller surgical results––a phallus about the size of a thumb––and tends to have less or no visible scarring––as compared to an RFF or ALT phalloplasty.

How long is the full recovery timeline for phalloplasty?

The recovery time after each stage of phalloplasty depends on what was accomplished during each surgery. Recovery from each stage can take from 2-6 weeks, sometimes longer. Given that many patients take 12-18 months to complete all stages of their phalloplasty, patients may be in recovery for months in total.

Can you urinate standing up after phalloplasty?

Patients who undergo a primary urethral lengthening (PUL) as a part of their phalloplasty can urinate out of the tip of their phallus, which can make it easier to urinate standing up. Please note that Dr. Ley requires patients who undergo a PUL to undergo a vaginectomy to prevent urinary complications.

Is phalloplasty worth it based on patient satisfaction?

Whether or not undergoing phalloplasty is worth it is a deeply personal choice. We encourage patients to speak openly with Dr. Ley, our care team, and their mental health provider about their concerns and goals to help them make informed decisions for their health.

What is alt phalloplasty and who is it best suited for?

An anterolateral thigh (ALT) flap phalloplasty uses a donor flap of tissue from the patient’s outer thigh to construct a phallus. Because of the donor zone, ALT phalloplasty results tend to have greater girth––an amount that dissuades many patients. However, with nerve innervation microsurgery, it opens the possibility of the phallus having greater, erogenous sensitivity. Please note that few patients actually qualify for this procedure because of skin elasticity requirements.

Ready to Take the Next Step Toward Phalloplasty?

Schedule a consultation with Dr. Ley’s expert surgical team in San Francisco. Whether you’re just beginning to explore bottom surgery or ready to plan your procedure, our patient coordinators are here to guide you through every step — from insurance verification to post-operative care. Contact us today to start your journey.