Penis-Creating Bottom Surgery Masterpost
This is going to be a long post about penis-creating bottom surgery, also referred to separately as Phalloplasty and Metoidioplasty. For simplicity, I will be using their shortened versions, Phallo and Meta.
What are Phallo and Meta?
Phallo is a form of penis-creating bottom surgery that involves taking a skin graft from somewhere else on the body to create a penis. There are several places that this skin graft could be taken from. A forearm skin graft is the most common type, but there’s also skin grafts from the thigh, abdomen, back, and there is also a new graft site in the groin as of writing this, but few surgeons do this one, as it’s very new. In this post, I will go over the different graft sites and information on all of them, as they have different results for each one.
Metoidioplasty is a form of penis-creating bottom surgery that largely uses your existing genitalia (ie. bottom growth) to create a penis. This penis will be considered a micropenis.
Which one is right for me?
They are each better fits for different people. You can also have both separately if you would like. We’ll get into non-traditional penis-creating bottom surgery as we go further.
For Phallo, consider the following:
-The size of your penis isn’t limited by your bottom growth. Within the ranges for each skin graft, you can typically choose around what size you want. However, it may grow or shrink post op.
-Besides the initial growing and shrinking post op, your penis will not change lengths between flaccid and erect states. Whatever size your penis is is going to be the size of your penis at all times. If you have a 5in penis at the end of this surgery, you will have both a 5in erect penis and a 5in flaccid penis.
-You will not be able to have unassisted erections. You will need either an internal or external erection device to get an erection. Also consider, no awkward unwanted erections and you can stay erect as long as you want.
-You will be of a size to penetrate a partner unassisted (though again, no unassisted erections).
-Different skin graft areas will have different benefits, but typically, the grafts that leave the most visible scarring (forearm and thigh) have the best erogenous sensation, while the grafts that leave minimal/no visible scarring will not have erogenous sensation. The forearm flap typically has the same erogenous sensation as your anatomy pre op, and while I hear different things about the thigh flap, people are typically happy with their erogenous sensation with it.
-Depending on what all you have done, expect 3 or more surgeries and potentially medical tattooing to get the aesthetics and functions that you want out of your penis.
-As of now, you cannot have foreskin with your Phallo penis. You can tattoo the foreskin on, but you will not have that separate moving skin layer.
-If you are bigger bodied, you may have trouble finding a surgeon willing to perform Phalloplasty on you, and certain skin grafts require a certain BMI limit.
-No dick piercings post op Phallo.
For Meta, consider the following:
-You will have a penis about as big as your bottom growth is pre-op, and might not be able to penetrate someone without assistance (an external erection device).
-Your penis should have the same erogenous sensation as your anatomy pre-op
-You will have foreskin. You could probably get circumcised if you REALLY wanted to, but I’m not sure.
-If you are bigger bodied, you will probably need additional surgeries to get the skin out of the way of the penis (monsplasty).
-You will be able to get erect unassisted, just as your pre-op anatomy does.
Notice how I’m not making a pros/cons list. This is because some of these things are going to be neutral, negative, or positive for different people. Meta and Phallo are great choices for different people. One is not better or worse than the other, and different people require different penises. You might read all this and decide you want Meta instead of Phallo, or vice versa. That’s fine! We should all be careful about how we talk about these surgeries, though. These are real people’s bodies you’re talking about!
Designer Penis
Notice how I’ve only discussed the creation of the penis, and not other stuff such as Vaginectomy, Urethral Lengthening, ect? That’s because all of these are opt-in and opt-out. You don’t have to have a Vaginectomy, Scrotoplasty, implants, or anything. But a lot of us do want/need these things, so I’ll list them here:
Universal:
-Urethral Lengthening/UL (rerouting the urethra through the penis)
-Vaginectomy (removal/closure of the vagina)
-Scrotoplasty (creation of the scrotum (sac))
-Testicular Implants (implants to create the testicles (not actual testicles))
Phallo extras:
-Clitorial Burial (“burying” the bottom growth inside your penis and out of sight)
-Erection Implants (either the semi-rigid rod or inflatable pump, designed to give erections internally, work in different ways)
-Glansplasty (creation of the glans, the circumcised head of the penis)
-Medical Tattooing (aesthetic tattooing to give your penis a more “natural” look)
These are all completely optional, and you don’t need literally any of these to get the surgery. They are also typically mix and matchable, which means you can have any combination of these things. I will say that surgeons typically will not perform UL without a Vaginectomy (though not true for the inverse) so keep this in mind when looking for a surgeon.
Now that we have the universals out of the way, let’s dive in deeper to each individual surgery.
Phalloplasty:
There are currently five areas where the surgeon will take skin grafts from. We’re going to go over what each one entails so that you know which one is right for you.
Forearm/RFF:
-Typically taken from the non-dominant forearm, but can be taken from the dominant forearm if needed
-Typically the highest potential for erogenous sensation out of all other techniques, will have tactile sensation
-Requires another skin graft (usually from the thigh) to cover the forearm where the skin graft was taken from
-If looking into UL, the UL graft is taken from the same place
-Requires permanent hair removal on AT LEAST the UL skin graft
-Very visible scar
-If all goes well, you will have full tactile and erogenous sensation
-Roughly between 4.5-6in in length, can ask for smaller
Thigh/ALT:
-Takes a skin graft from the outer thigh
-Typically not suitable for bigger bodied people (or just people who carry a lot of fat in their thighs)
-Typically results in a larger penis than RFF (can get up to 8-9in) with girth that may require multiple debulking sessions, but for length you can still typically decide what you want (though again, it can grow/shrink)
-Easier to conceal scar than RFF while still maintaining erogenous sensation, will have tacticle sensation
-May have less potential for erogenous sensation than RFF
-Higher risk of UL complications than RFF
Abdominal Flap:
-Uses graft from lower abdomen
-Scarring is very easy to conceal
-Is not typically done with UL, but can be (requires MUCH SMALLER forearm flap)
-No hair removal required
-Less invasive and faster recovery
-Do not expect more erogenous sensation than at the base. Can still orgasm through stimulating bottom growth if buried. Will have tactile sensation
-No nerve hookup
Back/MLD:
-UL done in multiple stages
-No erogenous sensation in penis, will have erogenous sensation in bottom growth. Typically no tactile sensation
-Typically less or no hair removal required
-Easier to hide scarring
-Larger penis, may need more debulking
-No nerve hookup
Groin Flap:
-Smaller penis
-Easy to conceal scarring
-No erogenous sensation, little tactile sensation. Can still orgasm through bottom growth
-Much less expensive than other methods
-No nerve hookup
-Inflatable erectile rod is not possible, but semi-rigid rod is
-Few surgeons do it
This is what I’ve found on each graft, if anyone who has had phallo wants to amend anything, let me know and I can edit this post.
Meta:
There are two different kinds of meta now!
Standard Meta:
-Will be about as long as your bottom growth is
-Cuts the ligaments holding your bottom growth in place and allows it to stand upright
-All universal extras above can be added
Extended meta:
-Can extend the length of your penis
-Typically done without UL, as it can negate the extension
On Implants
Not everyone will get testicular implants or erectile implants, but for those who do:
Testicular Implants:
Testicular implants for penis-creating bottom surgery come in 4 sizes: extra small, small, medium, and large. The size of your penis (and also Phallo or Meta) will be used to determine your implant size. You can always size up later.
Erectile Implants:
Because Phallo isn’t made with erectile tissue, your post op Phallo penis cannot have an unassisted erection. However, they make implants for this. There are two kinds, the saline inflatable pump, and the semi rigid rod. The inflatable pump can only be used if your penis is over 4.5in long. The pump is stored in one side of your sac (so you will be missing one testicular implant for the pump) and you squeeze it to get an erection. The semi rigid rod is always hard, so you will always have a “semi” erect penis, but all you have to do is position it for sex.
Alternatives to Erectile Implants:
Erectile implants can have complications, and some people don’t want to have their erectile implant replaced every 7 years or so. So there are alternatives:
-The Elator (made for cis men with ED, but has opened up to people with Phalloplasty and have actual instructions for them: https://www.theelator.com/pages/phalloplasty?srsltid=AfmBOorfyW_y3hhobjh-Z1CJ30k_xQaEFPzphX4jJK-eftxAq_hgHjnJ)
-Other erection sleeves you can buy online
We as trans men are not the only or even the first men to have needed erectile assistance devices. Every method of erectile assistance has been made with cis men in mind first. Not even Phalloplasty was created with trans men in mind, it was originally made for cis men. Don’t feel ashamed of needing it!
Non-traditional Penis-Creating bottom surgery
There are many options with penis-creating bottom surgery to have genitals that are separate from perceived male/female anatomy. Some examples are:
-Both Phallo and Meta, leaving you with two penises. You can only have a urethra out of one of them. You can also opt out of a Vaginectomy and have a vagina as well
-Penis and vagina, you can have either Phallo or Meta and opt out of a vaginectomy, and have both a functioning penis and vagina
-Phallo can look like many different things. You can tattoo your penis to have anything on it. Many people have tattoos on their penis (besides just medical tattooing). Go crazy with it!
-You don’t have to get a scrotum
-Simple Release Meta (Meta without Scrotoplasty, Vaginectomy, UL, ect) exists just to put your penis where you want it
Look into the Salmacian community, there is a subreddit for them! r/Salmacian! Alternatively, r/Altersex for people who identify outside of the male/female sex binary who weren’t born intersex.
NOTE FOR PERISEX PEOPLE: Getting surgery to have both a penis and a vagina, or otherwise atypical anatomy DOES NOT MAKE YOU INTERSEX. Being intersex is something you are born as, you cannot “transition to” intersex. You can, however, transition to be altersex. Please be mindful of your language regarding intersexuality. When in doubt, ask real intersex people, we exist! A lot of us are trans and are in the same spaces you are!
How do I go about getting Phallo or Meta?
Answering for the US, because that’s where I live and I have no idea what goes on anywhere else.
That is a question for your insurance provider. Typically, they will need at least 2 letters, one from a mental health provider and one from either a PCP or a hormone provider. From there:
-Check who’s in network with your insurance
-Pick a surgeon. You may need a referral from a doctor, call their office and find out. They should also have a website
-See their requirements. Some have BMI requirements. Check wait times, reviews, talk to others who have had surgery with them
-If all is well, they should schedule you for a consultation. If you’re sure about what skin graft you’re using, do the preparations ASAP (laser, ect.)
-Don’t be afraid to schedule multiple consultations with different surgeons! This is going to be your penis for the rest of your life! Be picky! Be selfish!
-You will probably need your letters and everything within a year of the surgery, and you may need to have them written again at least once to stay current. Ugh, insurance
I want more resources!
Understandable! There are many different places to find more information and personal accounts on Phallo and Meta. Notably, I use the r/Phallo and r/Metoidioplasty subreddits for penis-creating bottom surgeries. Both subreddits have hundreds of post op people sharing their stories, photos, advice, ect.
Alternatively, TransBucket is a website where many post op people share their surgery photos.
There are Facebook groups for Phallo and Meta as well, look into those!
Closing notes
I am not the single bearer of knowledge on the subject here, I’m only just now having my first consultation with a surgeon in July. This post is a compilation of resources regarding Phallo and Meta. If anything is wrong or needs to be updated, let me know and I’ll get that sorted. Otherwise, join communities of people who have had these surgeries and want to help others to have them, and get to talking! Do your own research! And good luck in your future penis endeavors!
