The risks of female-to-male (FTM) bottom surgery, also known as transmasculine bottom surgery, encompass a range of potential complications affecting both physical and psychological well-being. These risks vary depending on the specific surgical procedures involved, which can include metoidioplasty, phalloplasty, scrotoplasty, and urethroplasty, among others.
General Surgical Risks
As with any major surgery, certain risks are common across all types of FTM bottom surgery:
- Bleeding: Excessive bleeding can occur during or after surgery, potentially requiring blood transfusions.
- Infection: Infections can develop at the surgical site and may necessitate antibiotic treatment or further surgery.
- Poor Wound Healing: Incisions may not heal properly, leading to wound breakdown or delayed healing.
- Hematoma: A collection of blood beneath the skin can form, which may require drainage.
- Nerve Damage: Surgical procedures can potentially damage nerves, resulting in altered sensation, pain, or numbness.
- Scarring: Unsightly or excessive scarring is a possibility, and scar revision surgery may be considered.
- Anesthesia Risks: All surgeries involving anesthesia carry inherent risks, such as adverse reactions or complications related to breathing.
Specific Risks by Procedure
The specific risks are also dependent upon the procedures performed:
Metoidioplasty
This procedure involves releasing the existing clitoris (enlarged due to testosterone therapy) to create a small penis.
- Small Size: The resulting penis may be smaller than desired.
- Urethral Complications: Urethral lengthening can lead to strictures (narrowing), fistulas (abnormal connections), or incontinence.
Phalloplasty
Phalloplasty involves creating a penis from a skin flap taken from another part of the body (e.g., forearm, thigh, or abdomen).
- Flap Necrosis: Failure of the transplanted tissue to survive due to insufficient blood supply. This is a serious complication and may require further surgery.
- Urethral Complications: A common risk is urethral stricture, fistula, or diverticulum, potentially requiring multiple corrective surgeries.
- Sensory Issues: Achieving adequate sensation in the newly created penis can be challenging.
- Erectile Dysfunction: If an erectile prosthesis is implanted, there is a risk of mechanical failure, infection, or extrusion.
- Donor Site Morbidity: The area from which the skin flap is taken can experience complications, such as scarring, pain, or functional limitations.
Scrotoplasty
Scrotoplasty involves creating a scrotum using labial tissue.
- Asymmetry: The resulting scrotum may be asymmetrical in appearance.
- Testicular Prosthesis Issues: If testicular implants are placed, there is a risk of infection, extrusion, or malposition.
Urethroplasty
Urethroplasty, used to lengthen the urethra, is a high-risk procedure.
- Fistula formation: Abnormal connections between the urethra and the skin may occur.
- Stricture: The urethra may narrow preventing urine from freely passing.
- Incontinence: Difficulty controlling urination.
Psychological Risks
It's important to acknowledge the psychological aspects of FTM bottom surgery:
- Body Image Dissatisfaction: The surgical outcome may not meet the patient's expectations, leading to body image dissatisfaction.
- Psychological Distress: Complications or unsatisfactory results can lead to depression, anxiety, or regret.
- Sexual Dysfunction: Difficulty achieving orgasm or experiencing sexual pleasure can occur.
Mitigation Strategies
Surgeons take steps to minimize these risks:
- Careful Patient Selection: Ensuring that patients are medically and psychologically suitable for surgery.
- Detailed Pre-operative Planning: Thoroughly planning the surgical procedure to minimize complications.
- Experienced Surgical Team: Utilizing experienced surgeons and medical staff.
- Post-operative Care: Providing comprehensive post-operative care and monitoring.
It is crucial for individuals considering FTM bottom surgery to have a thorough discussion with a qualified surgeon to understand the potential risks and benefits, and to set realistic expectations. Consultation with a mental health professional is also recommended to address any psychological concerns.
