Bottom Surgery Results: What to Expect

By Nick Peplow·Gender-affirming surgery coordinator

Last reviewed 27 September 2026· How this site is researched

Bottom surgery results take more homework to research than top surgery results. Fewer people post photographs, and because the result takes time to mature, much of what you find online is somebody's halfway point rather than their finished result. The procedure pages describe each operation's outcome. This page puts metoidioplasty and phalloplasty side by side and follows what changes between month three and year two.

Metoidioplasty

Size. Typically three to six centimetres once released, sometimes more. The main factor is how much the clitoris grew on testosterone, which is why surgeons want growth to have levelled off, usually after a year or more on T. Ask whether your surgeon uses topical testosterone or a pump beforehand, and how much difference they have seen it make. No surgeon can promise a figure until they see how much length is buried.

Appearance. A small penis with a glans, sitting above a scrotum if a scrotoplasty was done. Soft, it is often partly hidden by the fat pad over the pubic bone, which is why surgeons raise weight before meta. It becomes more prominent with arousal and gets erect on its own. With urethral lengthening the opening sits at or near the tip, and at a urinal it reads as a penis.

Scars. Inside the natural genital folds, closed with fine dissolvable stitches, and hard to find once healed. There is no donor site anywhere else on the body.

How it matures. Swelling can double the apparent girth and hide the length for the first weeks, so the week-two result is not the one you keep. Most of it settles by three months, and the final size and shape are clear at three to six months. Testicular implants, if planned, go in from about six months.

Phalloplasty

Size. Roughly 12 to 16 cm, set at surgery by the flap and your body. Girth follows the thickness of the donor tissue. A forearm gives a slimmer shaft. A thigh or back flap gives more, sometimes more than wanted, and a thinning operation afterwards is common with a thigh flap. Length doesn't change with arousal, and without an erectile implant the phallus hangs soft.

Appearance. A penis that reads as one in clothes and out of them. The skin matches the donor site rather than the groin, so a forearm shaft stays a little paler and smoother than the skin around it. Hair on the shaft depends on how thorough donor-site hair removal was before stage one. Expect a visible seam on the underside, where the flap was closed.

The head. Without glansplasty the tip is a smooth cylinder. The later operation cuts a ridge and grafts a groove below it, and it does more for how the penis looks than any other refinement. In a thin flap the ridge can be crisp; in a thick one it is a softer suggestion of a head. It also tends to soften over the first year, and a redo is not unusual.

Scrotum. Built from the outer labia, usually in stage one, with testicular implants placed months later. The implants feel firmer than testes and often sit a little higher and closer together.

Donor scar. Permanent, and the part people most often say they underestimated. A forearm flap leaves a skin-grafted patch from the wrist to near the elbow, visibly different in colour and texture. The thigh patch sits on the outer thigh, under the hem of most shorts; a back flap leaves a long closed line across the back, and an abdominal flap a low belly scar. Judge a grafted donor site at a year, not before: until then it is red and raised, and even settled it stays a patch, sometimes slightly indented.

How it matures. For the first months the phallus is swollen, mottled and uneven in colour. The shape settles by about six months. The later stages (urethral join, glansplasty, testicular implants) fall six to twelve months apart, and the erectile implant comes last, once the shaft has protective sensation. A finished result arrives one to two years after stage one when things go smoothly, and later when a complication adds a repair.

Side by side

Function in brief

Meta keeps all its sensation and gets erect on its own, but works for penetration in only a minority. Phallo can penetrate once an implant is in. Its erotic sensation stays at the buried clitoris, and feeling in the shaft grows in over one to two years. Both can let you stand to pee if the urethra is lengthened, and neither reliably gives the clean stream of a cis penis. The detail is on sensation and function.

Setting expectations for a result you love

After meta, the thing to get clear on is size. People who ask their surgeon for a realistic figure up front tend to be the happiest with it, and if you later want more, that door isn't closed: a later phalloplasty can build on the meta, which meta vs phallo weighs up.

After phallo, there are more details to talk through: colour match, hair on the shaft, how the donor scar will look, girth after a thigh flap, how the head holds its shape, and the stream. Most of these can be planned for or refined later. The biggest one is patience: the good results arrive at year two, and month six is not a fair test of anything.

After either, the urethra. A fistula (a leak) or stricture (a narrowing) follows urethral lengthening in roughly one in ten to one in three metas, and in a quarter to half of phalloplasties, depending on the series and how they are counted. For most it delays a working urethra rather than ruling one out, but it is the single likeliest reason a result takes longer than planned.

Revisions and refinements

The common ones are thinning a bulky phallus, a second glansplasty, and donor-site scar revision, which tidies the edges but never removes the patch. Add repositioning or resizing testicular implants, fistula repair and stricture treatment. With phalloplasty I would budget time and money for at least one. Revisions covers how to decide whether one is worth it.

Looking at results

Galleries are most useful when you know what you're looking at, because a photograph is often taken at month four. When you are comparing surgeons, ask to see:

• Results at a year or more, not fresh post-op
• People with a similar build and the same flap as you
• The donor site, not just the penis
• A complication and how it was handled

A surgeon who has done a lot of these has a house style, and it shows once you have looked at thirty photographs rather than three. In the consultations I have sat in on, the surgeons I came to trust brought up their revision cases before anyone asked. I would weight how a surgeon handles the results that went wrong as heavily as the ones that went right, because with phalloplasty something needing fixing is closer to normal than to unlucky. Choosing a surgeon goes further.