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MTF Bottom Surgery San Francisco | Genital Surgery Bay Area
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In general, bottom surgery refers to the work done in order to augment the patient’s lower body, creating congruence with one’s gender identity, while improving self-confidence and self-image. Each patient will have different goals for their transition, so our team create a highly personalized set of procedures that will achieve the most seamless and satisfying outcome for transfemale, non-binary, and gender non-conforming individuals.

Among these treatments are:

Bottom Surgery with Dr. Safir


During this procedure, your surgeon will remove the testicles through an incision in the scrotum. Once the testicles are removed, the flow of testosterone is sustainably interrupted. Androgen-blockers will no longer be needed after orchiectomy.

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Here, the scrotal tissue is removed. This procedure is not compatible with vaginoplasty, but it can be performed at the same time as an orchiectomy.

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This procedure is sometimes performed for gender non-conforming clients who simply wish to no longer have a penis, but may not necessarily seek further genital feminization. For some individuals, penectomy is performed in conjunction with orchiectomy and scrotectomy in a procedure referred to as nullification.

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Vulvoplasty/Minimal Depth Vaginoplasty/Zero-Depth Vaginoplasty

During vulvoplasty, will construct a shallow vagina and vulva using the penile and scrotal tissues. Scrotal tissue is used for shaping the labia majora, while the glans of the penis is used to form a clitoris. A vaginal canal is not created, which is ideal for patients who do not desire penetration.

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During this treatment, we will construct a fully functioning vagina from the penile and scrotal tissues. Scrotal grafts and penile shaft tissue is used to form the vaginal walls. The urethra is then shortened and repositioned to confirm female urination patterns.

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Phallus-Preserving Vaginoplasty

For some individuals, preservation of the phallus is desired, while creating a fully functional vagina.

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Labiaplasty/Vaginal Revision

After a vaginoplasty, there can be some unpredictability in wound healing requiring revisional procedures, which are typically performed 1 year from the original operation. This may include labiaplasty (to create more distinct labia minora), fat transfer to labia majora, clitoral hood creation, clitoral resizing, monsplasty, scar contracture release of vagina, scar revisions, and vaginal deepening.

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What are the benefits of MTF bottom surgery?

  • Gender-confirming procedure
  • Provides the means to have enjoyable intercourse with a partner
  • Improves one’s self-image and personal confidence
  • Can lead to a profound sense of completion
  • Long-lasting outcome
  • Natural-looking aesthetic results

Who is an ideal candidate for genital surgery?

  • Has 2 letters of support from a mental health professional detailing the MTF patient’s transition journey
  • Has at least 1 year of real life experience living as desired gender.
  • Is of sound body and mind
  • Is a non-smoker
  • Has realistic expectations for her results
  • Is willing to follow post-op instructions to the letter
MTF Bottom Surgery San Francisco

What does recovery entail?

Since each procedure is different, the recovery for bottom surgery will vary widely from patient to patient. Rest assured that we will give you a detailed aftercare plan that is customized to your needs and will provide you with all the necessary pain medications and antibiotics so that you are completely comfortable and healthy as you recover from surgery.

What is the cost of bottom surgery?

The costs for gender reassignment surgery will vary depending on the number of procedures performed, the anesthesia, facility fees and surgeon’s fees.

As always, our surgical team will conduct a thorough physical exam and consultation, providing you with a customized quote for your treatment that takes into account all aspects of your care. Our office will assist you with securing the proper insurance coverage and any additional financing you may need from a variety of trusted healthcare lenders.

Why is Align Surgical in San Francisco the right choice for my bottom surgery?

Dr. Satterwhite, Dr. Pang, Dr. Gurjala, and Dr. Safir combine compassion and personalized attention with consummate skill as award-winning plastic surgeons. As the creator of Align Surgical Associates, Dr. Satterwhite himself is an accomplished and experienced authority in the field of gender-affirming procedures. He completed an elite residency in plastic surgery at the world-renowned Stanford Hospital, after which he further honed his abilities by pursuing a craniofacial fellowship under the guidance of the internationally respected Dr. Anthony Wolfe.

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