Q & A with Dr. Gallagher

Deciding on mtf bottom surgery is an overwhelming process for many transgender women.  There are so many factors to consider when deciding which surgeon to choose for surgery:  location, cost, comfortability, outcomes, aesthetics, experience, rate of complications, surgery style, willingness to work on higher BMI or other potential health complications, aftercare availability, and your overall comfort with his or her personality and bedside manner.  Once you’ve decided on a surgeon, you must also consider your surgical options.  Most people think of vaginoplasty when they think of MTF bottom surgery.

There are also three other options that are less commonly talked about when considering gender affirming surgery.  Some women are not interested in penetration, or the dilating and maintenance that accompanies vaginoplasty.  In particular, older ladies may be more interested in these  less invasive options for surgical affirmation.

MTF bottom surgery

I asked Dr. Gallagher to share her thoughts on the following four questions related to choosing the right MTF Bottom Surgery.

What are the different options for MTF bottom surgery?

What factors are important to consider for each one?


An orchiectomy is the most affordable and least invasive procedure available for MTF bottom surgery.  For some women, this is the only bottom surgery necessary. The orchiectomy  allows women to eliminate testosterone blockers, and estrogen doses may also be reduced. For those hoping to have vaginoplasty later on, this will not prevent you from pursuing additional surgery when you are ready.

Scrotoplasty and orchiectomy

This procedure removes the testicles and the scrotal skin. This is only recommended for patients who will not be undergoing vaginoplasty in the future. Because the wound is slightly bigger, it is a little more invasive than an orchiectomy.  Surgery is completed in one hour, and recovery time before returning to work is typically 1-2 weeks or less.

Zero depth procedure

Zero depth procedure is less invasive and much less likely to cause rectal injury or other complications. This surgery includes all of the steps involved in vaginoplasty (removal of testicles, scrotoplasty, labia pasty, clitoroplasty, shortening of the urethra), except for the creation of a new vagina between the bladder and rectum. This is ideal for women who are not interested in penetration, and wish to avoid the upkeep involved with a new vagina.

What is the most common mtf bottom procedure you do?

Orchiectomy is the most common procedure I do. This is often because many of our patients still sadly don’t have insurance coverage for their full bottom surgery. Orchiectomy is much more affordable for these folks and doesn’t take away any options.

What else is important to know about the various bottom procedures?

It is important to remember that with every surgery there are risks, downtime and in some cases a lot of care required. In order to have a happy vagina that will serve you well, it must be taken care of properly.  You must be able to commit the time necessary to do the dilation, take the time off to recover, and have a good support system of friends and family to get you through this demanding surgery.

For folks who are not at a point in their lives where they can commit to this level of post-surgery-self-care, the other options described above may be more appropriate.