Gender Affirmation Surgery: Genital Reconstruction Procedures in Sydney

Gender Affirmation Surgery Sydney

Gender affirmation "bottom surgery" refers to a range of genital reconstructive procedures
These are complex procedures that require careful assessment, detailed consent, and planned follow-up
A consultation is required to confirm suitability, discuss options and alternatives, and explain risks
Outcomes vary and depend on anatomy, chosen technique, healing response, and post-operative care

Home » Gender Affirmation Surgery (Bottom Surgery)

Overview

Gender affirmation “bottom surgery” refers to a range of genital reconstructive procedures that can modify external and/or internal genital anatomy in line with an individual’s goals as part of gender affirmation care. These are complex procedures that require careful assessment, detailed consent, and planned follow-up. A consultation is required to confirm suitability, discuss options and alternatives, and explain risks, scarring, and recovery. Outcomes vary and depend on anatomy, chosen technique, healing response, and post-operative care.

Before and After Images

The outcomes shown are only relevant for this patient and do not necessarily reflect the results other patients may experience, as results may vary due to many factors including the individual’s genetics, diet and exercise.

Before After

Procedure: Corset Abdominoplasty (360)

Recovery Timeline: 4 Months

Before After

Procedure: Abdominoplasty, Breast Lift

Recovery Timeline: 3 Months

Before After

Procedure: Brachioplasty (Arm Lift)

Recovery Timeline: 2 Years

Before After

Procedure: Abdominoplasty

Recovery Timeline 4 Months

Before After

Procedure: Abdominoplasty, Breast Lift

Recovery Timeline: 3 Months

Before After

Recovery Timeline: 6 Months

Procedure: Abdominoplasty, Breast Lift

*It is important to note that individual results vary depending on factors such as anatomy, skin quality, surgical approach and healing response. The images shown are not intended to guarantee or predict the outcome of any procedure.

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About This Procedure

Bottom surgery is not one single operation. The most appropriate procedure (or staged plan) depends on anatomy, goals, health factors, and what is clinically suitable. Procedures are commonly discussed in two broad groups:

Male to Female (MTF) Procedures (selected cases)

These procedures may involve removal of testes and reconstruction of genital tissues to create external genital appearance and/or a vaginal canal, depending on the procedure selected.

Options that may be considered include: Orchidectomy (selected cases): removal of the testes. This may be performed as a standalone procedure or as part of a broader surgical plan. Vaginoplasty (selected cases): creation of a vaginal canal and external genital structures using established reconstructive techniques. Technique selection depends on anatomy and clinical factors. Vulvoplasty / “zero-depth” vaginoplasty (selected cases): creation of external genital structures without creating a vaginal canal. Labiaplasty / refinement procedures (selected cases): staged refinement of external tissues may be considered as part of the overall plan.

Female to Male (FTM) Procedures (selected cases)

These procedures may involve creation of a phallus or modification of existing genital tissues depending on individual goals and what is clinically suitable.

Options that may be considered include: Metoidioplasty (selected cases): modification of the hormonally enlarged clitoris; may be combined with additional procedures depending on goals (e.g., urethral lengthening in selected cases). Phalloplasty (selected cases): construction of a phallus using tissue from a donor site (often performed in stages). Technique and staging depend on anatomy, donor site suitability, and clinical planning.

Your surgeon will explain which options may be appropriate for you, expected limitations, and whether a staged approach is recommended.

Key Benefits

Gender affirmation bottom surgery refers to complex genital reconstructive procedures that may assist with aligning physical anatomy with gender identity. Outcomes vary significantly and depend on the procedure selected, individual anatomy, healing response, and post-operative care. These are major procedures with significant recovery demands, permanent scarring, and variable sensory and functional outcomes.

Individualised treatment plan based on clinical assessment
Potential observable changes depending on individual response
Structured approach with follow-up and adjustment

Ideal Candidate

A suitable candidate is generally a healthy adult with realistic expectations about variability and the need for aftercare. A consultation is required to confirm suitability.

Is in good general health and medically stable for major surgery.
Has capacity to commit to post-operative care and follow-up, including dilation protocols where relevant.
Has capacity to commit to post-operative care and follow-up, including dilation protocols where relevant.
Understands that sensory and functional outcomes vary and cannot be guaranteed.
If using nicotine, is willing to cease well in advance as nicotine may significantly increase complication risk.

Techniques & Approaches

The specific approach is selected based on individual assessment and clinical goals. Your clinician will discuss the most appropriate options during your consultation.

Reconstructive tissue design and grafting (selected cases)

skin grafts and/or tissue flaps may be used. Donor sites (where tissue is taken) will also heal and will scar.

Microsurgery (selected cases)

for some phalloplasty techniques, vessels and nerves may be connected using microsurgical methods to support tissue viability and potential sensory outcomes.

Nerve preservation strategies (selected cases)

where clinically appropriate, techniques aim to preserve key nerves; however, sensory outcomes vary and cannot be guaranteed.

Urethral reconstruction (selected cases)

may be required depending on the chosen procedure and goals. This can carry specific risks that will be discussed.

Anesthesia

Genital reconstruction procedures are generally performed under general anaesthesia in an appropriately accredited hospital facility. Procedure duration varies significantly depending on the type and stage of surgery. Anaesthetic and hospital requirements are confirmed after clinical assessment and surgical planning.

What we will cover in consultation

Your medical practitioner will explain:

review of medical history, gender affirmation goals, and coordination with your usual treating team.
discussion of procedure options which may include vaginoplasty, phalloplasty, metoidioplasty, or other approaches depending on individual goals.
explanation of surgical techniques, donor sites where applicable, expected scarring, and sensory considerations.
discussion of recovery demands, activity restrictions, follow-up care, and dilation protocols where relevant to the planned procedure.
detailed discussion of risks including bleeding, infection, tissue viability, urinary considerations, and the possibility of revision procedures.

Your surgeon will explain recommended incision placement, expected scarring, and the trade-offs of each approach during consultation.

Possible Risks and Complications

All surgical procedures carry risks and outcomes vary. Your surgeon will discuss risks specific to your procedure plan and health profile. Potential risks may include:

Potential risks and complications may include:

Bleeding, bruising, infection, delayed wound healing, Scarring concerns (including hypertrophic scarring in some individuals), Adverse reaction to anaesthesia, Tissue loss/compromised tissue viability (risk varies by technique, higher with nicotine use and some flap procedures), Urinary complications (e.g., strictures or fistulas), particularly where urethral reconstruction/lengthening is performed, Sensory changes (temporary or permanent); sensation and sexual function vary and cannot be guaranteed, Asymmetry, contour irregularities, or functional concerns requiring revision surgery (sometimes required, not guaranteed), Need for staged procedures and prolonged recovery depending on the surgical pathway

Preparation typically includes:

Complete all pre-operative assessments and clearances
Cease smoking and nicotine use well in advance
Follow fasting instructions for general anaesthesia
Arrange post-operative care and support at home

Recovery Milestones

Week 1

Recovery varies depending on procedure type and technique

Week 2

Compression garments and drains may be required

Week 2 - 6

Activity restrictions are typically required for several weeks

Week 6 - 12

Swelling resolves gradually over weeks to months

3 - 12 Months

Follow-up appointments for monitoring and scar care

Pricing & Estimate

Costs vary significantly depending on the procedure, technique, hospital and anaesthetist fees. A detailed written quote is provided after consultation once a surgical plan is confirmed. Medicare and private health insurance arrangements vary and will be discussed with you.

Disclaimer

Prices vary based on individual assessment. A personalised quote will be provided during consultation.

Starting From

Available on consultation

Indicative pricing only

Final exact cost will be confirmed after consultation.

Why Choose Us

At COSMEX, we combine advanced surgical expertise with personalized care to deliver natural, confident results. Your safety, comfort, and satisfaction are always our priority.

Specialist Plastic Surgeons

Our surgeons hold Fellowship of the Royal Australasian College of Surgeons (FRACS) in Plastic and Reconstructive Surgery. Each procedure is performed by qualified specialists with extensive training in cosmetic and reconstructive surgery. You are welcome to verify your surgeon's credentials via the AHPRA public register.

Accredited Surgical Facilities

All surgical procedures are performed in licensed, accredited hospitals in Sydney. Our facilities meet Australian standards for theatre safety, anaesthesia, infection control, and emergency care. Your safety is the foundation of every treatment plan.

Individualised Care

No two patients are the same. Every treatment plan at COSMEX is developed following a thorough one-on-one consultation where your anatomy, concerns, goals, and medical history are carefully assessed. You will receive a personalised recommendation — not a standardised package.

Structured Aftercare and Follow-Up

Your care continues well beyond the day of your procedure. COSMEX provides a structured aftercare program including scheduled follow-up appointments, access to your surgical team for questions during recovery, and long-term monitoring where clinically indicated.

Video FAQs

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Dr Sepher Lajevardi interview at the 2022 Plastic Surgery Congress