Female to Male Gender Transition Surgery in Ankara, Turkey

Female-to-male transition surgeries are a set of surgical procedures performed to align trans male individuals’ biological sex characteristics with a male identity. In this process, the goal is to reconstruct genital structures and achieve masculine body contours.

Mastectomy, meaning the surgical removal of breast tissue, is one of the primary first-step procedures. With this operation, the chest is flattened, a male-type thorax appearance is achieved, and nipple positioning is performed. Its aesthetic and psychological impact is quite high.

With hysterectomy (uterus) and oophorectomy (ovaries), the internal reproductive organs are removed. This step is important in terms of hormonal balance and legal gender recognition. After surgery, testosterone therapy supports the continuation of masculine characteristics.

Penis construction procedures can be performed with phalloplasty or metoidioplasty. Phalloplasty involves creating a penis via tissue transfer from different areas of the body, while metoidioplasty is performed by lengthening the clitoris that has grown with hormone therapy. Both methods are planned with urination and sexual function in mind.

What Is Female-to-Male Transition Surgery?

Female-to-male transition surgery is the surgical stage of the gender affirmation process performed in individuals who were assigned female at birth but have a male gender identity. In this process, chest surgery (mastectomy), removal of the uterus and ovaries, and genital reconstruction surgeries such as metoidioplasty or phalloplasty may be performed. The aim is to align the person’s physical characteristics with their gender identity and support psychological and social well-being. The process is planned by a multidisciplinary team.

In the Gender Affirmation Process, What Do Legal Procedures and Article 40 of the Turkish Civil Code Require?

In Turkey, gender affirmation surgeries are a serious procedure with a strict legal framework, beyond a personal request. This should not discourage you; on the contrary, these rules are a safety mechanism designed to ensure the process is carried out accurately and to avoid irreversible regret. Article 40 of the Turkish Civil Code is like the constitution of this process. For a surgeon to enter the operating room, it is essential that the legal and psychiatric preparation has been completed in full.

The court process and medical requirements are intertwined. The lawmaker wants to ensure that this decision is not a momentary impulse. For this reason, you are expected to meet certain conditions.

These conditions are:

• To have reached the age of 18
• To be single
• To have a transsexual structure
• Necessity in terms of mental health
• Lack of reproductive capacity

The age requirement is quite clear. Being declared legally adult at an earlier age by court decision, or gaining majority through marriage, is not considered valid in this process; the biological age must be over 18. Marital status is equally important. If there is an ongoing marriage, in order to avoid legal complexities and to protect the family structure, the marriage must be terminated before filing the gender change case.

The medical aspect is the part that requires the most patience. The court requests an official report proving that you truly have a transsexual structure and that this change is a necessity for your mental health. This report is not a simple paper obtained from any doctor. It must be issued by the medical board of a fully equipped training and research hospital. Generally, the follow-up process in psychiatry clinics lasting between 6 months and 2 years, your response to hormone therapy, and your social adaptation are decisive in this report. When all these steps are completed and the court grants “surgical permission,” the surgical process legally begins.

Which Methods Are Used for Mastectomy and Chest Masculinization Surgery?

In the gender affirmation process, the procedure that patients most often pursue first and that provides the fastest psychological relief is chest masculinization, also known as upper body surgery. Known as “top surgery,” the goal is not merely to remove breast tissue. The main objective is to create a masculine, muscular, flat, and natural-looking chest wall. Since every patient’s body is unique, there is no single correct method. Your surgeon determines a roadmap based on your current breast volume, skin quality, and rib cage structure.

Methods used for small-volume breasts include:

• Keyhole technique
• Periareolar technique
• Liposuction support

If the breast tissue is small and there is no significant skin laxity, “Keyhole” or “Periareolar” techniques can yield excellent results. What appeals most to patients is that scars can be well concealed. The incision is made along the border of the darker area around the nipple (areola). The breast tissue is removed through this small opening. However, this method has an important limitation: its capacity to remove skin is very low. If your skin is not elastic enough, or if the method is pushed in borderline cases, the skin may not retract well and unwanted fullness may occur. Therefore, this technique provides perfect outcomes only in a very selected patient group.

Methods used for larger-volume breasts include:

• Double-incision technique
• Free nipple graft
• Skin excision

For the vast majority of patients, the gold standard is the “Double Incision Mastectomy” technique. When the breast tissue is large or the skin is sagging, simply removing the inner tissue is not enough; excess skin must also be removed. In this surgery, horizontal incisions are made along the lower border of the pectoral muscle. The breast tissue is completely removed, the chest skin is tightened and flattened. The nipple is then repositioned as a free graft—meaning it is fully detached, reduced to a male-appropriate size, and grafted to its new location. Yes, a horizontal scar remains under the chest; however, it fades over time and typically becomes quite natural as it sits in the shadow of the chest contour.

What Is the Metoidioplasty Method and Who Is It Suitable For?

Genital reconstruction is the most complex stage from a surgical standpoint and requires the highest level of technical skill. Patient expectations are very important here. If the goal is lower surgical risk, faster recovery, and maximum preservation of sensation, metoidioplasty is a strong option. Testosterone used in the female-to-male transition process causes significant growth of the clitoris. In metoidioplasty surgery, this hormone-enlarged tissue is released from its surrounding attachments and freed and lengthened forward.

The advantages of this method include:

• Use of natural tissue
• Full preservation of sensation
• Lower complication risk
• Fast recovery
• No visible scars

The greatest benefit of metoidioplasty is that no “foreign” tissue is added to the body. Because the person’s own natural genital tissue is used, erogenous sensation and the ability to orgasm are preserved. Also, there are no large surgical scars on the leg or arm. However, the size of the constructed structure is generally limited. While it may allow standing urination (if urethral lengthening is performed), it is usually insufficient for penetrative intercourse. If the patient does not expect a “large penis” and prioritizes sensation above all, this method is ideal.

From Which Areas Is Tissue Taken for Penis Construction with Phalloplasty?

If the patient’s expectation is an adult-sized penis with enough volume and fullness for penetrative sex, then “Phalloplasty” comes into play. Phalloplasty is the creation of a penis from scratch by using a flap consisting of skin, fat, nerves, and blood vessels taken from another area of the body. This is an advanced procedure that requires microsurgery.

Common donor areas include:

• Inner forearm
• Front thigh
• Abdominal region
• Back region

The most widely accepted and commonly performed technique worldwide is the “Radial Forearm Free Flap” (RFFF). In this method, tissue from the inner forearm is used. Why the forearm? The forearm skin is thin, which allows easier shaping and facilitates urethra creation using the “tube-in-tube” method. More importantly, the nerve density in this area is high. When these nerves are connected via microsurgery to nerves in the genital region, the chance of developing touch and erogenous sensation in the new penis is quite high. The biggest disadvantage is that a visible scar will always remain on the arm.

Alternatively, the “Anterolateral Thigh Flap” (ALT) can be used. Tissue is taken from the upper leg to create the penis. This method is a good alternative for patients who do not want an arm scar or do not have adequate vascular anatomy in the forearm. However, thigh skin and the underlying fat are thicker. This can sometimes result in a thicker-than-expected penis, and the development of sensation may not be as refined as with the forearm. Using tissue advancement from the abdomen is a simpler technique, but it has limitations regarding sensation development and urethra construction:

How Is Urethroplasty Performed to Enable Standing Urination?

One of the most important parts of male identity in social and practical life is the ability to urinate while standing. During phalloplasty, not only the external appearance of the penis but also the urethra (urinary channel) must be created. Surgeons typically use the “tube-in-tube” technique. A portion of the harvested skin is rolled inward to form a tube (the urethra), and the remaining portion covers this tube to create the penile shaft.

Potential problems that can occur at this stage include:

• Fistula formation
• Development of strictures
• Weak urinary stream
• Infection
• Stone formation

Urethroplasty is the “Achilles’ heel” of the surgery, meaning it is the part with the highest risk of complications. Urine is a harsh, irritating fluid for healing tissues. The most common issue is a fistula. Small leaks can occur at the delicate junction where the newly constructed urethra meets the original urinary channel. This can cause urine to drip not from the tip, but from the base or a small opening along the shaft. Another risk is a stricture—narrowing of the urethra as it heals, leading to reduced urinary flow. Although these complications sound alarming, most are manageable. Some fistulas close on their own, and persistent fistulas or strictures can be corrected with minor revision procedures a few months after the primary surgery.

How Is the Aesthetic Appearance Completed with Glansplasty and Scrotoplasty?

A penis that is merely a cylindrical piece of tissue is not aesthetically satisfying. Details are crucial for a natural appearance. “Glansplasty” (glans shaping) and “Scrotoplasty” (scrotum creation) are the procedures that complete the look.

After phalloplasty, once tissues have fully healed and swelling has subsided—typically 6 months to 1 year later—an aesthetic refinement is performed at the tip. By folding the tissue onto itself or using specialized techniques, a circumcised glans appearance and the characteristic ridge (corona) are created. In later stages, medical tattooing can be used to adjust pigmentation and further enhance naturalness.

The scrotum is created from the patient’s existing “labia majora” tissue. This tissue is structurally very similar to male scrotal skin—darker and more folded. While the vaginal opening is being closed (vaginectomy), these tissues are brought together at the midline to form a pouch. To achieve male-typical fullness, silicone testicular implants are placed.

Features of the implants include:

• Silicone material
• Different size options
• Natural consistency
• Tissue compatibility

Implants selected in sizes appropriate to the person’s anatomy are secured with sutures inside the scrotum to prevent upward migration or displacement. This is the final touch that completes the masculine genital appearance and significantly boosts the patient’s self-confidence.

Which Types of Penile Prostheses Are Used for Sexual Function?

A newly constructed penis created by phalloplasty does not contain natural erectile tissue (the spongy structures that fill with blood to become rigid). Therefore, implantation of a “Penile Prosthesis” is necessary to provide the rigidity required for intercourse. This stage is planned after complete tissue healing and after sensation begins to return in the penile tissues—typically at least 1 year after phalloplasty. Patience is crucial, as rushing can increase the risk of infection.

The main types of prostheses available include:

• Semi-rigid (malleable) prostheses
• Inflatable prostheses

Semi-rigid prostheses are bendable rods. The penis remains in a constant degree of firmness but can be bent downward or upward. During intercourse, the patient positions the penis manually; afterward, it can be bent down to conceal it in underwear. The advantage is that there are no mechanical parts, so there is no risk of device failure, and it is very simple to use. However, the constant firmness can make concealment difficult in tight clothing, during sports, or in environments like the beach.

Inflatable prostheses provide the closest experience to a natural erection and are high-technology devices. The system consists of three parts: a fluid reservoir placed in the abdomen, a pump hidden in the scrotum, and cylinders placed inside the penis. When the patient wants an erection, they press the scrotal pump a few times; fluid transfers from the reservoir into the cylinders, and the penis becomes rigid. After intercourse, a button allows the fluid to drain back, and the penis returns to a soft, natural state. These prostheses offer excellent concealment and are not noticeable from the outside. However, since it is a mechanical system, there is a small possibility of technical malfunction:

What Should Be Considered During the Postoperative Recovery Period?

This surgical marathon does not end in the operating room; the recovery period is at least as critical as the surgery itself. In modern surgery, patients are no longer expected to remain bedridden for days. Thanks to “ERAS Protocols” (Enhanced Recovery After Surgery), patients are encouraged to get up and walk as early as possible—usually on the day of surgery or the next morning. Early mobilization improves circulation, reduces the risk of clots, and helps the bowels function.

Key points to follow during recovery include:

• Stopping smoking
• Protein-rich nutrition
• Wound hygiene
• Avoiding heavy sports
• Sexual abstinence

Smoking is the greatest enemy of this process. It blocks the small vessels that nourish tissues, impairs blood circulation, and can lead to loss (necrosis) of the newly constructed penis tissue or the nipple graft. Therefore, quitting smoking before and after surgery is vital. Nutrition is also a cornerstone of wound healing. A protein-rich diet provides the building blocks needed for tissue repair.

After chest surgery, patients typically stay in the hospital for 1–2 days. Wearing a chest compression garment for a period is important to reduce swelling and help the skin adhere to the chest wall. Drains (thin tubes that remove accumulated fluid) are usually removed within the first week. In phalloplasty and genital surgeries, the hospital stay is longer and can be 1–2 weeks. Flap perfusion is monitored hourly. Patients should avoid heavy sports, sexual activity, and movements that strain sutures for at least 6–8 weeks.

What Are the Long-Term Outcomes and Possible Risks?

Transparency is essential in communication with your plastic surgeon. While these surgeries can dramatically improve quality of life, they are not completely risk-free. Every surgical intervention carries inherent risks, and as a patient, you have the right to know them.

Potential risks include:

• Loss of reproductive capacity
• Permanent scars
• Loss of sensation
• Vaginal narrowing issues
• Nipple-related issues

Changing biological sex characteristics surgically means permanent loss of reproductive capacity; with removal of the ovaries and uterus, the possibility of biological parenthood ends. The patient must fully accept this reality. Surgically, there will be permanent scars at donor sites (arm or leg). Although these scars fade over time, they do not disappear completely. In addition, after vaginectomy (closure of the vagina), some issues with healing tissue (granulation) may occur at the site and small bleeding can be seen.