Surgical techniques vary from surgeon to surgeon. This is the procedure common at GRS Montreal:

Some people choose to have erectile tissue release surgery without any additional procedures, while others may choose to have it in combination with additional procedures. 

Erectile tissue release:

Surgical techniques vary from surgeon to surgeon. Before surgery, testosterone is taken to enlarge the erectile tissue (clitoris). Some people choose to wait 2-3 years to achieve maximum growth before proceeding with surgery. 

The ligaments holding the erectile tissue (clitoris) in place under the pubic bone are cut, allowing the shaft to fall away form the body, giving it a more pronounced appearance

Fat may be removed from the pubis and skin may be pulled upward to bring your phallus forward.

Urethral lengthening:

Re-routing the urethra up through the tip of the penis, with the goal of allowing urinating from a standing position.

Lengthening may be done using nearby tissue (ie: inner labia) or buccal (cheek) tissue, depending on the individual.

Scrotoplasty:

The external genitals (labia or outer labia) may be shaped into a scrotum. 

Vaginectomy

Removal of internal genital (vaginal) tissue and closing of genital opening (vaginal canal).

Implants

Testicular implants may be placed inside the scrotum at a later stage, usually a minimum of six months after the initial surgery.