i haven't had mine yet, but my partner had her bofaectomy almost two years ago.

• it wasn't difficult finding a place to do it, though we do live just a few hours from san francisco, and i've had friends fly across the country to get bottom surgery there.
• recovery was not too bad, all told. it's a one day procedure that left her uncomfortable, but perfectly lucid on the ride home, so in some ways, it was less disruptive than getting her wisdom teeth out a few years before. she did have to stay off her motorcycle for like a month though, which sucked.
• idk if taking the skin is an option, but she still has it. if you're considering a vaginoplasty down the road, you'll want the material around, as it opens up a lot of options. that said, without anything to weigh it down, it shrinks quite a lot on its own.
• it was entirely covered by Medi-Cal for us. I think she had to get signed off for it by a couple different doctors. The only costs to us were in the transportation aspect. Maybe a few hundred bucks in gas, road snacks, and ice packs.
• she took ibuprofin for pain for a few days afterwards, but no significant long term changes to her meds were needed. that said, if you aren't already on some form of hrt, you ought to be afterwards, lest your bones wither away.