What is Metoidioplasty?
Metoidioplasty is a type of female to male bottom surgery that surgeons utilize to create a neophallus by enlarging the clitoris. This is done by the removal of the skin around the clitoris and allowing it to be released outside of the pubis to create the appearance of length. Patients are given the appearance of the “penis tip” or glans similar to the look of an uncircumcised penis.
Metoidioplasty can be performed on anyone with an enlarged clitoris following hormone therapy. Most plastic surgeons recommend undergoing testosterone therapy for at least two years before having metoidioplasty.
There are four basic types of Metoidioplasty used in gender affirmation surgeries:
Simple Release, or simple metoidioplasty, is a gender-affirming procedure that involves only clitoral release. This means the plastic surgeon will free the hormonally enlarged clitoris from the surrounding tissues and the labia minora to create the new penis. The surgeon will also cut the ligaments that connect the clitoris to the pubic bone.
The simple release procedure only works with the existing genital tissue but does not alter the urethra or vagina. It would also increase the length and exposure of the new penis.
Surgeons performing a full metoidioplasty release the testosterone-enlarged clitoris and use a tissue graft from the inside of the patient’s cheek to connect the urethra to the penis made through surgical creation.
During this procedure, the patient may also request another gender-affirming surgery, a vaginectomy. During a vaginectomy, the surgeon will remove the vagina and insert testicular implants or silicone implants.
The ring metoidioplasty is similar to a full metoidioplasty. However, the surgical procedures differ in the type of graft used to create the neopenis.
In ring metoidioplasty, the surgeon takes a skin graft from the inside of the patient’s vaginal wall combined with the labia majora. This graft will be used to connect the urethra and the penis.
The advantage of this procedure is the patient would only have to health at one site. There will also be fewer surgical complications when taking the skin graft from the vaginal wall as opposed to taking it from the mouth.
Some patients who have had a full metoidioplasty experienced pain while eating and decreased production of saliva following the surgical removal of tissue from the mouth to form the graft.
Centurion Metoidioplasty is a procedure that involves releasing the round and clitoral ligaments running up the labia from the labia major and using it to create extra girth for the neopenis.
Unlike other gender affirmation process, the Centurion metoidioplasty does not require any graft. This means there will be less pain and minimal complications.
Phalloplasty is another common form of lower surgery that gives female transsexuals a male genitalia. While metoidioplasty works with the existing tissues to create a natural-looking genitalia, phalloplasty take a large skin graft from the patient’s arm or leg to create the new penis.
Currently, the metoidioplasty or ring flap technique is the most advanced surgery available for female to male bottom surgical techniques. The surgery usually produces good results based on a variety of factors and patient considerations including, but not limited to, how much clitoris enlargement is achieved after the use of testosterone.
Urethral lengthening can also be done in tandem with metoidioplasty. This allows the patients to urinate standing up and it requires complete vaginal mucosa removal. In several patients, the removal of the fat and the skin of mons-pubis while simultaneously pulling the skin upwards will also help to improve the overall result.
In addition to the penis, a scrotum is also formed during the surgery. Patients may also opt for testicle prostheses to be added during the procedure but it is not required and may be done at a later time. It is important to note though that there is usually limited space for tissue expanders in the newly formed scrotum. Additionally, if urethral lengthening is also done then a patient must wait to have the prosthesis or expanders placed. The waiting time would be about 3 months. Metoidioplasty surgery leaves a curvilinear scar around the pubic hair. The scar is discreet though and will generally fade over time.
The initial metoidioplasty surgery may take anywhere from 2.5 to 5 hours, depending on the surgeon and the procedures to be performed.
Patients who opt to go with simple meta will be placed under constant sedation. Those having urethral lengthening or vaginectomy will likely be placed under general anesthesia.
Surgeons operating on patients who chose scrotoplasty would have to insert tools called tissue expanders into the labia during the first procedure. This prepares the surrounding tissue to accept the larger testicle implants to be put in place at least three months after the initial surgery.
In most cases, metoidioplasty is performed as an outpatient surgery.
Patients often choose the ring flap metoidioplasty surgery because it is a less invasive bottom surgery. It also preserves clitoris sensitivity and does not leave scars that are too visible.
Another big advantage of this procedure is that it does not rule out or prevent any future genital surgery from being done.
However, it is important to note that the penis will be smaller and not appear adult-sized. The created penis will also not be big enough for vaginal intercourse.
A board-certified plastic surgeon will take care to answer every question that a patient may pose before and after performing any procedures. It is often advised for a patient to list the questions on a paper in advance of the initial consultation.
Some key questions to ask a specialist plastic surgeon before any surgery include:
