More and more people are undergoing gender-affirming surgeries to bring their bodies into alignment with their gender identities. For transmasculine people, phalloplasty and metoidioplasty are the most common options for phallus creation.
Metoidioplasty uses existing clitoral tissue, which typically enlarges with testosterone therapy, to create a phallus. There are many different types of metoidioplasty, including simple meta, meta with scrotoplasty, and extended metoidioplasty.
This article focuses on extended metoidioplasty, including surgical techniques, what to expect during recovery, and important considerations for choosing the right surgical option and the right team of extended metoidioplasty surgeons.
Understanding Metoidioplasty: Goals and Techniques
What is Metoidioplasty?
Metoidioplasty is a surgical procedure designed to create a functional and aesthetically pleasing phallus for transgender men and nonbinary individuals. It uses the clitoral tissue, which typically enlarges due to testosterone therapy.
After a year or two of testosterone therapy, the clitoris usually grows to about 1 or 2 inches in length.
Extended Metoidioplasty vs. Simple Metoidioplasty
Extended metoidioplasty takes the simple release of the clitoris a few steps further. It involves additional procedures like urethral lengthening, scrotoplasty, and sometimes vaginectomy.
The goal of extended techniques is to improve functionality and aesthetics, leading to greater patient satisfaction.
Key Components of Extended Metoidioplasty
- Urethral Lengthening: This part of the surgery lets you stand to urinate. It involves using skin grafts from other parts of your body to extend the urethra.
- Scrotoplasty: Surgeons create a scrotum using the labia majora and can then place testicular implants for a more natural look and feel.
- Vaginectomy (optional): This involves removing the vagina. Some people choose to have this procedure for personal or aesthetic reasons, while others opt to keep the vagina intact.
The Surgical Procedure: A Step-by-Step Overview
Extended metoidioplasty is a complex, multi-stage procedure. Here’s a general overview of what you can expect:
Pre-operative Preparation
Before surgery, you’ll undergo:
- Psychological evaluation and counseling: This is to ensure you’re mentally prepared for the surgery and have realistic expectations about the outcome.
- Hormone therapy considerations: Your surgeon will likely want to optimize your testosterone levels before the procedure.
- Pre-surgical consultations and planning: You’ll have detailed discussions with your surgeon about your goals for the surgery, as well as the potential risks and complications.
Stages of the Surgery
The surgery itself typically involves these stages:
- Clitoral Release and Phallus Formation: This involves carefully dissecting and shaping the existing clitoral tissue to create a larger phallus.
- Urethral Lengthening: This is a crucial step where the urethra is extended using grafting techniques so you can stand to urinate.
- Scrotoplasty and Testicular Implants: The surgeon creates scrotal pockets and implants prosthetic testicles.
- Vaginectomy (if desired): This is the surgical removal of the vaginal canal, and it’s an optional part of the procedure.
Surgical Techniques and Approaches
Surgeons may use different techniques for:
- Urethral lengthening
- Scrotoplasty
A skilled surgeon will also prioritize nerve preservation to maximize sensation in the new phallus. Surgeons experienced in this procedure are often recognized for excellent sensory outcomes.
Recovery and Post-operative Care
Getting an extended metoidioplasty is a major surgery, so it’s important to understand what to expect during recovery.
Immediate Post-operative Period
After the first surgery, you’ll likely need to stay in the hospital for about a week.
Pain management is crucial during this time, and you’ll receive instructions on how to care for your wounds to prevent infection. It’s vital to follow these instructions carefully.
The surgical team will closely monitor you for any complications, such as infection, bleeding, or graft failure.
Rehabilitation and Long-Term Care
For about four weeks after the second surgery, you’ll have a catheter in place. You’ll return to the surgeon to have it removed.
Physical therapy can help with regaining strength and mobility, and occupational therapy can be beneficial for adapting to any changes in function. Scar management is also an important part of the healing process.
You’ll have regular follow-up appointments with the surgical team to monitor your progress and address any concerns.
Potential Complications and Their Management
As with any surgery, there are potential complications, including urethral stricture, fistula formation, infection, and implant complications.
If complications arise or if you’re not satisfied with the aesthetic outcome, revision surgery may be an option. Talk to your surgeon about the possibilities and what to expect.
Considerations, Risks, and Expected Outcomes
Undergoing any surgical procedure is a big decision. Here are some factors to consider when thinking about extended metoidioplasty.
Realistic Expectations
It’s important to have realistic expectations about the size and appearance of the phallus after surgery. While extended metoidioplasty aims to create a phallus that’s both functional and aesthetically pleasing, individual results can vary. You should discuss these potential variations with your surgeon before the procedure.
Potential Risks and Complications
Like all surgeries, extended metoidioplasty carries potential risks and complications. These can include infection, bleeding, nerve damage, and complications related to the graft. A skilled surgeon will thoroughly discuss these risks with you and explain how they can be minimized.
Choosing a Surgeon
Selecting an experienced surgeon specializing in gender-affirming surgeries is crucial for a successful outcome. Look for a surgeon with extensive experience in metoidioplasty and a strong understanding of the specific needs of transgender patients.
Factors to consider when choosing a surgeon include their qualifications, experience, and patient reviews. It’s also important to have open communication with your surgeon and a clear understanding of the surgical plan. Consider working with OHSU, which offers high-level expertise in phalloplasty and metoidioplasty.
Frequently Asked Questions
Can you penetrate after metoidioplasty?
Some individuals can achieve penetrative ability after metoidioplasty, particularly with the addition of procedures like scrotoplasty and placement of a penile implant, though other options like Caverject may also be explored. However, this varies depending on individual anatomy and the specific surgical techniques used. It’s best to discuss your goals with your surgeon.
How much does a full metoidioplasty cost?
The cost of metoidioplasty can vary widely depending on the surgeon, geographic location, and the specific procedures included (e.g., scrotoplasty, vaginectomy, urethral lengthening). Generally, you can expect the cost to range from $30,000 to $80,000 or more. It’s essential to get a detailed quote from your surgeon that outlines all potential expenses.
Does insurance cover metoidioplasty?
Insurance coverage for metoidioplasty is becoming more common, but it depends on your specific insurance plan and its policies regarding gender-affirming surgeries. Many insurance companies follow the World Professional Association for Transgender Health (WPATH) guidelines. You’ll likely need letters of support from mental health professionals. Contact your insurance provider directly to understand your coverage.
Can you get urethral lengthening with metoidioplasty?
Yes, urethral lengthening (UL) is a common component of metoidioplasty. UL allows individuals to urinate while standing. It involves extending the urethra through the newly formed phallus. This procedure can have a higher risk of complications, such as fistulas or strictures, so it is important to discuss the risks and benefits with your surgeon.
Who is the best FTM top surgeon in the US?
There’s no single “best” surgeon, as the ideal choice depends on individual needs and preferences. Factors to consider include the surgeon’s experience, specialization, surgical technique, patient reviews, and location. Researching surgeons and consulting with several before making a decision is important. Online transgender communities can provide valuable recommendations and insights.
Putting It All Together
Extended metoidioplasty is an option for creating a phallus with improved functionality and appearance.
If you’re considering this surgery, it’s important to plan carefully, have realistic expectations, and choose a surgeon with a lot of experience.
Remember that metoidioplasty is only one piece of the gender affirmation journey. It’s important to have a supportive care team throughout the entire process, from your initial consultation to your last follow-up.