METOIDIOPLASTY

METOIDIOPLASTY
Sometimes referred to as meto or meta,
is an alternative to phalloplasty for
Transmen. With the effects of
testosterone treatment, the clitoris
enlarges to an average of 4-5 cm. The
enlarged clitoris is released from its
position and moved to more closely
approximate the position of a normal
penis.
The labia majora can be united to form a
scrotum where prosthetic testicles (usually
made of silicone) can be inserted. If a
metoidioplasty is performed without a
urethral lengthening or scrotoplasty
(formation of a scrotum from the labia
majora), this is sometimes called a clitoral
release. It does not allow for urination
(through the new penis) while standing. This
offers surgery with less risk because the
urinary system remains unaltered without a
urethral extension and still affords some of
the visual effects of a complete
metoidioplasty.
Metoidioplasty may additionally involve
a urethral lengthening procedure to
allow the patient to urinate through
the penis while standing. Surgeons
may employ tissue from the vaginal
area or from inside the mouth/cheeks
to create a urethral extension. Usually
a catheter is placed inside the urethral
extension for 2-3 weeks while the body
heals and adapts to the new
arrangement.
The vaginal cavity may or may not be closed
or removed (this is typically referred as
“vaginectomy”, “colpectomy”, or
“colpocleisis”). Often, a vaginectomy is
performed in conjunction with scrotoplasty
and/or urethral lengthening.
The typical operating time for a
metoidioplasty procedure is about 3-5 hours,
and may require additional follow-up
procedures and revisions at a later date.
Recovery time is usually between 2-4 weeks
with very limited activity.
 PROS CONS
ü Natural looking × Penis is usually quite
ü Erotically sensate penis small; often cannot be
ü Can achieve an used for penetration
unassisted erection × May not be good choice
when aroused for a transman whose
ü Doesn’t leave visible clitoris has not grown
scars on other parts of substantially as a result
of testosterone therapy
the body
of at least 6 months to 2
years
 RISKS
o Extrusion of testicular implants
o Formation of stricture
o Fistula
o Potential problems of infection and
tissue death
 COSTS and RECOMMENDATION
 Range in cost from about $2000 (for clitoris release
only) to $18000 (including urethral extension and
testicular implants), and perhaps more if
hysterectomy/oophorectomy is performed at the
same time.
 When considering a metoidioplasty procedure, it is
important to research the surgical options carefully
and discuss them with the surgeons you are
considering.
preoperative
appearance
 
Appearance of
the external
female
genitalia
before surgery.
Clitoris is
enlarged using
topical
dihydrotestoste
rone combined
with vacuum
device.
 
Marked lines
show incisions.
Urethral plate,
mucosal part
from urethral
opening and
glans cap, is
marked to be
wide. Labia
minora are
marked for
labial skin flaps
use.
 clitoral
lengthening
All clitoral
ligaments should
be divided to
lengthen clitoris.
These ligaments
are very well
developed and
make hooded
clitoris in normal
female. Division
should be radical
and includes
lateral and
suspensory
ligaments.
 
Urethral plate is
too short and
causes ventral
curvature. Plate
is mobilized
together with
spongiosal
tissue before
cutting to
prevent
extreme
bleeding.
 
 
 
Appearance after
division of
ligaments
dorsolaterally
and short
urethral plate
ventrally. Clitoris
is completely
lengthened.
Marked places on
the dorsum show
levels of
ligament
attachments.
 
Ventral aspect
after division of
the urethral
plate. Gap
between glans
cap and
urethral
opening is 6 cm
long. Bleeding is
minimal thanks
to very precise
dissection
of spongiosal
tissue
  

urethral
reconstruction
 
 
Reconstruction
of the bulbar
urethra. Well-
vascularized
vaginal flap is
created from
anterior vaginal
wall.
 
 
Vaginal flap and
urethral plate
are joined to
form bulbar
urethral part.
This way,
urethra is
lengthened.
 urethral
reconstruction -
buccal mucosa
Buccal mucosa
graft is placed
to cover the gap
between glans
cap and bulbar
urethra.
 
Appearance of
the donor site
after harvesting
the graft and
closure the
defect.
Buccal graft is
fixed to the
corporal bodies
by quilting
sutures. It is
very important
to prevent
haematoma
formations and
for better
survival of the
graft.
 urethral
reconstruction -
clitoral skin flap
Very long skin
flap is
harvested from
the dorsal
clitoral skin.
Flap is
harvested with
very wide
subcutaneous
vascularized
tissue
Flap is
transposed
ventrally by
button-hole
maneuver and
prepared to join
with buccal
mucosa graft.
Joining of the
skin flap and
buccal mucosa
graft. Glans is
also opened
for creation of
glandial part
of the urethra.
Urethral
reconstruction
is done. All
suture lines are
covered with
vascularized
tissue. It is
very important
in prevention
of fistula
formation
 urethral
reconstruction -
labia minora flap
Flap from inner
labial surface is
designed in
appropriate
size.
Flap is
dissected from
the border
between inner
and outer labial
surface. It is
attached to the
base for better
blood supply
support. One
edge is joined
with dorsal part
of urethra
formed from
buccal mucosa
graft
 
Urethra is
formed. Suture
lines will be
covered with
outer surface
of the labia
minora that
will be ventral
part of the
penile skin.
scrotoplasty/testicul
ar implants
Reconstruction
of the penile
skin is done.
Scrotum is
formed by
joining of both
labia majora.
Perineum is
created to be as
a male.
Testicle
implants are
inserted into
the scrotum
using two
similar
incisions at the
top of the
scrotum.
final aspects
Appearance
after surgery.
Penis is
positioned at
right position.
Very well
relationship
between penis
and scrotum is
achieved.
  
results
Outcome
three months
later.
Voiding in
standing
position.
Three years
after
metoidioplasty.