Phalloplasty & Metoidioplasty

Phalloplasty uses a piece of (non-genital) skin that is fully removed (free flap) or partially removed (pedicled flap) and then re-attached to the genital area to create a penis.

Depending on the surgeon, phalloplasty can be completed in a 'single stage' or multiple stages. Regardless, if we are seeking an erectile device and/or testicular implants, we will need at least two surgeries, if not more.

Going through all of the surgeries involved with phalloplasty can take at least 1-2 years, but for many people it can take longer than that. We should also factor in time for replacing erectile devices every few years as well.

Phalloplasty can be combined with:

• Urethral lengthening
  • In order to stand to pee
  • Usually performed by a surgeon who has completed a reconstructive urology fellowship
• Vaginectomy
  • Removal of the vaginal opening
• Scrotoplasty
  • Creation of a scrotum or ballsack
• Glansplasty
  • Creation of a ridge or head of the penis
• Mons reduction
  • Pubic area lift and debulking
• Insertion of testicular implants and erectile device

Metoidioplasty ('Meta'): frees the existing erectile tissue by cutting the tissue that holds it down against the body.

The penis might be enhanced by using nearby tissues to create more girth in “ring” and “centurion” methods, but generally length is dependent on growth from testosterone.

The penis can also loose length post op.

• No additional donor site, no large area of scarring
• Low risk of loss of sensation
• Often able to achieve unassisted erection
• Fewer stages
  • Generally only 1-2 surgeries

• May or may not be able to have penetrative sex depending on personal anatomy and growth from HRT (53% chance of being able to)

Metoidioplasty creates a small penis made out of the clitoris. It is usually done in one step, meaning one visit to the operating room (OR). The penis can become erect and stand up, but is usually between 1 and 2 inches in length. The penis size depends on the size of the clitoris before surgery, and how much it grows from T. Some of us use methods like pumping to try to get more growth.