Female to Male Sex reassignment surgery

The initial metoidioplasty surgery can take anywhere from 2.5 to 5 hours depending on the surgeon and on which procedures you choose to have as part of your metoidioplasty.

If you’re seeking out simple meta only, you’ll likely be placed under a conscious sedation, meaning that you’ll be awake but mostly unaware during the surgery. If you’re having a urethral lengthening, hysterectomy, or vaginectomy performed as well, you’ll be placed under general anesthesia.

If you choose to have scrotoplasty, the doctor may insert what are known as tissue expanders into the labia during the first procedure in order to prepare the tissue to accept the larger testicle implants during a follow-up procedure. Most surgeons wait three to six months to perform the second surgery.

Most doctors perform metoidioplasty as an outpatient surgery, meaning you’ll be able to leave the hospital on the same day that you have the procedure. Some doctors may request that you stay overnight following your surgery.

As with any surgery, the recovery process will vary from person to person and from procedure to procedure.

While recovery times vary somewhat, you’re likely to be out of work for at least the first two weeks. As well, it’s generally recommended that you don’t do any heavy lifting for the first two to four weeks following surgery.

In general, doctors typically advise against travel between 10 days to three weeks after the procedure.

Apart from the standard issues that may arise from having surgery, there are a few potential complications you may experience with metoidioplasty. One is called a urinary fistula, a hole in the urethra that can cause leakage of urine. This can be repaired surgically and in some instances may heal itself without intervention.

The other potential complication if you’ve chosen scrotoplasty is that your body may reject the silicone implants, which may result in needing to have another surgery.

There are several procedures that can be performed as a part of metoidioplasty, all of which are completely optional. describes these procedures as follows:

Clitoral release

The ligament, the tough connective tissue that holds the clitoris to the pubic bone, is cut and the neophallus is released from the clitoral hood. This frees it from the surrounding tissue, increasing the length and the exposure of the new penis.

Vaginectomy

The vaginal cavity is removed, and the opening to the vagina is closed.

Urethroplasty

This procedure reroutes the urethra up through the neophallus, allowing you to urinate from the neophallus, ideally while standing up.

Scrotoplasty/testicular implants

Small silicone implants are inserted into the labia to achieve the look and feel of testicles. Surgeons may or may not suture the skin from the two labia together to form a joined testicular sac.

Mons resection

A portion of the skin from the mons pubis, the mound just above the penis, and some of the fatty tissue from the mons are removed. The skin is then pulled upward to shift the penis and, if you choose to have scrotoplasty, the testicles further forward, increasing the visibility of and access to the penis.

It’s entirely up to you to decide which, if any, of these procedures you would like to have as a part of your metoidioplasty. For instance, you may wish to have all of the procedures performed, or you may wish to undergo the clitoral release and urethroplasty, but retain your vagina. It’s all about making your body align best with your sense of self.

A phalloplasty is the construction or reconstruction of a penis. The phalloplasty is a common surgical choice for transgender and nonbinary people interested in gender confirmation surgery. It’s also used to reconstruct the penis in cases of trauma, cancer, or congenital defect.

The goal of a phalloplasty is to build a cosmetically appealing penis of sufficient size that is capable of feeling sensations and releasing urine from a standing position. It’s a complex procedure that often involves more than one surgery.

Phalloplasty techniques continue to evolve with the fields of plastic surgery and urology. Currently, the gold standard phalloplasty procedure is known as a radial forearm free-flap (RFF) phalloplasty. During this procedure, surgeons use a flap of skin from your forearm to build the shaft of the penis.

During a phalloplasty, doctors remove a flap of skin from a donor area of your body. They might remove this flap entirely or leave it partially attached. This tissue is used to make both the urethra and the shaft of the penis, in a tube-within-a-tube structure. The larger tube is basically rolled up around the inside tube. Skin grafts are then taken from inconspicuous areas of the body, where they will leave no visible scars, and grafted on to the donation site.

The female urethra is shorter than the male urethra. Surgeons can lengthen the urethra and attach it to the female urethra so that urine will flow from the tip of the penis. The clitoris is usually left in place near the base of the penis, where it can still be stimulated. People who can achieve orgasm before their surgery can usually still do so after their surgery.

A phalloplasty, specifically, is when surgeons turn a flap of donor skin into a phallus. But generally, it refers to a number of separate procedures that are often done in tandem. These procedures include:

• a hysterectomy, during which doctors remove the uterus
• an oophorectomy to remove the ovaries
• a vaginectomy or vaginal mucosal ablation to remove or partially remove the vagina
• a phalloplasty to turn a flap of donor skin into a phallus
• a scrotectomy to turn the labia majora into a scrotum, either with or without testicular implants
• a urethroplasty to lengthen and hook up the urethra inside the new phallus
• a glansplasty to sculpt the appearance of an uncircumcised tip
• a penile implant to allow for erection

There is no single order or timeline for these procedures. Many people do not do all of them. Some people do some of them together, while others spread them out over many years. These procedures require surgeons from three different specialties: gynecology, urology, and plastic surgery.

When looking for a surgeon, you may want to look for one with an established team. Before any of these medical interventions, talk to your doctor about fertility preservation and impact on sexual functioning.

The difference between the prevailing phalloplasty techniques is the location from which the donor skin is taken and the way in which it is removed and reattached. Donor sites can include the lower abdomen, groin, torso, or thigh. However, the preferred site of most surgeons is the forearm.

Radial forearm free-flap phalloplasty

The radial forearm free-flap (RFF or RFFF) phalloplasty is the most recent evolution in genital reconstruction. In a free flap procedure, the tissue is completely removed from the forearm with its blood vessels and nerves intact. These blood vessels and nerves are reattached with microsurgical precision, allowing blood to flow naturally to the new phallus.

This procedure is preferred to other techniques because it provides excellent sensitivity along with good aesthetic results. The urethra can be constructed in a tube-within-a-tube fashion, allowing for standing urination. There is room for the later implantation of an erection rod or inflatable pump.

The chances of mobility damage to the donor-site are also low, however skin grafts to the forearm often leave moderate to severe scarring. This procedure is not ideal for someone worried about visible scars.

Anterior lateral thigh pedicled flap phalloplasty

The anterior lateral thigh (ALT) pedicled flap phalloplasty is not the leading choice of most surgeons because it results in a much lower level of physical sensitivity in the new penis. In a pedicled flap procedure, the tissue is separated from the blood vessels and nerves. The urethra can be restructured for standing urination, and there is ample room for a penile implant.

Those who have undergone this procedure are generally satisfied, but report low levels of erotic sensitivity. There is a higher rate of urinary and other complicationsTrusted Source with this procedure than with RFF. The skin grafts can leave significant scaring, but in a more discrete place.

Abdominal phalloplasty

The abdominal phalloplasty, also called the supra-pubic phalloplasty, is a good choice for trans men who don’t require a vaginectomy or a restructured urethra. The urethra will not go through the tip of the penis and urination will continue to require a seated position.

Like the ALT, this procedure does not require microsurgery, so it is less expensive. The new phallus will have tactile, but not erotic sensation. But the clitoris, which is preserved in its original location or buried, can still be stimulated, and a penile implant can allow for penetration.

The procedure leaves a horizontal scar stretching from hip to hip. This scar is easily hidden by clothing. Because it does not involve the urethra, it is associated with fewer complications.

Musculocutaneous latissimus dorsi flap phalloplasty

A musculocutaneous latissimus dorsi (MLD) flap phalloplasty takes donor tissue from the back muscles underneath the arm. This procedure provides a large flap of donor tissue, which allows surgeons to create a larger penis. It is well-suited for both a restructuring of the urethra and the addition of an erectile device.

The flap of skin includes blood vessels and nerve tissue, but the single motor nerve is less erotically sensitive than the nerves connected with RFF. The donor site heals well and is not nearly as noticeable as other procedures.