Metoidioplasty

Metoidioplasty or “meta” is a transmasculine genital surgery that utilizes existing genital tissue to create a neophallus by releasing ligaments around a testosterone- influenced clitoris giving the shaft more length.

It is recommended that patients are on testosterone for one year to stimulate tissue length and girth. Most surgeons are skilled in different types of metoidioplasty techniques, it is important to understand all your options to select the best procedure for you and your anatomy.

POSSIBLE SURGICAL PROCEDURES:

Phalloplasty

• Creation of phallus, average size is 1.5” to 3” 

Glansplasty

• Glansplasty is sculpting the head of the phallus

Vaginectomy

• Vaginectomy is the removal/partial removal of vagina

Monsplasty

• Monsplasty is the removal of excess skin and tissue from the pubic bone area

Urethroplasty

• Urethral lengthening, for urination though tip of neophallus

Scrotoplasty

• Scrotoplasty is the creation of a neo-scrotum

Testicular implants

• Testicular implants can be placed in the neo-scrotum to augment fullness and appearance

POSSIBLE GOALS & BENEFITS

• Internal and external congruency of one’s gender identity
• Preservation of tactile & erogenous sensation
• Standing to urinate
• Capable of erection

Metoidioplasty is considered less invasive and less risky than phalloplasty due to a single surgical stage, no large donor site, and length of recovery. If I patient desires urethral lengthening surgeons may recommend vaginectomy to help reduce complications.

It is possible to convert a metoidioplasty procedure to a phalloplasty later if goals change. If a patient desires a phallus larger than 1.5” - 3” and penetrative sex is important—phalloplasty should be discussed further.

FERTILITY

• Metoidioplasty can include hysterectomy - the removal of the uterus and ovaries.
• Having a family planning and fertility discussion with your care team is an important step in your surgery process.

Metoidioplasty

• No need for donor skin graft
• Less invasive
• Shorter recovery process
• Less complications and risks
• Patient’s report maintaining erogenous sensation
• Urethral lengthening allows for standing urination

Phalloplasty

• Donor site and flap used to create a phallus from patient
• More invasive procedure using microsurgical techniques
• Multiple surgeries and staged longer recovery
• Higher risk and complications are more common
• Urethral lengthening allows for standing urination

Patients who understand the surgical procedures for Phalloplasty often have a more successful consultation experience.

Your navigator will provide surgical education and help you prepare for consult. Talking through your expectations, desired outcome, and concerns can be helpful practice prior to seeing a surgeon.

It is essential that you and your surgeon agree on a surgical plan that will be gender affirming to you. 

It is important to note that desired outcomes may not be surgically possible due to anatomy and surgical limitations, please discuss possible limitations with surgeon for best understanding.

Bring a list of questions to ask your surgeon at the consultation to help you plan for your surgery and set expectations. If you don’t understand something, it’s okay to ask your surgeon to repeat or explain it in a different way.

Expectations

• What are common complications and how are they managed? 
• What are some possible changes to my sexual health and when can I be sexually active? 
• Will I have a catheter and for how long during recovery?
• If I get meta now, can I get phalloplasty later?

Planning

• What are the different types of meta options, and what is best for my goals?
• I want to stand and pee, what procedures and recovery planning is needed?
• Based on my goals, will my meta need to be staged in different surgeries?
• Where will my surgery take place and how long will it take? 
• How long will I need to take off work/school? 
• What medications or hormones do I need to alter or stop before surgery?  
• Will I need medical supplies?

Your PCP, surgeon, and Gender Health Navigator can help you achieve optimal surgical outcomes by actively preparing for your surgery and making sure expectations are surgically possible.

PHYSICAL HEALTH

• Maintain a healthy body weight, high body weight can increase complications and interfere with wound healing.
• Although there is not a strict Body Mass Index (BMI) requirement, your surgeon may discuss specific anesthesia risks or considerations, depending on your BMI. It is beneficial to reach your own personal sustainable goal weight prior to surgery

MENTAL HEALTH/WELLNESS

• Having surgery takes both physical and mental preparation.  Surgery is stressful, some people feel an increase in depression or anxiety after surgery. 
• If you notice any changes in your mood or sleep, especially with anesthesia, please discuss with your care team.
• If you struggle with mental health, reach out to your mental health provider or navigator for support.

SMOKING

• Nicotine intake by smoking, patches, chewing gum, or vaping may interfere with wound healing. If you use nicotine, you should discuss a quit date with your PCP and surgeon. Surgeons require patients to stop nicotine prior to surgery and may test for confirmation.
• If you inhale cannabis, it’s important to find another way to use it, for example, topical, edibles, and tinctures, or to stop altogether.

SUPPORT

Build your network of support with providers, family, and community to help you plan and organize your recovery prior to and after surgery

• Transportation to and from appointments 
• Meal planning and preparation
• Providing a calm and supportive healing space

Everyone heals differently.  Patients will experience:

• different levels of pain,
• bruising, swelling, and
• fluid drainage at incision sites.

Each aftercare recovery plan is catered to a patient’s unique medical needs. You will receive post-op care instructions from your surgeon, make sure to review these instructions with your surgeon, PCP, and navigator as needed.

For optimal results and to help avoid complications, it is essential to follow post-op directions and engage in follow-up care appointments as scheduled. Your surgeon will cover post-surgery topics, such as:

• Hormone changes and effect on hormone therapy
• When to resume exercise, physical, and sexual activity 
• Healing process & pain management 
• Complications

• Medicare A&B
• Full Scope Medi-cal
• San Francisco Health Plan (Medi-cal, Healthy Workers and Healthy Families)
• Anthem (Medi-cal)
• Healthy San Francisco (Health Access Program)