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Metoidioplasty Surgery

Metoidioplasty, or “meta” for short, is a good option for trans men who do not want to undergo phalloplasty. The average length of a phallus after metoidioplasty is about 4-6 cm. This is long enough to direct a stream while standing.

Metoidioplasty surgery generally involves releasing a hormonally (Testosterone) enlarged clitoris, urethroplasty (lengthening the urethra to the tip of the phallus), and covering the phallus with neighboring skin. It may be combined with vaginectomy and scrotoplasty.

A metoidioplasty without urethroplasty is called a simple meta. The patient will void from their native urethra.

Metoidioplasty Photos

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How Dr. Crane Performs Metoidioplasty

Dr. Crane developed his metoidioplasty technique after completing his self-made transgender surgery fellowship with Dr. Djordjevic in Serbia and Dr. Hoebeke, a member of Dr. Monstrey’s team, in Belgium.  It is no coincidence that Dr. Crane, Dr. Hoebeke and Dr. Djordjevic all have urologic surgery backgrounds.  Urologists commonly treat a condition called hypospadias, which is a birth defect resulting in abnormal development of the urethra. The consequence can be a mild defect where the urethral meatus (opening to the urethra) location is under the phallus and a short distance away from the tip of the phallus, or it can be more severe with the opening as far posterior as the female urethral opening.  Dr. Crane has extensive experience in various hypospadias surgeries. Many of the same surgical principles that are used to lengthen the urethra to the tip of the penis in hypospadias repairs are utilized in performing metoidioplasty.  Instead of offering all patients one procedure for metoidioplasty, Dr. Crane is proficient in many different types of metoidioplasty to best suit the patient’s anatomy.  He takes into consideration the size of the clitoral hood, urethral plate, and neighboring tissue to maximize the aesthetic result.  Dr. Crane also performs a complete vaginectomy to create an anatomically male perineum. Some metoidioplasty surgeons do not perform complete vaginectomy and leave a drainage hole for the remaining vaginal mucosa.

Scrotoplasty is performed using rotational flaps of the labia majora so that the scrotum is anterior in the anatomic male position. Testicular implants can be placed 6 months after scrotoplasty to minimize risk of implant erosion. If the patient desires a larger scrotum, tissue expanders can be placed prior to scrotoplasty.

Urethral lengthening (UL) can be performed but it is optional. Patients who opt for UL are able to stand to void with metoidioplasty if they are close to their ideal body weight. Heavier patients will likely have more difficulty standing to urinate due to excess neighboring soft tissue and skin. Some patients may choose no urethral lengthening if they do not desire to void standing. They would therefore get a simple metoidioplasty (meta without UL). Some patients opt for a simple release with or without scrotoplasty, and others prefer to avoid vaginectomy.

Patients should plan on staying in town for 10-12 days after a metoidioplasty with urethral lenghthening. It is typically an outpatient procedure (patient goes home the day of surgery).

Metoidioplasty vs. Phalloplasty

Patients often have difficulty deciding on metoidioplasty versus phalloplasty with or without urethral lengthening.  When Dr. Crane counsels patients on their options, his goal is to have the happiest patients possible and at the same time, minimize their risk and cost.  He approaches the choice by asking patients what is most important to them:

  • How important is standing to urinate? If this is very important, you will definitely want urethral lengthening, via metoidioplasty or phalloplasty. If a patient is not near their ideal body weight, meta may not allow a patient to stand to urinate.
  • How important is size? If a 4-6 cm phallus is adequate, meta is a less expensive surgery with less risk.
  • How important is penetration with intercourse? Most meta patients cannot have meaningful penetration during intercourse. If penetration is very important, phalloplasty should be strongly considered.

NOTE: Phalloplasty can be undertaken after metoidioplasty, but if phalloplasty is the long term goal, Dr. Crane’s technique of free flap phalloplasty does not require patients to first have a metoidioplasty performed first.

For more information about having metoidioplasty surgery with Brownstein and Crane Surgical Services, please contact us.

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