Metoidioplasty or Female to Male (FTM) Bottom Surgery
What is Metoidioplasty?
Metoidioplasty is a type of female to male bottom surgery that surgeons utilize to create a neophallus by enlarging the clitoris. This is done by the removal of the skin around the clitoris and allowing it to be released outside of the pubis to create the appearance of length. Patients are given the appearance of the “penis tip” or glans similar to the look of an uncircumcised penis.
In the end, the result is a natural-looking small penis.The Metoidioplasty procedure is a common bottom surgery in the female to male transition.
Is Metoidioplasty the standard procedure for FTM bottom surgery?
Currently, the metoidioplasty or ring flap technique is the most advanced surgery available for female to male bottom procedures. The surgery usually produces good results based on a variety of factors and patient considerations including, but not limited to, how much clitoris enlargement is achieved after the use of testosterone.
Urethral lengthening can also be done in tandem with metoidioplasty. This allows the patients to urinate standing up and it requires complete vaginal mucosa removal. In several patients, the removal of the fat and the skin of mons-pubis while simultaneously pulling the skin upwards will also help to improve the overall result.
In addition to the penis, a scrotum is also formed during the surgery. Patients may also opt for testicle prostheses to be added during the procedure but it is not required and may be done at a later time. It is important to note though that there is usually limited space for tissue expanders in the newly formed scrotum. Additionally, if urethral lengthening is also done then a patient must wait to have the prosthesis or expanders placed. The waiting time would be about 3 months.Metoidioplasty surgery leaves a curvilinear scar around the pubic hair. The scar is discreet though and will generally fade over time.
What are the advantages of metoidioplasty?
Patients often choose the ring flap metoidioplasty surgery because it is a less invasive bottom surgery. It also preserves clitoris sensitivity and does not leave scars that are too visible.
Another big advantage of this procedure is that it does not rule out or prevent any future genital surgery from being done.
However, it is important to note that the penis will be smaller and not appear adult-sized. The created penis will also not be big enough for vaginal intercourse.
Types of metoidioplasty techniques?
There are two recognized types of metoidioplasty procedures.
- Simple release – In this version the surgery releases the clitoris without touching any of the surrounding tissue. There is no urethral extension and the vagina is not closed. When utilizing this procedure, the penis looks slightly more natural but the length is limited.
- Full metoidioplasty – If patients opt for this procedure, the clitoris is released and then a tissue graft is done from inside the vagina. The vulva’s ring flap is used to create the urethra alongside the neophallus. During this type of surgery, the patient may also opt to have the surgeon perform a scrotoplasty and vaginectomy at the same time.