Female to Male (FTM)
Male to Female Gender Reassignment
Genital Surgery (GRS)
Male to Female Metoidioplasty
A. Metoidioplasty or Metaidoioplasty (phallic clitoral enlargement, stand to void)
The procedure confers the advantage of minimal surgery with preservation of natural sensation and erectile function. Donor site forearm scars avoided. Overweight patients may achieve greater length with pubic lipectomy which will recess the body surface line.
In this procedure the clitoral hood is lifted and the suspensory ligament of the clitoris is detached from the pubic bone, allowing the clitoris to extend out further. When the female tissues have been primed with testosterone, the clitoral head may resemble an adolescent glans penis, although the proportionality or size may be smaller.
The term “juvenile” sized phallus might be apt. If you have been on testosterone and experience clitoromegaly, self examination of your glans and clitoral body will give you a very good idea of what to anticipate post-operatively once surgical swelling subsides (6 to 8 weeks). Although visible engorgement may occur during arousal, the phallus is not suitable for penetration, nor is ejaculation possible.
For those patients who desire to void standing, the urethra is extended into the neo-penis. This may be accomplished simultaneously or performed secondarily using either a vaginal flap or buccal mucosal graft.
Please understand in that metoidioplasty involves a fair amount of tissue transfer, some degree of post-operative swelling is expected.
Complications may include but are not limited to less than anticipated length, torquing of the clitoris (usually amenable to release), loss of sensation, tissue necrosis, localized infection, persistent tenderness or hypersensitivity, transient or permanent narrowing of the vaginal opening which may render the vagina incapable of penile penetration, urethral narrowing, urethral obstruction, and urethral fistula (leakage of urine anywhere along the pathway of urethral extension). Between the first and second stages leading to urethral extension, voiding patterns and trajectory may vary.
Best results are achieved when the patient has previously had a laparoscopic assisted vaginal total hysterectomy with removal of tubes and ovaries, and this is followed by closure of the vagina (colpocleisis).
Fee $12,500. Please call for details.
B. Penile Implantation for the Neo-Phallus patient.
A penile prosthesis confers the wherewithal to penetrate which may be the defining moment for a successful conclusion to gender reassignment surgery. Clearly the intimacy of complete sexual contact is sought equally by patients and their partners.
Fee including inflatable prosthesis $15,000.
If a malleable implant is used, fee $8,500.
C. Insertion of Testicular Implants into Labia.
This should be performed as a procedure unto itself or with urethral extension to minimize complications. To prepare the labia majora for implantation, a tissue expander may be employed for a few months. This also creates a more pleasing scrotal appearance. Soft silicone implants are used and are available in varying sizes.
Fee including prostheses $6,000.
Example #1 – 1/1
Patient came to us for urethral extension, insertion of penile prosthesis, testicular implants and glans plasty (a recent post op photo).
Example #2 – 2/1
Example #3 – 3/1 and 3/2
Recent post-operative Metoidioplasty photographs from one of Dr. Reed’s patients.
Early photos of another Metoidioplasty patient.
Example #4 – 4/1 and 4/2
“Dr Reed, this picture was taken last week. I am very pleased with the results so far.
I’ll continue updating you on my progress.”
Example #5 – 5/1 through 5/11
Example #6 – 6/1 through 6/3
Surgery date for urethral extension without testis implants, September 19, 2005, photos taken on October 7, 2005. Some pubic fat obscures length. Patient needs to lose 35 pounds. First time voided, out came 500 cc (about 1/2 quart) with huge stream and excellent trajectory.
Example #7 – 7/1 through 7/3
Another metoidioplasty patient status post urethral extension and testicular implants. Excellent glans formation and manly shaft.
Testicular Implant on Genetic Male
Example #8 – 8/1 and 8/2
Testicular Implant on Genetic Male
Example #9 – 9/1 and 9/2
Two post op views
Phalloplasty: glans and coronoplasty Miami Munawar
Example # 10 – 10/1 through 10/7
Phalloplasty patient presents with attempted glans plasty which failed post early removal of sutures. Distal end of shaft is more flat than cylindrical.
The meatal grove was reconstituted and a glans plasty was performed. Following that the Norfolk modification (interposition of a skin graft) of the Munawar procedure was done. Without the graft a raw area had been known to heal with a contracting scar which pulled down the corona. The split thickness skin graft measuring about 8.5 X 1.2 cm is taken from the right groin parallel to the inguinal ligament in line with the cutaneous vessels to reduce scarring.
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