Metoidioplasty : Ring flap technique
Metoidioplasty is one of the most common lower surgeries for a female to male transition. It is a surgical procedure to create a neophallus or a new penis. The procedure involves removing the surrounding skin of the clitoris and releasing it from the pubis to give the appearance of more length. This gives the appearance of the glans ‘tip of the penis’ as a circumcised penis in most patients. The final result is a normal-appearing but small penis.
Metoidioplasty is the creation of a penis from a hormonally enlarged clitoris. During a metoidioplasty, the clitoral ligaments are detached which allows the clitoris to lengthen and drop into a position similar to that of a cisgender penis. On average metoidioplasty creates a penis that is between 5 and 7 centimeters long.
The ring flap method for metoidioplasty is the most advanced method currently available. This method surgery usually yields a very favorable result. The actual result will depend on various factors, as described below. The outcome is mostly dependent upon how much enlargement of the clitoris has occurred after using testosterone. Urethral lengthening can also be done at the same time or later, to allow the patient to stand to urinate. Urethral lengthening requires complete removal of the vaginal mucosa. The best results from the metoidioplasty are in patients who are thin or near their ideal body weight. In most patients, removal of the skin and fat of the mons-pubis and pulling the skin upwards will improve the result. This procedure will leave a curvilinear scar in the pubic hair and is usually done as a second stage when the expanders are replaced with a permanent testicular prosthesis.
The principal advantage of the ring flap metoidioplasty is that it is less invasive, maintains the sensitivity of the clitoris, and does not create apparent surgical scars. Furthermore, it does not prevent future genital surgery from being done at a later time should one decide. The penis will not, however, appear adult in size, and it is not large enough for vaginal intercourse. The formation of the scrotum (Scrotoplasty) is done during the metoidioplasty. Should you desire, prostheses for testicles could be placed at this time or a later date, since there is frequently only limited place for two tissue expanders in the new scrotum. The permanent prosthesis can be placed in the scrotum at the same time. There is probably no harm in placing two testicular prosthesis. If urethral lengthening is done, the patient must wait three months to have expanders or prosthesis placed.
There are two options of metoidioplasty procedures
- Simple release. This operation releases the clitoris free from the surrounding tissue. And does not extend the urethral or close the vagina. The appearance of the penis is more natural but limited in its length.
- Full metoidioplasty, this procedure releases the clitoris and then uses a tissue graft from inside your vagina and a ring flap of the vulva to make the urethra with the neophallus. If desired, the surgeon may also perform vaginectomy and scrotoplasty at the same procedure.
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| Figure 1. | Figure 2. |
| Schematic of the ring flap Figure | Schematic of full metoidioplasty with ring flap and testicular implants |
Benefits of metoidioplasty include:
- Metoidioplasty usually has a slightly lower risk of complications than phalloplasty.
- Metoidioplasty is usually more affordable.
- This procedure offers a shorter healing time.
- The phallus created by metoidioplasty has natural erectile function, and there is no need for a penile prosthesis.
- Erotic sensitivity of the clitoris is maintained in the phallus.
- It has lower complication rates and requires fewer procedures, even with urethroplasty.
- It does not result in large scars.
Who is a good candidate of Metoidioplasty?
- Good Health with physically + emotionally stable and realistic expectations.
- Take homone therapy until the clitoris growth at least 2-3 cm.
- Real life experience.
- Psychiatrist letter.
- Must be over 20 years old.
Prepareation for Metoidioplasty
- Consultation with the surgeon to discuss your surgical goals, medical conditions, and treatments.
- Stop smoking and drinking alcohol for at least 2 weeks before surgery.
- Stop medicines, vitamin, or herbs that interfere with blood clotting, such as aspirin
Post-Op
1- After surgery, the patient will be kept in the PACU (post-anesthesia care unit) for 3-4 hours to recover from the anesthesia. They will then be moved to a hospital room.
2- The patient should dress the surgical site every day and remove stitches after 7 days.
3- The catheter should be kept in place for at least 3 weeks to allow the urethra to heal properly.
4- After the catheter is removed, the patient can urinate normally, including standing to urinate if desired.
5- The patient should dilate the urethra for at least 3-6 months to prevent scarring at the urethral junction.
6- It is important to keep the surgical site clean to prevent infection.
Risk and Complications
Risk and complications: Complications from metoidioplasty vary in severity. Minor complications may be resolved through minor supportive care, while more serious complications may require surgical correction. As with other surgical procedures, metoidioplasty has the possibility of causing infection, bleeding, blood clots, damage to surrounding tissues, pain, as well as negative reactions to anesthesia or other required medications.
If urethral lengthening is performed, urethral complications such as urethral leakage may occur. Patients who experience post-void incontinence or dribbling following surgery should observe within 3 months. The junction of urethral lengthening, between the skin graft and the urethra, may result in scarring which can make urination difficult and uncomfortable. The surgeon may recommend dilating the urethra using a catheter daily for at least 3-6 months.
Getting to Know for Body Sculpting Surgery / Liposuction
Metoidioplasty versus Phalloplasty
Metoidioplasty versus Phalloplasty
Before and After Metoidioplasty
Why Kamol Cosmetic Hospital is popular for Metoidoplasty?
First, the hospital has a team of highly skilled and experienced surgeons who have successfully performed numerous metoidioplasty procedures. This is important because metoidioplasty is a complex surgery that requires a surgeon with a high level of expertise in order to achieve optimal results.
Second, the hospital has state-of-the-art facilities and equipment. This ensures that the surgery is performed safely and efficiently, and that patients receive the best care possible.
Third, Kamol Cosmetic Hospital has a reputation for excellent patient care. The hospital's staff is known for being kind, compassionate, and attentive to the needs of their patients. This can be especially important for patients who are undergoing a significant and potentially emotionally challenging procedure like metoidioplasty.
Fourth, the hospital is located in Thailand, which is a popular destination for medical tourism. Many people travel to Thailand for metoidioplasty because the cost of the surgery is significantly lower than in other countries. Kamol Cosmetic Hospital is well-equipped to handle international patients, with staff who are fluent in English and other languages.
Finally, Kamol Cosmetic Hospital has a high success rate for metoidioplasty procedures. This means that patients who undergo surgery at the hospital are more likely to be satisfied with the results and experience fewer complications. All of these factors contribute to the hospital's popularity for metoidioplasty.
Why Thailand is a plastic surgery destination?
Thailand is a top destination for plastic and cosmetic surgery, as it is the high quality and specialist skills of the surgeons, they provide first-class hospital treatments, and the affordable cost all add up to a satisfying all-around package. There is also the added temptation to recover post-procedure in luxury hotels or recovery service apartments
