Phalloplasty Risks

It is important to note that most phalloplasty procedures require multiple surgical visits as well as some revisions, can be quite painful, require significant recovery time, and often leave large areas of visible scarring. Because of the nature of using skin grafts, there is always a risk of tissue death and loss of part or all of the penis. Other potential complications include the extrusion of testicular implants, the formation of a stricture (an abnormal narrowing; blockage) or fistula (an abnormal connection; leakage) in the newly constructed urethral passage, and infection. There may also be damage to the nerves of the donor area, resulting in numbness or loss of function. Erotic sensation may be changed or diminished. And the results may not be as aesthetically pleasing as one might like them to be. Also, one must consider the usual risks of any surgery, including bleeding, infection, problems from anesthesia, blood clots, or death (rare).
Phalloplasty procedures also tend to be very expensive (between $50,000 to $150,000) and are not typically covered by insurance.
However, if one desires an average-sized penis that looks acceptable in the locker room, through which he can urinate, and with which he can engage in penetrative sex, a phalloplasty is certainly a way to achieve that end. Additionally, many trans men do not feel complete without a penis, and so may pursue a phalloplasty with that in mind. It is often reported by trans men that the forearm free flap phalloplasty provides the most realistic-looking penis of the options currently available, if you are willing to accept the surgical risks and the forearm scarring.

Metoidioplasty Risks

The advantages of metoidioplasty are that it results in a natural looking (albeit small), erotically sensate penis. Additionally, since the clitoris is made of erectile tissue, the patient can achieve an unassisted erection when aroused. The procedure takes advantage of existing genital tissue, and doesn't leave visible scars on other parts of the body.
The disadvantages are that the resulting penis is usually quite small, and as such often cannot be used for penetration. It also may not be a good choice for a transman whose clitoris has not grown substantially as a result of testosterone therapy (most surgeons recommend being on testosterone therapy for at least 6 months to 2 years in order to maximize growth of the clitoris). And, as with any surgery, there are potential risks of complication, such as the extrusion of testicular implants, the formation of a stricture (an abnormal narrowing; blockage) or fistula (an abnormal connection; leakage) in the newly constructed urethral passage, and potential problems of infection and tissue death (though tissue death is less common in metoidioplasty as compared to phalloplasty). One must also consider the usual risks of any surgery, including bleeding, infection, problems from anesthesia, blood clots, or death (rare).
Metoidioplasty procedures range in cost from about $2,000 (for clitoral release only) to $18,000 (including urethral extension and testicular implants), and perhaps more if hysterectomy/oophorectomy is performed at the same time. Fees will vary among surgeons.
When considering a metoidioplasty procedure, it is important to research the surgical options carefully and discuss them with the surgeons you are considering. Each surgeon has a different approach and technique, and some may offer an array of options, such as clitoris release only, different types of scrotoplasty or urethral lengthening, etc. Also, if you are unsure if you wish to have additional genital surgery (such as phalloplasty) in the future, discuss with your surgeon which procedures will leave you with the most options for later surgery.

Metoidioplasty Infomations

(Also sometimes spelled "metaoidioplasty," a term meaning "a surgical change toward the male")Metoidioplasty--a surgical procedure developed in the 1970s--takes advantage of the fact that ongoing testosterone treatment in a trans man typically causes his clitoris to grow longer. The amount of clitoral growth varies with each individual, but it is not uncommon to see an increase in size to about the length of one's thumb. By cutting the ligament that holds the clitoris in place under the pubic bone, as well as cutting away some of the surrounding tissue, the surgeon is able to create a small phallus from the elongated clitoris. This is why metoidioplasty is sometimes referred to as a "clitoral free-up" or "clitoris release"-- the clitoris is freed from some of its surrounding tissue and brought forward on the body in a manner that makes it appear like a small penis. In order to further enhance the result, fat may be removed from the pubic mound and skin may be pulled upward to bring the phallus even farther forward.
Metoidioplasty may also involve the creation of a scrotum (scrotoplasty) by inserting testicular implants inside the labia majora, then joining the two labia to create a scrotal sac. This is often done in two stages, where in the first stage, tissue expanders are inserted in the labia in order to gradually stretch the skin in preparation for the insertion of permanent testicular implants at a later date. Some surgeons may insert the implants in the first procedure, and join the two labia in a later procedure.
Metoidioplasty may additionally involve a urethral lengthening procedure to allow the patient to urinate through the penis while standing. Surgeons may employ tissue from the vaginal area or from inside the mouth/cheeks to create a urethral extension. Usually, a catheter is placed inside the urethral extension for 2-3 weeks while the body heals and adapts to the new arrangement.
Depending on the surgeon and the desires/goals of the patient, the vaginal cavity may or may not be closed or removed (this is typically referred to as a "vaginectomy," "colpectomy," or "colpocleisis"). Often, a vaginectomy is performed in conjunction with scrotoplasty and/or urethral lengthening.
The typical operating time for a metoidioplasty procedure is about 3-5 hours, and may require additional follow-up procedures and revisions at a later date. Time required may differ depending on the options chosen by the patient (i.e., if he chooses scrotal implants and/or urethral lengthening), as well as the available tissue for the procedure, and the overall health and condition of the patient. Recovery time is usually between 2 to 4 weeks of very limited activity.

Metoidioplasty (Clitoral Release) By Michael L. Brownstein

Metoidioplasty is a procedure that enables the clitoris to be released from its "hood" and then appear as a small penis. A form of circumcision can be performed at this time to enable the tip of the clitoris to appear as the male glans.
Besides dehooding the clitoris, the undersurface of the structure, known as the chordee, must be freed of its dense fibrous tissue to allow the entire structure to be free of surrounding tissues and release it to allow more exposure. This technique may also provide some additional length, though it is somewhat limited in this regard. Care must be taken to avoid injury to the internal erectile tissues during removal of this fibrous band so as not to lose that important function.
The labia minora are used as flaps to provide protection of this denuded undersurface of the clitoris and to provide additional girth and circumference.
The labia majora are descended from their natural position using plastic surgical techniques, and pockets are created within them to allow the placement of testicular implants. This simulates a male scrotum with testicles. At a later stage, or in the initial procedure this divided scrotum may be joined centrally to have the appearance of a single scrotum with two testicles within. Expanders may be used to enlarge the "scrotal" pockets prior to placement of permanent implants, but this is usually not necessary. It does also require additional surgery. The testicular implants usually descend further on their own due to their weight and the effects of gravity.
As an option, along with metaidoioplasty the urethral may be advanced to the tip of the new penis. A vaginal mucosal flap is used for the extension of the urethral from the native urethral opening (without disturbing that opening directly and endangering sphincter function). In this situation the labial minora flaps are used to protect the vaginal flap urethral extension as well as provide girth. This procedure is more complex and entails additional risks such as fistula formation (urinary leakage).
It is important to recognize that this is not formal phalloplasty and that the result will depend in great part upon the size of the clitoris and its enlargement under the influence of hormones.