Phalloplasty vs. Metoidioplasty: Understanding Gender-Affirming Surgical Options

In their journey towards gender affirmation, individuals may seek surgical procedures that align their physical appearance with their true identity. Two common options for individuals seeking masculinizing bottom surgery are phalloplasty and metoidioplasty. These procedures are performed at Reconstructive Surgical Arts and offer transformative opportunities for transgender and non-binary individuals, providing them with a sense of self that is congruent with their inner identity. 

It can be difficult to understand the difference between these gender-affirming surgeries. In this blog, we’re going to give you expert insights and information about both procedures.

Understanding Phalloplasty

Phalloplasty is a complex surgical procedure that involves constructing a neophallus, or new penis, using various tissue grafts. During the surgery, doctors use tissue from another part of the body, like the forearm or thigh, to create a new penis. The choice of technique depends on factors such as patient preference, anatomical suitability, and desired outcomes.

During the procedure, the surgeon carefully sculpts the neophallus, ensuring both aesthetic appeal and functional viability. Additionally, the surgery may involve the incorporation of erectile prosthetics to allow for sexual functionality. The overall goal of phalloplasty is to create a penis that closely resembles the patient's desired size and appearance while also providing the potential for urinary function and sexual sensation.

The Metoidioplasty Approach

Metoidioplasty, also known as meta surgery, is another technique used for masculinizing bottom surgery. It's a way to make the clitoris, which can get bigger with hormone treatment, work more like a small penis. This surgery doesn't involve making a whole new penis, like in a phalloplasty. Instead, the surgeon helps to enhance what's already there. The clitoris is repositioned to resemble a microphallus, allowing for a more masculine appearance.

While metoidioplasty generally does not result in a significant increase in penile length, it is preferred by individuals seeking a less invasive procedure. Many patients appreciate the natural sensation and the ability to achieve erections through testosterone therapy alone.

Surgical Techniques, Results, and Recovery Times

When considering the differences between phalloplasty and metoidioplasty, it is important to understand the variations in surgical techniques, anticipated results, and recovery times. Here’s what you need to know:

Phalloplasty Techniques and Outcomes

Phalloplasty offers individuals the opportunity to have a more sizable neophallus. Depending on the chosen technique, the neophallus can range from 4 to 8 inches in length or even longer. The patient's preference and anatomical considerations play a crucial role in determining the size and shape of the neophallus.

With advancements in surgical techniques, patients can also expect improved functional outcomes. These may include the ability to stand to urinate, engage in penetrative sexual intercourse, and experience erogenous sensation in the reconstructed area. However, it is significant to note that the extent of functional outcomes may vary between individuals.

At Reconstructive Surgical Arts, Dr. McClung works closely with other urologic surgeons to make sure the result is aesthetically appealing and functional.

Metoidioplasty Techniques and Outcomes

In contrast to phalloplasty, metoidioplasty yields more modest changes in penile length due to the reliance on clitoral growth during hormone therapy. On average, metoidioplasty typically results in a 2 to 3 centimeter increase in penile length. Patients who choose this procedure often prioritize improved urinary function and a more masculine appearance over size.

While metoidioplasty may not offer the same level of size enlargement as phalloplasty, it can still provide patients with enhanced genital dysphoria relief and a penis that becomes more erect during arousal. The decision to undergo metoidioplasty should be based on individual preferences, priorities, and desired outcomes.

Recovery Times and Post-Operative Care

Both phalloplasty and metoidioplasty require a significant recovery period. It is important for patients to follow their surgeon's post-operative care instructions diligently to optimize healing and minimize complications.

After phalloplasty, patients typically stay in the hospital for a few days before being discharged. They will need several weeks of rest and limited physical activity to allow the surgical site to heal properly. It is common for patients to require multiple surgeries to achieve their desired outcomes, with each subsequent surgery spaced months apart.

Metoidioplasty tends to have a shorter initial recovery period, with patients often being discharged within a couple of days. However, it is crucial to note that full recovery may still take several weeks or even months. Patients should refrain from heavy lifting and strenuous activities during this time to ensure optimal healing.

Choosing the Right Procedure for You

When considering whether phalloplasty or metoidioplasty is the right choice, it is essential to consult Reconstructive Surgical Arts. The consultation process allows us to assess the patient's individual needs, discuss surgical options, and provide personalized recommendations.

Factors to consider when choosing between phalloplasty and metoidioplasty include specific medical needs, personal preferences, and desired outcomes. Here are some insights and considerations based on our experience in performing these procedures:

Medical Needs:

The choice between phalloplasty and metoidioplasty may depend on individual medical needs. For example, individuals who require a larger neophallus due to significant dysphoria or functional goals may lean towards phalloplasty. On the other hand, those who prioritize a less-invasive procedure and are satisfied with the potential results of metoidioplasty may opt for this option.

Personal Preferences:

Personal preferences play a significant role in selecting the appropriate surgical approach. Patients should consider factors such as desired penile size, appearance, sexual function, and overall satisfaction with their body. Open and honest communication with the surgeon is crucial to ensure that these preferences are taken into account during the decision-making process.

Desired Outcomes:

Understanding the desired outcomes of each procedure is essential. Phalloplasty offers the potential for a larger neophallus and more extensive functional possibilities, including sexual sensation. Metoidioplasty, while typically resulting in a smaller size increase, can still provide improved urinary function and a more masculine appearance. Patients should carefully weigh their priorities and goals when deciding which procedure aligns best with their desired outcomes.

Frequently Asked Questions:

Insurance Coverage:

One common question is whether insurance covers gender-affirming surgeries. It is important to note that insurance coverage for phalloplasty and metoidioplasty can vary depending on the patient's insurance provider and plan. Patients should work closely with their insurance company and surgeon to understand coverage options and potential expenses. 

If you want to get any of these procedures, at Reconstructive Surgical Arts, we have a team of insurance experts who will work hand-in-hand with you to help you out and answer any questions you may have. You can also check the list of insurance companies we work with here.

Weight and Age Limits:

Another concern that patients often have is whether there are weight or age limits for these procedures. While there may be general guidelines or recommendations, decisions regarding weight and age limits are made on a case-by-case basis. During our consultation, our surgeon assesses individual circumstances and provides personalized advice.

Post-Recovery Care Instructions:

Patients should also be aware of the post-recovery care instructions for both phalloplasty and metoidioplasty. These instructions may include wound care, activity restrictions, and follow-up appointments. Adhering to these instructions is crucial to ensuring proper healing and minimizing the risk of complications.

The Importance of Selecting a Qualified Surgeon

Regardless of the chosen procedure, it is vital to select a qualified and experienced surgeon who specializes in gender-affirming surgeries. Gender-affirming procedures require a comprehensive understanding of both the surgical techniques involved and the emotional needs of the patients. That’s why, at Reconstructive Surgical Arts, we have Dr. McClung, a board-certified urologist with fellowship training in reconstructive and trauma surgery. 

Reconstructive Surgical Arts is dedicated to providing compassionate and personalized care for individuals seeking gender-affirming surgeries. Dr. McClung’s team of experienced surgeons and staff are committed to helping patients achieve their desired outcomes while prioritizing their overall health and well-being.

Preparing for the Journey

Undergoing gender-affirming surgery is a significant step in an individual's transition journey. It is important to acknowledge the emotional aspects of this process and ensure that patients are emotionally prepared for the journey ahead. Seeking support from friends, family, and mental health professionals can be beneficial during this time.

By choosing Reconstructive Surgical Arts, individuals can rest assured that they are in the hands of experts who understand the unique challenges and triumphs of gender-affirming surgeries. Contact us today to schedule a consultation and take the first step toward achieving your desired gender-affirming outcomes.

If you still have questions about these two surgeries, check out this video! Here, Dr. McClung goes over both procedures to help you make an informed decision.