Surgical techniques vary from surgeon to surgeon. This is the procedure common at GRS Montreal:

Some people choose to have erectile tissue release surgery without any additional procedures, while others may choose to have it in combination with additional procedures. 

Erectile tissue release:

Surgical techniques vary from surgeon to surgeon. Before surgery, testosterone is taken to enlarge the erectile tissue (clitoris). Some people choose to wait 2-3 years to achieve maximum growth before proceeding with surgery. 

The ligaments holding the erectile tissue (clitoris) in place under the pubic bone are cut, allowing the shaft to fall away form the body, giving it a more pronounced appearance

Fat may be removed from the pubis and skin may be pulled upward to bring your phallus forward.

Urethral lengthening:

Re-routing the urethra up through the tip of the penis, with the goal of allowing urinating from a standing position.

Lengthening may be done using nearby tissue (ie: inner labia) or buccal (cheek) tissue, depending on the individual.

Scrotoplasty:

The external genitals (labia or outer labia) may be shaped into a scrotum. 

Vaginectomy

Removal of internal genital (vaginal) tissue and closing of genital opening (vaginal canal).

Implants

Testicular implants may be placed inside the scrotum at a later stage, usually a minimum of six months after the initial surgery.

All surgical procedures involve some risks. Risks include negative reactions to anesthesia, blood loss, blood clots and infection. These complications can, in extreme cases, result in death. It’s important to discuss these risks in detail with your surgeon. Your surgical care team will take a wide variety of steps to prevent these problems, detect them if they arise and respond to them appropriately. They will also inform you about what you can do to minimize your risks. Some complications are particularly associated with metoidioplasty. 

Below are a list of some possible complications of this surgery. Please note – this list is not comprehensive and you should have a detailed discussion of risks with your surgeon.

Abscess formation

An abscess is a collection of pus caused by a bacterial infection. It can be treated with antibiotics or drained by the surgeon.

Decreased sensation

The risk of decreased sensation after metoidioplasty is less than with phalloplasty, but changes to sensation are still possible.

Dissatisfaction…

Some people may be dissatisfied with the size or shape of the penis. You can check with your surgeon to see if surgical revision is possible.

Hematoma

When blood collects in the surgical site, causing pain, swelling and redness. It is the most common complication. Drains and compression bandages are used to prevent hematomas. Smaller hematomas can be sucked out, but larger ones require removal through surgery.

Seroma

When clear fluid accumulates in the surgical site. Small seromas may need to be aspirated, or sucked out, once or more by the surgeon. Big seromas may need to be removed through surgery.

Wound separation

The partial or complete opening of incisions along the sutures.

Scarring

You can take steps to prevent significant scarring by following your surgeon’s advice about getting rest, avoiding the sun and doing massage exercises. Severe scarring may require surgical revision.

Urological complications

Even with urethral lengthening, some people will not be able to urinate while standing. This can be because of the urine stream (it may spray or dribble), or because the penis does not extend far enough out from the body.

Other urological complications include fistulas (flow of urine to areas other than urethra opening), stenosis (narrowing of the urethra, causing difficulty urinating), strictures (scarring inside the urethra, causing difficulty urinating) and hair growth inside the urethra. If these problems don’t resolve on their own, they may require additional surgery.

Surgical techniques vary from surgeon to surgeon.

• Skin, nerves, veins and arteries from your forearm or another site such as the thigh are removed. This is called a graft.
• A small part of the graft is used to extend your urethra.
• A larger part of the graft is wrapped around the urethra to create the penis shaft and glans, the head of the penis.
• The labia are repositioned and reshaped to make a scrotum.
• The vagina may be removed or closed (if desired).
• If the forearm is the site used, skin from the thigh is used to cover the graft site.
• A surgery to reposition the urethra through the penis (urethral lengthening) may be done a minimum of 6 months after the creation of the penis.
• Testicular implants and an erectile device may be put in at a later stage (if desired).

All surgical procedures involve some risks. Risks include negative reactions to anesthesia, blood loss, blood clots and infection. These complications can, in extreme cases, result in death. It’s important to discuss these risks in detail with your surgeon. Your surgical care team will take a wide variety of steps to prevent these problems, detect them if they arise and respond to them appropriately. They will also inform you about what you can do to minimize your risks.

Some complications are particularly associated with phalloplasty. Below are a list of some possible complications of this surgery. Please note – this list is not comprehensive and you should have a detailed discussion of risks with your surgeon.

Abscess formation

An abscess is a collection of pus caused by a bacterial infection. It can be treated with antibiotics or drained by the surgeon.

Decreased sensation or ability to achieve orgasm

There is risk of decreased sensation or inability to achieve orgasm after surgery. 

Dissatisfaction with size or shape

Some people may be dissatisfied with the size or shape of the erectile tissue (penis). You can check with your surgeon to see if surgical revision is possible.

Hematoma

When blood collects in the surgical site, causing pain, swelling and redness. It is the most common complication. Drains and compression bandages are used to prevent hematomas. Smaller hematomas can be sucked out, but larger ones require removal through surgery.

Implant complications

Complications associated with penile implants include poor positioning, technical failure and infection. The implant can be either be repaired or surgically removed and replaced. Complications associated with testicular implants include poor positioning and infection.

Numbness in the hand or wrist of the donor arm

Usually resolves in a few weeks. Permanent changes to sensation or function are very rare but possible. Some people require prolonged physiotherapy to recover.

Wound separation

The partial or complete opening of incisions along the sutures.

Scarring

You can take steps to prevent severe scarring by following your surgeon’s advice about avoiding sun and doing massage exercises. Severe scarring may require surgical revision.

Seroma

When clear fluid accumulates in the surgical site. Small seromas may need to be aspirated, or sucked out, once or more by the surgeon. Big seromas may need to be removed through surgery.

Tissue transfer complications

Related to the transfer of skin from your forearm to your groin. There is a small risk of a partial or complete loss of the penis if the transfer is unsuccessful.

Urological complications

Very common, though they often resolve with time. Examples include fistulas (flow of urine to areas other than urethra opening), stenosis(narrowing of the urethra, causing difficulty urinating), strictures (scarring inside the urethra, causing difficulty urinating) and hair growth inside the urethra. If these problems don’t resolve on their own, they may require additional surgery.