What really happens during metoidioplasty?

Posted: August 19, 2010 in Bottom Surgery, DHT, Fistula, Growth, Metiodioplasty, Phalloplasty, Pre-op, Pumping, TLH-BSO, Total Laprocopic Hysterectomy, Transgender, Urethral Extention, Vaginectomy


Over the years I’ve seen a large disgusting pool of misinformed and uneducated information flying around about FTM lower surgery. I just want to bring a bit of light and clarity to whats what and what definitely is not.

FACT: Transmen have 2 lower surgery options(metoidioplasty and phalloplasty that consist of many different techniques) that ARE NOT the same procedure. The only similarity they have is the fact they produce more male appearing genitalia.

FACT: Not all Transmen want or need lower surgery. That does not make them any less of a man.

Now that, that is out there let me begin by saying I will be talking about one version of metoidioplasty. Please keep in mind there are at least 4-5 possible ways to approach metoidioplasty. It is more so dependent on the Dr. you are pursuing.

1. Full metoidioplasty (what i will be discussing):

  • Clitorial release
  • Clitorial lengthening
  • Extended urethra
  • Full or partial Vaginectomy(depends on the dr)
  • Scrotoplasty
  • Testicular implants

2. Clitorial release or Simple Meta

3. Ring metoidioplasty with or without testicular implants at patients discretion

4. Centurion metoidioplasty

5. Full metoidioplasty with no Urinary extension

Numbers 1, 3, 4 and 5 are similar but all entail different things that make then a bit different from the next. Some are done in one stage and others are in 2-3 stages depending on the Dr. and the patients preference.

The metoidioplasty i will be talking about today is preformed by my Dr./Team of choice in Belgrade Serbia. It is a full metoidioplasty so refer back to 1 to see what it entails as i continue on.

First and for most the main requirement for this surgery is growth associated with being on testosterone. There are some people with natural length and T enhances it then others that get mass gain from being on testosterone. Either or when consulting with a Dr. about this procedure growth is a key point. The Dr. will tell you what he/she thinks in regards to if you are a good candidate for the procedure as well as if you need to do anything to enhance your surgical outcome such as pumping or DHT use. Most require you be at least a year on testosterone before having this done to get some decent growth in that region.

FACT: Just because you have metoidioplasty at year 2 on testosterone does not mean you will not grow after surgery. this is a common misconception if you are still growing you will continue after surgery.

Then from there the steps of surgery come into play…

For step by step pictures: ONE STAGE METOIDIOPLASTY


  • All clitoral ligaments should be divided to lengthen clitoris. These ligaments are very well developed and make hooded clitoris in normal female. Division should be radical and includes lateral and suspensory ligaments.
  • Urehral plate is too short and causes ventral curvature. Plate is mobilized together with spongiosal tissue before cutting to prevent extreme bleeding.
  • Appearance after division of ligaments dorsolaterally and short urethral plate ventrally. Clitoris is completely lengthened. Marked places on the dorsum show levels of ligament attachments.
  • Ventral aspect after division of the urethral plate. Gap between glans cap and urethral opening is 6 cm long. Bleeding is minimal thanks to very precise dissection of spongiosal tissue.


  • Reconstruction of the bulbar urethra. Well-vascularized vaginal flap is created from anterior vaginal wall.
  • Vaginal flap and urethral plate are joined to form bulbar urethral part. This way, urethra is lengthened.

URETHRAL RECONSTRUCTION – buccal mucosa graft

  • Buccal mucosa graft is placed to cover the gap between glans cap and bulbar urethra.
  • Appearance of the donor site after harvesting the graft and closure the defect.
  • Buccal graft is fixed to the corporal bodies by quilting sutures. It is very important to prevent haematoma formations and for better survival of the graft.

URETHRAL RECONSTRUCTION – clitoral skin flap

  • Very long skin flap is harvested from the dorsal clitoral skin. Flap is harvested with very wide subcutaneous vascularized tissue.
  • Flap is transposed ventrally by button-hole maneuver and prepared to join with buccal mucosa graft.
  • Joining of the skin flap and buccal mucosa graft. Glans is also opened for creation of glandial part of the urethra.
  • Urethral reconstruction is done. All suture lines are covered with vascularized tissue. It is very important in prevention of fistula formation.


  • Flap from inner labial surface is designed in appropriate size
  • Flap is dissected from the border between inner and outer labial surface. It is attached to the base for better blood supply support. One edge is joined with dorsal part of urethra formed from buccal mucosa graft
  • Urethra is formed. Suture lines will be covered with outer surface of the labia minora that will be ventral part of the penile skin.


  • Reconstruction of the penile skin is done. Scrotum is formed by joining of both labia majora. Perineum is created to be as a male.
  • Testicle implants are inserted into the scrotum using two similar incisions at the top of the scrotum.


  • Appearance after surgery. Penis is positioned at right position. Very well relationship between penis and scrotum is achieved.

FACT: once surgery is complete you have a fully sensanate, functioning, able to void while standing penis. Depending on your prior size you can penetrate seeing as though through this method you tend to gain a bit of length and girth. Continued pumping after post op can also add to this ability very much.

Within this procedure there is also a full vaginectomy.  Vaginectomy is a medical procedure to remove all or part of the vagina. For those like myself that do not like to think about the black hole or those parts even being there this is excellent to have done. Also seeing as though once the vaginal opening is closed there is no way for the moisture to escape which can cause later on issues that you really don’t want or need.

Seeing as though I’ve already had a total hysterectomy it will not be need in this procedure but it can be done at the same time for someone who has not already had TLH-BSO.

Like with any surgery everything carries complication, risks, and differences but the more you know your body and the procedure the better you can prepare yourself for all possibilities. one of the most common things that happens with any surgery that involves dealing with teh urethra you can experience fistula. In medicine, a fistula(pl. fistulas or fistulae) is an abnormal connection or passageway between two epithelium-lined organs or vessels that normally do not connect. You will notice leakage from points and places they aren’t supposed to be. This is not the case for everyone but it is something that happens that you should be aware of. These can solve themselves at times and others you will need surgical intervention.

For this particular surgery the duration is about 4 hours. Also you will have a catheter to aid in urinary relief while your new urethra is healing. The sub-pubic cath. stays in about 4-6 weeks with combined usage of antibiotics to ensure no infections occur.

FACT: Each mans outcome is VERY VERY different then the next. No two cis-men have the same shape nor sized penis not even biological twins. So what you have will not be the shape, size, nor appearance as the next. Only use pictures for perspective medical capabilities of the Dr. NOT what you will look like.

Now that some truths are out there regarding one procedure I feel a lot better and I hope I have helped to truthfully educate some of you who did not really know the truths behind it and held speculations.

111 More days and I will be able to give very detailed accounts of whats what and what is not…


  1. Great post. I think this only scratches the surface.

    • toyneboi says:

      heck yea man you know when I wake up from it i will get super duper deep lol

    • Piotr Wesoły says:

      Dużo przeglądam stron o metoidioplasty. Każdy kto umieszcza informacje robi to bardzo skrupulatnie. Jednak chcę wiedzieć Ile kosztuje taka operacja i gdzie najlepiej ją zrobić. Czy faktycznie tylko w Belgradzie.

      • Adam says:

        metoidioplasty jest dostępny w wielu krajach.Koszt waha się od 6,000 USD do ponad 40.000 $ USD w zależności od lekarza.

      • toyneboi says:

        Actually depending on where you go and what meta you get it can be as low as 3500 and in the higher priced San Fran yes it’s about 40k. Most will not pay that much as many utilize overseas still and there I paid 14k

  2. I can see you happen to be an expert at your field! I am launching a web site soon, and your info will likely be really exciting for me.. Thanks for all your aid and wishing you all of the success.

  3. You wouldn’t believe it but I’ve wasted all day digging for some articles or blog posts about this. You might be a lifesaver, it was an beneficial read and has helped me out to no end. Cheers!

    • toyneboi says:

      Trust me I know how it can be man, thats why I try to make things a bit more easily accessible for people. I may not know it all but I try to stay up to date on things that I know we in the T-community need the most.

  4. Pierce Logan says:

    Hey man. Thanks so much for posting this info. Though it’s out there scattered about, it’s nice to have it like this, nice and digestible. So, assuming I want a full metoidioplasty, which includes all the particles you’ve enboldened above, isn’t this procedure split into two separate procedures? This is what I have understood from my research. I have understood that the scrotoplasty is performed as a second procedure. You mention many times that these things depend on the doctor, which of course makes sense. However, I haven’t found out just yet how long that time in between would have to be. I am trying to arrive at a timeline for my procedure(s).
    I’d appreciate anything you know as a response. A reference, whatever. Thanks and happiness your way.

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