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Female to Male (FTM)
Gender Reassignment Surgery (GRS)
A. Metoidioplasty or Metaidoioplasty (phallic clitoral enlargement, stand to void)
The procedure confers the advantage of minimal surgery with preservation of natural sensation and erectile function. Donor site forearm scars avoided. Overweight patients may achieve greater length with pubic lipectomy which will recess the body surface line.
In this procedure the clitoral hood is lifted and the suspensory ligament of the clitoris is detached from the pubic bone, allowing the clitoris to extend out further. When the female tissues have been primed with testosterone, the clitoral head may resemble an adolescent glans penis. An embryonic urethral plate must be teased away from the underside of the clitoris to permit outward extension and a visible erection.
For those patients who desire to void standing, the urethra is extended into the neo-penis. This may be accomplished simultaneously or performed secondarily using either a vaginal flap or buccal mucosal graft.
Please understand in that metoidioplasty involves a fair amount of tissue transfer, some degree of post-operative swelling is expected. Complications may include but are not limited to less than anticipated length, torquing of the clitoris (usually amenable to release), loss of sensation, tissue necrosis, localized infection, persistent tenderness or hypersensitivity, transient or permanent narrowing of the vaginal opening which may render the vagina incapable of penile penetration, urethral narrowing, urethral obstruction, and urethral fistula (leakage of urine anywhere along the pathway of urethral extension). Between the first and second stages leading to urethral extension, voiding patterns and trajectory may be forwards or backwards and may splash wetting perineal, labial and vaginal skin.
Fee $12,500. Please call for details.
Testicular prostheses and scrotalplasty $5,000.
B. Penile Implantation for the Neo-Phallus patient.
A penile prosthesis confers the wherewithal to penetrate which may be the defining moment for a successful conclusion to gender reassignment surgery. Clearly the intimacy of complete sexual contact is sought equally by patients and their partners.
Fee including inflatable prosthesis $8,000.
C. Insertion of Testicular Implants into Labia.
This should be performed as a procedure unto itself or with urethral extension to minimize complications. To prepare the labia majora for implantation, a tissue expander may be employed for a few months. This also creates a more pleasing scrotal appearance.
Soft silicone implants are used and are available in varying sizes.
Fee including prostheses $5,000.