Metoidioplasty

In a metoidioplasty, the urethral plate and urethra are completely dissected from the clitoral corporeal bodies, then divided at the distal (far) end, and the testosterone-enlarged clitoris straightened out and elongated.

A longitudinal vascularized island flap is configured and harvested from the dorsal skin of the clitoris, reversed to the ventral side, tubularized and an anastomosis (connection) is formed with the native urethra.

[6] The term derives from meta- "change", Ancient Greek αἰδοῖον, aidoion, 'genitals', and -plasty, denoting surgical construction or modification.

Current studies show this method yielding penile lengths of 6 to 12 centimeters (2.4 to 4.7 in), with 7 out of 10 patients able to obtain erections that are capable of penetrative intercourse.

[11] In a phalloplasty, a plastic surgeon fabricates a neopenis by autografting tissue from a donor site (such as from the patient's back, arm or leg).

A phalloplasty takes about 8–10 hours to complete (the first stage), and is generally followed by multiple (up to three) additional surgical procedures including glansplasty, scrotoplasty, testicular prosthesis, and/or penile implantation.

Example of completed metoidioplasty including neourethra and scrotoplasty, two years post-operation [ 1 ]
Metoidioplasty procedure (via 'Belgrade technique'). A) Preoperative appearance (hormonally enlarged clitoris ). B) Cutting of ligaments that suspend the clitoris to elongate it. C) Division of urethral plate with gap filled with vaginal mucosa graft D) Combining the vascularized labial tissue with the formed urethra to form final structure.