Gender Surgery

Metoidioplasty

at Cadogan Clinic, London’s Leading Cosmetic Surgery Specialists. 

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What is Metoidioplasty surgery?

Metoidioplasty is a surgery carried out on those undergoing FTM (female to male) gender confirmation surgery and involves creating a penis using the body’s existing genital tissue, including the clitoris, labia and the vaginal wall. Metoidioplasty is sometimes referred to as ‘bottom surgery’ or ‘meta’.

Testosterone is used to lengthen the clitoris before metoidioplasty surgery. This tissue is then used to create a micropenis. By using the clitoris, this method of bottom surgery maintains sexual sensation. Other genital tissue can be used to increase the length and girth of the penis.

Some patients may also opt for other procedures to take place alongside their metoidioplasty surgery, such as the removal of the vagina (vaginectomy) or creating a scrotum using the labia majora, with artificial testicles to create a natural feel. Often these surgeries are carried out with two to four months between each one, allowing the body time to recover.

Metoidioplasty surgery is considered to be less risky than phalloplasty, a procedure that constructs a penis using skin taken from the arm, leg or side/back. One of our expert surgeons will be able to discuss the options with you at your initial consultation at the Cadogan Clinic.

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Why do people have it?

Metoidioplasty surgery creates a natural-looking penis using the body’s existing genital tissue, allowing transmen to have an erection, feel sexual pleasure and urinate standing up.

Metoidioplasty helps to alleviate gender dysphoria, a condition that causes great distress and stems from a feeling of disconnect between a person’s biological sex and gender identity.

Metoidioplasty surgery helps to treat gender dysphoria and helps to alleviate the mental health issues that can come with this diagnosis, such as depression and anxiety. Metoidioplasty will help to boost your confidence and self-esteem and help you feel at ease with your identity.

Metoidioplasty is much more straightforward than phalloplasty, with a lower chance of side effects and complications. It is also a more affordable option than phalloplasty surgery.

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The Cost of Metoidioplasty

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Included in this treatment

Up to two 60 minute consultations with a leading specialist plastic surgeon at our award-winning premises in Chelsea

Your procedure carried out at London’s leading specialist cosmetic surgery centre of excellence

24/7 on call nurse assistance 

Dedicated Patient Co-ordinator, as a personal point of contact through your journey with Cadogan 

A pre-operative medical assessment to ensure you are fit for surgery 

Comprehensive post-operative aftercare courtesy of our specialist cosmetic nurses


Who is suitable?

Metoidioplasty is for transmen who have been diagnosed as having gender dysphoria. Before you have metoidioplasty surgery, you should have been living as your preferred gender for at least a year and must have undergone a psychological assessment. You must be aged 18 or over for metoidioplasty surgery.

You must be taking the male hormone testosterone for at least one year before your metoidioplasty.

Your surgeon must be satisfied that you are in good mental health ahead of surgery.

Any person undergoing metoidioplasty must have realistic expectations of what can be achieved through surgery.

What are the different types of surgery?

There are four different types of metoidioplasty that we carry out here at the Cadogan Clinic.

A simple metoidioplasty involves releasing the clitoris by severing the ligament which attaches it to the pelvic bone. This pushes the clitoris forward, making it more exposed, and gives the appearance of a circumcised penis. This type of metoidioplasty results in a penis that is between four and ten centimetres long.

This type of metoidioplasty includes clitoral release, a scrotoplasty and the creation of a new urethra. The urethra is created by using tissue taken from either the vaginal lining, labia minora or the mouth. A catheter is put in place during the operation and is left in place for two weeks after surgery in order to help keep the new urethra open.

During the clitoral release, the labia majora descend from their normal position and tissue expanders are used to create enough room to allow scrotal implants to be implanted into the newly-created scrotal sac. These procedures may be carried out at the same time or spread out over a period of time. Metoidioplasty surgery with urethral extension at the same time can take up to five hours to complete.

Unlike a full metoidioplasty, ring metoidioplasty does not use tissue from the mouth, instead utilising tissue from the anterior vaginal wall and labia minora to create the urethral extension.

Ring metoidioplasty does not include vaginectomy (removal of the vagina) although associated procedures, such as scrotoplasty, can be carried out at a later date.

This type of metoidioplasty surgery helps to add girth to the micropenis by using the labia minora, the lips that sit around the entrance to the vagina. The surgeon releases the ligaments that run between the labia minora and labia majora and brings both sides together to add bulk to the penis. No skin grafts are required.

 

You will be able to discuss these options with your surgeon at your initial consultation in order to identify which type of metoidioplasty is best for you.


What to expect

Below you will find some key information to help you prepare for surgery and make necessary arrangements to ensure you have the support you need and that everything runs smoothly on the day.

Your journey with the Cadogan Clinic will start with a consultation with one of our leading specialist plastic surgeons at our award-winning premises in Chelsea. These consultations will take between 30 and 60 minutes.

During your consultation, your surgeon will ask about your expectations for surgery and talk about what will happen during the procedure. They will also explain how the procedure will affect you.

It is important that you are open and honest about what you hope to achieve through surgery to help ensure the best possible result. Your surgeon will be happy to answer any questions you may have at this point. It may be a good idea to write your questions down before attending the consultation. Having established what you want from the surgery, and what is possible given your anatomy, several key measurements will be made and standard clinical photography will be taken. Your medical history will be discussed and a physical examination will be carried out.

If your surgeon feels you are a good candidate for surgery, you are then invited to consider whether you would like to proceed with your surgery or not following a two week 'cooling off' period.

Avoid smoking and drinking for 48 hours ahead of your metoidioplasty surgery as this can delay the healing process. Avoid taking aspirin, anti-inflammatory drugs and herbal supplements in the week ahead of surgery.

In the six hours prior to surgery you must not consume food or any drink, other than small sips of still water, black coffee or black tea, which will be allowed up to two hours before you are admitted to the clinic.

You will be given general anaesthetic to put you to sleep during the surgery, so you won’t be able to feel any pain. The surgeon will then cut the ligaments to release the clitoris and use the labia to create girth or a scrotal sac, depending on which type of metoidioplasty is being carried out. The surgery will take in the region of three to five hours.

Following your metoidioplasty, you will recover in our ambulatory recovery rooms. You may feel a little drowsy but this often wears off within a few hours.  Once you are able to eat and drink, and our specialist nursing team are happy that your initial recovery is complete, you will be allowed to leave the clinic with a friend or family member.

It is important to wear loose-fitting clothes in the first few weeks after your surgery in order to avoid any discomfort during your metoidioplasty recovery.

You should expect to take at least two weeks off from work and avoid any heavy lifting for two to four weeks after metoidioplasty surgery. It can take between two and four weeks to recover from metoidioplasty surgery, depending on which type you have had done.

Our on-call nursing service is open 24/7 during your recovery period to help with any questions or queries that you may have.

It is important that you follow all the aftercare instructions issued by your doctor. Failure to do so may impact on your recovery and the final result.

The Patient Journey. A breakdown of what you can expect on your journey with us

We are deeply invested in ensuring that every step of your surgical journey with us is as informative and reassuring to you as it can be. This article outlines what you can expect at each stage of the journey

The Patient Journey

Frequently Asked Questions

There are several surgeries that you can get alongside a metoidioplasty. You may opt for one or more of the following:

Vaginectomy: This surgery removes the vaginal cavity and closes the vaginal opening, making it impossible to have vaginal sex.

Urethroplasty: This creates a urethral canal through the penis to allow you to urinate standing up.

Scrotoplasty: A scrotum can be created using labial tissue. Small silicone implants are inserted into the newly-created scrotum which will result in a natural feel and appearance.

Mons resection: Liposuction can be used to remove fat cells from the mons pubis, the fatty mound that sits just above the clitoris. The skin is then pulled upwards, making the penis look longer and giving the pubic area a more masculine appearance.

The average metoidioplasty cost in the UK is £35,000.

If you choose the Cadogan Clinic for your metoidioplasty surgery in London, you will get:

  • Up to two 60 minute consultations with a leading specialist plastic surgeon at our award-winning premises in Chelsea
  • Your metoidioplasty surgery at London’s leading specialist cosmetic surgery centre of excellence
  • 24/7 on-call nurse assistance
  • A Dedicated Patient Coordinator, as a personal point of contact through your journey with Cadogan
  • A preoperative medical assessment
  • Comprehensive aftercare courtesy of our specialist team of nurses

Yes, it is possible to achieve a natural erection after a metoidioplasty, without the need for penile prosthesis or implants. Because this micropenis is created from the clitoris, the sensitivity and ability to experience sexual pleasure and orgasm is maintained.

However, because of the size of the phallus created by metoidioplasty, it is not always possible to have penatrative sex. If the ability to have penatrative sexual intercourse is important to you, then you should discuss the pros and cons of phalloplasty with your surgeon.

Transmen who have undergone metoidioplasty are often very pleased with the result. A 2016 survey of several metoidioplasty studies found that 100 percent of those who have undergone the procedure retained sexual sensation and just over half were able to engage in penatrative sex. 89 percent were able to urinate standing up following metoidioplasty surgery.

If the ability to have penatrative sex is important to you, you may wish to consider phalloplasty instead of, or as well as, metoidioplasty surgery.

It takes between two and four weeks to recover from metoidioplasty surgery, depending on which type is carried out. You should expect to take at least a fortnight off work and avoid heavy lifting and exercise during the recovery period.

It may take a while to get used to your new body, so although you can participate in and enjoy sexual activity from four weeks post-surgery, it is also perfectly natural to want to take things slowly.

Once the clitoris has been released by the severing of the ligaments that anchor it to the labia, you can expect to gain three to four centimetres in length.

A metoidioplasty creates a micropenis which is unlikely to be any more than 10 centimetres long. If you want to add length to the phallus, then you may wish to consider phalloplasty afterwards.

Yes, it is possible to keep your vagina after metoidioplasty if you so wish. You may also choose to keep your uterus (womb). It is an entirely personal choice and we will respect your decision.

However, one important thing to bear in mind is that if you do choose to keep these, you remain at risk of certain gynaecological conditions and cancers. If you keep your cervix, you will still need to have regular cervical screening (smear tests).


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Founded in 2004 by world renowned plastic surgeon Mr Bryan Mayou, we now work with over 100 leading consultants and successfully treat over 20,000 patients each year. We have been winning industry awards since inception.

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What are the risks?

Complications are rare although, as with all surgery, possible. Your surgeon will discuss each of these risks comprehensively at your consultation. 


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We believe in the delivery of excellent outcomes and results, and exceptional levels of service. Our outcomes are natural and long-lasting, and we remain the premier choice for cosmetic surgery treatments in the UK.


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