The Transgender Dictionary
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Metoidioplasty

(also: bottom surgery, meta, lower surgery)

Table of Contents

Introduction

This is a surgical procedure typically performed on those who were AFAB, have undergone MHT, and desire a penis. It is one of the most common surgical procedures for such a thing. For many transgender men (and some nonbinary people) this gender affirming surgery is a great way to cope with gender dysphoria regarding lack of having a penis.

While it is true that some people later seek out phalloplasty for a larger size (and a greater likelyhood of being able to engage in penetrative sex), plenty of transgender men are perfectly content with the gender euphoria provided by metoidioplasty. Meta is significantly less expensive than phallo (especially if not covered by insurance). Meta also has minimal visual scarring, fewer total surgical procedures, and a shorter recovery time.

General Information

Metoidioplasty is a surgery that works with preexisting genital tissue to form a neophallus. This can be done on anyone with significant clitoral growth caused by the patient undergoing HRT. As this surgery works with bottom growth, it is generally recommended that the patient be on testosterone for one to two years prior to having this surgery.

Once healed from meta, the patient will have a fully functional penis that can become erect on its own. However, the size (both in length and girth) will be relatively small (anywhere from 3 to 8 cm in length). Whether or not someone is able to engage in penetrative sex after meta will vary from person to person (roughly 50% are able to do so). The exact specifications of one's results will also vary from person to person.

This surgery can take 2 1/2 to 5 hours depending on various factors such as the surgeon and surgical variants. Most types of meta typically involve the patient being placed under general anesthesia. Metoidioplasty is also typically an outpatient procedure.

Some variations of metoidioplasty involve what is called "urethral lengthening" which allows one to be able to pee standing up using his penis (roughly 90% of patients are able to urinate standing up after this surgery).

The risk of loss of erogenous sensation is virtually nonexistent.

Different Types of Surgery

Centurion

During centurion meta, the surgeon will release the round ligaments that go from the labia to the labia majora, then use them to surround the neophallus to create extra girth.

Unlike some other meta surgeries, this one does not involve any skin grafts.

Full

Many things are at play during a full metoidioplasty.

A tissue graft from the inside of the patient's cheek is used to link the urethra to the neophallus (urethral lengthening). Pain while eating and decreased production of saliva are possible complications from having this graft done. The patient will also have to heal at 2 separate locations.

If desired, this is also done alongside a vaginectomy and/or the insertion of scrotal implants.

Full meta includes what is done during simple meta.

Ring

Ring metoidioplasty is very similar to full. The primary difference is the site of the skin graft for urethral lengthing. During ring meta, the site for the graft is inside the vaginal wall combined with the labia majora. This has the advantage of having only one site to heal from and not dealing with any potential complications from a cheek graft.

Simple Release/Simple Meta

This procedure is one to free the clitoris from surrounding tissue. Neither the urethra nor vagina are altered. Simple release increases the length and exposure of the penis.

Unlike some other meta surgeries, this one does not involve any skin grafts. During this surgery, the patient is placed under conscious sedation.

Reddit - r/Metoidioplasty
YouTube Playlist: Jammidodger Lower Surgery Vlogs
YouTube Video: bcugrs: 12/16/2017: Single Stage Metoidioplasty Performed by Prof Djordjevic
YouTube Video: uppercaseCHASE1: 08/25/2017: Trans 101: Ep 25 - Metoidioplasty (Bottom Surgery) CC

Children's Hospital - Metoidioplasty
Cleveland Clinic - Metoidioplasty
Cranects - Metoidioplasty Photos
FTM Guide - Meta
Gurecon - Phoros
Healthline - Concious Sedation
Health Line - Metoidioplasty
John Hopkins - Metoidioplasty for Gender Affirming Care
metoidioplasty.net
phallometa.wiki
Reconstructive Surgical Arts - Metoidioplasty
Trans Language Primer - Metoidioplasty
UCSF - Phalloplasty and metoidioplasty - overview and postoperative considerations
VeryWellHealth - What to Know About Metoidioplasty (Bottom Surgery)
VeryWellMind - How Metoidioplasty Gender Affirming Surgery Works
Wikipedia - Metoidioplasty
Wikipedia - Sedation