Genital reconstruction surgery in transsexual men consists of transforming female-looking external genitalia into male-looking genitalia. The choice of one technique or another will depend on the length that the patient wants and the magnitude of the intervention that he wants to accept.
It will be the surgeon, together with his medical team, who decides the most appropriate technique for each individual patient, analyzing their physical and social characteristics. However, the patient will have all the information to be able to take part in the final decision on the technique to choose.
There are fundamentally two techniques for performing genital reconstruction in transsexual men: metoidioplasty and phalloplasty. Both techniques differ fundamentally in the magnitude of the intervention between one and the other and in the results that the patient wants to obtain. In metoidioplasty a small penis length of between 5 and 7 cm is achieved. To achieve that result it’s mandatory to have a clitoris hypertrophy before the surgery, if not, the result will be unsatisfactory. In phalloplasty the length is longer but the patient has to accept a longer and more laborious surgical procedure, with more risk.
It is not recommended if there is no significant clitoris hypertrophy with the hormonotherapy, in the same way if we are facing an obese person, it is also not recommended since the length result will be very poor.
It is a longer and more complex technique that requires several step procedures to reach a good final result, it’s expensive and also requires of scars at the donor site to perform the phallus.
It depends on the clitoris hypertrophy. If there is a marked hypertrophy and before performing any surgery erections are noted on that clitoris, a metoidioplasty can be performed because although the penis will be small, erections and therefore penetration can occur. They are the least frequent cases since people who want to have penetrative sex must undergo a phalloplasty.