XVII Harry Benjamin International Gender Dysphoria Association Symposium
31 October - 4 November 2001, Galveston, Texas, U.S.A.

A Novel Scrotoplasty in the Female to Male Transsexual: Technical Techniques

HOEBEKE, PIET Belgium
Co-authors: Stan Monstrey & Erik Van Laecke (Belgium)

Introduction and objectives: As transsexual patients want a natural reconstruction, in order to get better integrated in daily life, technical refinements of reconstructive surgery aim at more natural looking reconstructions. The scrotum, which is nearly always reconstructed from the labiae majora, offers some specific difficulties. In the female, the labiae majora are more between the legs, while the scrotum in the male is more in front of the legs. V-Y plasty of the labiae majora, offered a solution for this problem but the aesthetic results were imperfect. Therefore a new scrotum reconstruction in which V-Y plasty is combined with 90o turning of the labia majora flaps is used.

Material and methods: Since 1995, 81 female to male transsexuals have undergone free sensate radial forearm flap phalloplasty in one stage with urethroplasty, vaginectomy, hysterectomy and scrotoplasty. In the first 30 cases the labiae majora were left in situ and a scrotum was reconstructed by suturing the labiae in the midline. The aesthetic results of this procedure were minor and furthermore after implantation of the testis protheses, patients complained of the position of the prostheses between the legs. The next 30 patients underwent a V-Y plasty of the major labiae by which the scrotum was more in front of the legs. Functional results after testis prosthesis implantation were superior but aesthetic results remained imperfect. In the last 21 patients the labiae majora flaps are turned over 90o in combination with the V-Y plasty. Large dissection of the labiae is necessary. On the lateral aspect they are mobilized in the distal half. The right labium is turned counterclockwise and the left labium clockwise over 90o. By this manoeuvre, the distal part of the labiae makes the scrotum larger. Furthermore by this manoeuvre, the scrotum is more natural looking and offers large space to implant testis prostheses.

Results: Compared with the former techniques, this novel scrotoplasty offers superior aesthetic results. The large space obtained in the scrotum especially makes the scrotum natural looking after testis prosthesis implantation. Patient satisfaction is very high.

Conclusion: A novel technique for scrotum reconstruction is presented for the female to male transsexual. Excellent results were obtained in the first 21 patients undergoing the procedure.