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Scrotoplasty

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Scrotoplasty
Other namesOscheoplasty
SpecialtyPlastic surgery

Scrotoplasty, also known as oscheoplasty, is a form of male genital plastic surgery to create or repair the scrotum. The history of male genital plastic surgery is rooted in many cultures and dates back to ancient times. [1] However, scientific research for male genital plastic surgery such as scrotoplasty began to develop in the early 1900s. [1] There are a variety of reasons why scrotoplasty is done. Some transgender men and intersex or non-binary people who were assigned female at birth may choose to have this surgery to create a scrotum, as part of their transition. Other reasons for this procedure include addressing issues with the scrotum due to birth defects, aging, or medical conditions such as infection. For newborn males with penoscrotal defects such as webbed penis, a condition in which the penile shaft is attached to the scrotum, scrotoplasty can be performed to restore normal appearance and function. For older male adults, the scrotum may extend with age. Scrotoplasty or scrotal lift can be performed to remove the loose, excess skin. Scrotoplasty can also be performed for males who undergo infection, necrosis, traumatic injury of the scrotum.

Reasons for getting a scrotoplasty

Buried Penis and Penoscrotal Webbing

Buried penis is a condition when the penis is attached to their scrotum with an excess of skin. This condition can affect both newborn and adult males. Scrotoplasty can be performed to remove the extra skin in the scrotal area and reshape their scrotum. Penoscrotal webbing is another condition, where the skin connecting the penis to the scrotum extends along the underside of the penis shaft like a web. [2] This condition is easily confused with buried penis. Both conditions affect newborn and adult males but they do not always require surgery. Scrotoplasty can be considered to remove excess skin in order to restore normal appearance of their scrotum and penis length, which can improve a man's confidence. In both conditions, the scrotoplasty procedure involves making an incision in the fused part between the penis and scrotum and then reconstructing the scrotum.[2]

Female-to-Male Transition

Some trans men and intersex or non-binary people who were assigned female at birth may choose to have gender-affirming surgeries to create male genitals from existing tissue, as part of their female-to-male transition.[3] There are two types of gender-affirming surgeries for the creation of a penis, metoidioplasty and phalloplasty. In both of these surgeries, a scrotoplasty can be considered as an additional surgery to add testicular implants.[4] Metoidioplasty involves modification of the clitoris into a penis. Generally, the clitoris is hormonally enlarged with testosterone, making it possible for it to be straightened and lengthened into a penis. Outcomes of this surgery include the ability to urinate while standing and retain sexual stimulation.[4] Phalloplasty is the other type of surgery to create a penis, but utilizes skin from other areas of the body besides existing genitals. The most common part of the body used in this surgery is the forearm and has the same outcomes as a metoidioplasty.[5] The addition of a scrotoplasty with implants is an optional procedure for individuals to choose based on their goals with their transition. Deciding if a scrotum meets their needs in their transition is a consideration for adding a scrotoplasty procedure.[4][5]

Fournier's Gangrene, Trauma, and Cancer

There are various medical conditions that result in the loss of scrotal skin and require surgery repair. Fournier's gangrene is a condition that results in the necrosis or death of the skin tissue of the scrotum, which requires surgery. Scrotoplasty is performed to remove necrotic skin and reconstruct the scrotum to restore its function. Another reason for scrotoplasty includes trauma to the scrotum, such as from burns, machinery accidents, traffic accidents, firearm accidents, and surgical accidents.[6] People who experience these injuries may require scrotoplasty if they lose more than 50% of their skin.[6] Reconstructing scrotal skin can be accomplished by using skin grafts from other areas of the body. Tissue expansion, a procedure in which the skin is stretched to regenerate new cells, can also be an option in order to restore scrotal skin loss. Cancer that affects the scrotum and requires removal of tissue may also require scrotoplasty to repair the scrotum.[7]

Excess Skin

There are many reasons that can cause scrotal sagging such as natural aging, varicocele, hydrocele, and cancer patients. Scrotoplasty, in particular scrotal lift, is an option to remove excess loose scrotal skin, tighten, and reduce the size of the scrotum in order to reduce discomfort and improve appearance.

Procedure

Pre-Operation

Candidates must avoid any nicotine products, which can potentially affect wound healings and perioperative complications, for 3 months prior to the surgery. [8] People must also be screened for other contraindications, including obesity with specific adipose distribution. Diabetics can also lead to wound complications such as wound separation or wound disruption.[9] Other contraindications exist for specific types of phalloplasty. For instance, BMI of greater than 35 kg/m2 is contraindicated for radial forearm free flap (RFFF) phalloplasty. A metoidioplasty or anterolateral thigh (ALT) phalloplasty is only recommended for people with an ideal body weight.[8]

For gender-affirming scrotoplasty, people should have already been receiving hormone therapy for over 1 year with established mental and primary health care. Some transmasculine people have already undergone double mastectomy and hysterectomy. Scrotoplasty for transmasculine individuals is usually done with other GRGUS (gender-related genitourinary surgery), which consists of various procedures with variable personal desires for metoidioplasty, phalloplasty, vaginectomy, and urethroplasty.[4] A comprehensive history and physical assessment of the physical sites are taken during consultation to identify the candidates' surgical goals, which then help determine which procedures are needed.

Operation

Typically, when a trans man or transmasculine person has a scrotoplasty, the labia majora (the big lips of the vulva) are dissected to form hollow cavities and united into an approximation of a scrotum.

If there is not enough skin to make a scrotum, then the surgeon may use some sort of tissue expansion prior to the operation. This can be done by putting expanders under the skin. Over the course of a few months, more saltwater (saline) will be occasionally added to the expanders through a port on the outside. This helps the skin expand and grow more skin. Each expansion procedure is done in an outpatient hospital visit. The patient does not have to stay overnight in the hospital, but will have to stay near the hospital, and return several times.[10]

Later, silicone prosthetic testicles can be put in. These can be inserted through small cuts to fill the new scrotum. If expanders were used, they are no longer needed by this point. Then the skin is closed up around the artificial testicles.[10]

Artificial testicles only give a shape, and they do not create semen, sperm, or hormones. With today's technology, it is not yet possible to create testicles that do so.

Complications

People who are candidates for angioplasty need to be educated on the associated risks and complications before the procedure. Complications to scrotoplasty primarily deal with testicular implants. If they are too big, there is chance that the implants could feel uncomfortable, or be a cause of chronic pain.[10] Another complication is that the implant could erode the skin of the scrotum. This can cause infection, or an abnormal connection between two body parts (a fistula) where the implant may work its way outside the body.[10]

There have been advancements in the surgical techniques. However, the risk of recurrent condition still exists. In addition, the cosmetic results might not be satisfactory to some people after surgery.[11] Another factor to consider is the loss of sensation in the scrotal area due to the nature of the procedure which can involve removal of genital tissues.[11]

Other complications are those that are typical for any surgery, such as blood loss, infection, or problems with anesthesia.

Cost

A scrotoplasty for a trans man or transmasculine person typically costs around US$3,000 to $5,000.[10] These costs can be covered by health insurance, though the patient must communicate a great deal with their insurance in order to make certain that it will.

See also

References

  1. ^ a b Zaccaro, Claudia; Subirà, David; López-Diez, Iñigo; Manfredi, Celeste; Ascensios-Vargas, Julmar Paul; Moncada-Iribarren, Ignacio (2022). "History and future perspectives of male aesthetic genital surgery". International Journal of Impotence Research. 34 (4): 327–331. doi:10.1038/s41443-022-00580-6. ISSN 0955-9930.
  2. ^ a b Lucas, Jacob W.; Lester, Kyle M.; Chen, Andrew; Simhan, Jay (2017). "Scrotal reconstruction and testicular prosthetics". Translational Andrology and Urology. 6 (4): 710–721. doi:10.21037/tau.2017.07.06. PMC 5583055. PMID 28904904.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  3. ^ Frey, Jordan D.; Poudrier, Grace; Chiodo, Michael V.; Hazen, Alexes (2017). "An Update on Genital Reconstruction Options for the Female-to-Male Transgender Patient: A Review of the Literature". Plastic and Reconstructive Surgery. 139 (3): 728–737. doi:10.1097/PRS.0000000000003062. ISSN 0032-1052.
  4. ^ a b c d Djordjevic, Miroslav L.; Stojanovic, Borko; Bizic, Marta (2019). "Metoidioplasty: techniques and outcomes". Translational Andrology and Urology. 8 (3): 248–253. doi:10.21037/tau.2019.06.12. PMC 6626308. PMID 31380231.{{cite journal}}: CS1 maint: unflagged free DOI (link) Cite error: The named reference ":1" was defined multiple times with different content (see the help page).
  5. ^ a b Heston, Aaron L.; Esmonde, Nick O.; Dugi III, Daniel D.; Berli, Jens Urs (2019). "Phalloplasty: techniques and outcomes". Translational Andrology and Urology. 8 (3): 254–265. doi:10.21037/tau.2019.05.05. PMC 6626313. PMID 31380232.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  6. ^ a b Normal and Abnormal Scrotum. doi:10.1007/978-3-030-83305-3.
  7. ^ Lucas, Jacob W.; Lester, Kyle M.; Chen, Andrew; Simhan, Jay (2017). "Scrotal reconstruction and testicular prosthetics". Translational Andrology and Urology. 6 (4): 710–721. doi:10.21037/tau.2017.07.06. PMC 5583055. PMID 28904904.{{cite journal}}: CS1 maint: PMC format (link) CS1 maint: unflagged free DOI (link)
  8. ^ a b Chen, Mang L.; Reyblat, Polina; Poh, Melissa M.; Chi, Amanda C. (2019). "Overview of surgical techniques in gender-affirming genital surgery". Translational Andrology and Urology. 8 (3): 191–208. doi:10.21037/tau.2019.06.19. ISSN 2223-4691. PMC 6626317. PMID 31380226.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  9. ^ Gupta, Nikhil K.; Sulaver, Randy; Welliver, Charles; Kottwitz, Michael; Frederick, Luke; Dynda, Danuta; Köhler, Tobias S. (2019). "Scrotoplasty at Time of Penile Implant is at High Risk for Dehiscence in Diabetics". The Journal of Sexual Medicine. 16 (4): 602–608. doi:10.1016/j.jsxm.2019.02.001. ISSN 1743-6109. PMID 30852109.
  10. ^ a b c d e Erickson-Schroth L, ed. (2014). Trans Bodies, Trans Selves: A Resource for the Transgender Community. Oxford University Press. p. 282.
  11. ^ a b Pestana IA, Greenfield JM, Walsh M, Donatucci CF, Erdmann D (October 2009). "Management of "buried" penis in adulthood: an overview". Plastic and Reconstructive Surgery. 124 (4): 1186–1195. doi:10.1097/PRS.0b013e3181b5a37f. PMID 19935302. S2CID 36775257.

Further reading

  • Por YC, Tan BK, Hong SW, Chia SJ, Cheng CW, Foo CL, Tan KC (August 2003). "Use of the scrotal remnant as a tissue-expanding musculocutaneous flap for scrotal reconstruction in Paget's disease". Annals of Plastic Surgery. 51 (2): 155–60. doi:10.1097/01.SAP.0000058501.64655.31. PMID 12897518. S2CID 9488906.
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