thumb|Human male reproductive system
Scrotoplasty, also known as oscheoplasty, is a type of surgery to create or repair the scrotum. Scientific research for male genital plastic surgery such as scrotoplasty began to develop in the early 1900s. The development of testicular implants began in 1940 made from materials outside of what is used today. Today, testicular implants are created from saline or gel filled silicone rubber. 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. 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 the 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. 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. 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. 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 neoscrotum meets their needs in their transition is a consideration for adding a scrotoplasty procedure.
The second category of scrotal injury includes trauma to the scrotum, such as from burns, machinery accidents, traffic accidents, firearm accidents, and surgical accidents. People who experience these injuries may require scrotoplasty if they lose more than 50% of their skin. 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. In addition to surgically reconstructing the scrotum, antimicrobial medication and the tetanus vaccine should be given to prevent infection and reduce the risk of developing an infection. Many people develop scrotal sagging later in life, but it does not affect everyone. Scrotal lift is done not just as a cosmetic surgery to improve the appearance of the scrotum, but also as a way to reduce discomfort.
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. People must also be screened for other contraindications, including obesity with specific adipose distribution. Diabetes can also lead to wound complications such as wound separation or wound disruption. Other contraindications exist for specific types of phalloplasty. For instance, a body mass index (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.
The scrotoplasty procedure requires skin grafting to reconstruct the scrotum for scrotal skin loss. Full-thickness skin grafts (FTSGs) and split-thickness skin grafts STSG are two types of skin graft can be used for reconstruction. The suprapubic skin and the anterior thigh are the most common donor sites.
The novo scrotoplasty is one stage of female-to-male transition, performed together with phalloplasty, which creates the penis. 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 scrotal sack. If there is not enough skin to make a scrotum, then the surgeon may need to make tissue expansion before the operation by putting expanders under the skin. Over the course of a few months, more salt water (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. Initially, a secondary surgery was carried out to insert 2 silicone prosthetic testicles into the newly constructed scrotum between 6–12 months following the initial scrotoplasty. An erectile inflatable device was then implanted during a tertiary surgery at least 12 months from the initial scrotoplasty. The artificial testicles only give a shape and do not create semen, sperm, or hormones.
Post-operation
In general, post-operative hospital stays for people undergoing scrotoplasty range from days to weeks, corresponding to the complexity of the procedure.
Usually after the procedure, people may wear a support garment to limit the movement of the surgical sites to limit the risk of complications. In addition, a flexible tube for draining urine from the urinary bladder (urinary catheter) is placed and held in place until the genitals heal. Swelling of the scrotal areas is normal and can last up to months.
Individuals with buried penis undergoing a scrotal lift can be discharged on the same day as procedure, and are not allowed to engage in sexual activities for many weeks. People can ambulate or must rest in bed during recovery, depending on the surgeon's decision. A blood thinner (anticoagulant) is considered for people with risk factors for deep vein thrombosis. 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.
Complications to scrotoplasty among transmasculine individuals 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. 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. However, individuals may run into issues with their insurance plan coverage because insurance will only cover surgeries that are considered medically necessary. Insurance plans can deny coverage of a scrotoplasty if deemed to be an esthetic or cosmetic surgery instead of a reconstructive one. In this case, all of the costs will be covered by the individual under care.
See also
- Sex reassignment surgery (female-to-male)
- Sex reassignment surgery (male-to-female)