RECONSTRUCTIVE Scrotal Reconstruction in Female-to-Male Transsexuals: A Novel Scrotoplasty Gennaro Selvaggi, M.D. Piet Hoebeke, M.D., Ph.D. Peter Ceulemans, M.D. Moustapha Hamdi, M.D. Koen Van Landuyt, M.D. Phillip Blondeel, M.D., Ph.D. Griet De Cuypere, M.D. Stan Monstrey, M.D., Ph.D. Ghent, Belgium Background: One of the goals of genital construction in female-to-male transsex- uals is the creation of an aesthetically acceptable result, both for phallus and scrotum, leaving minimal morbidity and recreating function. In the last 15 years, transsexuals have become more demanding, and scrotoplasty has received more attention than before. Traditional flaps for scrotal reconstruction in a biological male do not really apply in transsexuals: the labia majora seem to achieve the best results; still, they may not provide enough tissue and can be located much too posteriorly. Methods: Since November of 1993, more than 300 scrotal reconstructions (and radial forearm flap phalloplasties) have been performed in female-to-male trans- sexuals by the authors’ gender team. Based on the authors’ large experience, they modified previous techniques and developed a novel scrotoplasty consisting of a V-Y advancement of the major labia together with a rotation of these superiorly based labial flaps. Refinements (to achieve better sensation and shaping) are described. Twelve months after the original operation, one testicle implant and erection prosthesis procedures were performed. Results: No major complications related to scrotoplasty occurred in the authors’ series. Patients were all pleased at short- or long-term follow-up with their scrotum, located in its natural position in front of the legs. Conclusion: The authors’ novel scrotoplasty can become the ultimate surgical technique to reconstruct the scrotum in female-to-male transsexual patients, further improving the final cosmetic result, with the possibility of enhanced erogenous sensitivity. (Plast. Reconstr. Surg. 123: 1710, 2009.) A s mentioned by Hage and Bouman, 1 one of the goals of genital construction in female- to-male transsexuals, nowadays called gen- der identity disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, 2 should be the creation of an aesthetically acceptable re- sult for both the phallus and the scrotum, leaving minimal morbidity and recreating function. Scro- toplasty should not interfere with the reconstruc- tion of the proximal part of the urethra (pars fixa), increase the risk of urinary problems, or interfere with vaginectomy. Since surgeons started performing female- to-male sex-reassignment surgery, however, the focus has been mainly on phalloplasty, while the scrotum has received less attention. In the last 15 years, transsexuals have become more de- manding, and scrotoplasty has received more attention than before. A complete review of the literature on scrotoplasty was presented by Hage and Bouman 1 in 1993. Traditional flaps for scro- tal reconstruction in a biological male, however, are not really applicable in transsexuals; tech- niques applying pedicled thigh, groin, and pu- bic flaps are too elaborate for scrotal recon- struction in transsexuals, scars in the donor area are unsatisfactory, and the results are not aes- thetically pleasing enough to these patients. Fi- nally, myocutaneous flaps are also unnecessary and too complex, with ultimately unnatural feel- ing, absence of erogenous sensation, and diffi- culty in palpation of testicular implants. In the specific case of transsexual patients, techniques involving the use of labia majora flaps, with or From the Departments of Plastic Surgery, Urology, and Psy- chiatry, Ghent University Hospital. Received for publication April 10, 2008; accepted November 17, 2008. Copyright ©2009 by the American Society of Plastic Surgeons DOI: 10.1097/PRS.0b013e3181a659fe Disclosure: The authors have no commercial asso- ciations or financial disclosures in relation to the content of this article. www.PRSJournal.com 1710