Vaginal Preservation in Shaft-Only Phalloplasty: Y-to-V Advancement Technique for Clitoral Hood Redundancy and Reduction Labiaplasty.

Abstract

As the prevalence and understanding of genital gender-affirming surgery have grown, so has the spectrum of surgical techniques to better serve a wider range of transgender and nonbinary individuals. Given the diverse spectrum of individuals seeking phalloplasty, patient-driven decision-making, beginning with the initial consultation, is critical. Phalloplasty is not a one-size-fits-all surgery, but instead should be viewed as an individually customized approach. This article discusses the technical details of vaginal preservation without scrotoplasty or clitoral tissue burial in a shaft-only phalloplasty. The technique involves degloving the clitoral shaft with inset at the ventral base of the phallus, addressing the redundant clitoral hood, and accompanying reduction labiaplasty with a Y-to-V adjacent tissue transfer. The phallus may be neurotized with clitoral nerves from one side of the clitoris and/or the ilioinguinal nerve. This technique obliterates the degloved clitoral hood and resuspends the labia minora anteriorly, improving final aesthetics and striving to meet the patient's genital goals.