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Metoidioplasty.net ยป Metoidioplasty Procedures

Ring Metoidioplasty or Ring Flap Metoidioplasty

Ring Metoidioplasty, or Ring Flap Metoidioplasty, is a technique that was first developed in Japan by Dr. Ako Takamatsu, a plastic surgeon who is currently the sole surgeon offering sex reassignment surgery in Japan. Ring meta offers similar results to other Metoidioplasty procedures, including urethral lengthening.

Ring metoidioplasty uses a flap of tissue from the anterior vaginal wall, along with the labia minora, to create the urethral extension, instead of tissue from the mouth (buccal mucosa.) Additionally, the clitoral chordee is released. The result is a lengthened phallus with added girth, and the ability to urinate while standing.

Ring metoidioplasty does not include Vaginectomy, though surgeons who perform ring meta routinely minimize the vaginal opening (penetration is not possible.)

Scrotoplasty, testicular implants, mons resection and phallus repositioning are optional as second stage surgeries.

Urinary fistula is a common complication (approximately 8-9%), but fistulas sometimes heal spontaneously. If not, fistula repair surgery is usually done on an out-patient basis, and some surgeons wave their fees for repair surgeries.

Advantages of Ring Metoidioplasty

  • Ring meta doesn't require a second surgical site (as in the case with metoidioplasties that use buccal mucosa), eliminating problems such as poor wound healing in the mouth and decreased production of saliva
  • Ring meta can later be converted to a phalloplasty, if needed.
  • Ring meta is reasonably priced, in the area of $15,000 USD.
  • Ring meta provides most patients with the ability to urinate while standing.
  • Ring meta preserves erotic sensation.
  • Ring meta does not require vaginectomy.
  • Ring meta can be combined with hysterectomy.

Ring Metoidioplasty Journal Articles

Dr. Mang ChenNEW! Ring Flap Metoidioplasty
Alysen Demzik, Liem Snyder, Solomon Hayon, Mang Chen, Bradley D. Figler. Urology, Volume 158, December 2021, Page 243.
In a ring flap metoidioplasty, the urethra is created from bilateral anteriorly based labia minora and vestibular flaps. This technique is combined with Ghent scrotoplasty, vaginectomy (distal mucosal excision and proximal mucosal fulguration followed by cavity closure) and perineal masculinization. Suprapubic tube is placed for urinary diversion. To avoid disrupting the anteriorly based urethral pedicles, we do not perform monsplasty, division of the suspensory ligament, or resection of the labial folds adjacent to the penis at the time of ring flap metoidioplasty. Typically, resection of labial folds adjacent to the penis and testicular prosthesis insertion are performed 4-6 months after metoidioplasty.

Labial ring flap: a new flap for metaidoioplasty in female-to-male transsexuals.
Takamatsu A, Harashina T. J Plast Reconstr Aesthet Surg. 2009 Mar;62(3):318-25. Epub 2009 Jan 24.
This new technique uses all the labia minora skin incorporated with the anterior vaginal flap for urethral lengthening. The clitoral chordee is also released by this procedure.

Beginnings of Sex Reassignment Surgery in Japan (Includes ring metoidioplasty photos)
Takamatsu Ako, M.D., Harashina Takao, M.D., Inoue Yoshiharu, M.D., Kinoshita Katsuyuki, M.D., Ishihara Osamu, M.D., Uchijima Yutaka, M.D., Department of Plastic and Reconstructive Surgery, Gynecology, Urology, Saitama Medical Center, Saitama Medical School, Japan. The International Journal of Transgenderism, Volume 5, Number 1, January - March 2001.

Last updated: 01/13/22


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