Metoidioplasty Surgery » Surgeons

Dr. Nick Esmonde

Fellowship-Trained Metoidioplasty Surgeon In Portland

Dr. Nick Esmonde, MD, MPH is a Gender Surgeon in Portland, Oregon who gained deep expertise in Gender Affirmation Surgery during his plastic surgery residency at Oregon Health & Science University (OHSU) where he worked in the Transgender Health Program. He then completed a year-long Gender Surgery Fellowship with Dr. Toby Meltzer and Dr. Ellie Zara Ley. Dr. Esmonde is now full-time Associate Surgeon with The Meltzer Clinic and offers Metoidioplasty in Portland.

Dr. Esmonde performs Dr. Meltzer's Metoidioplasty technique. In use since 2010, this method is a modified version of Ring Metoidioplasty which doesn't require vaginal wall flaps, or buccal grafts, avoiding a second surgical site in the mouth. If urethral lengthening (UL) is not performed with the initial Metoidioplasty and converting it to a Phalloplasty with UL is later desired, then a buccal graft would be used at the time of Phalloplasty.

Dr. Esmonde requires patients who are having UL to have a Vaginectomy due to the high rate of complications associated with UL without Vaginectomy. Dr. Esmonde coordinates with gynecologist Dr. Megan Bird and urogynecologist Dr. Will Winter at Legacy Good Samaritan Medical Center for Hysterectomy and Vaginectomy. Hysterectomy can be done at the same time as Metoidioplasty.

Dr. Esmonde may recommend a Monsplasty to be done either before or after Metoidioplasty to improve both aesthetics and functionality.

You can read more about how Dr. Esmonde and Dr. Meltzer perform Metoidioplasty in this free access journal article (which contains graphic intra-operative images and photos of Metoidioplasty results.) The study is a retrospective review of all patients who had Metoidioplasty done by The Meltzer Clinic from 2010 to 2020. Notably, urological complications were very low:

• Fistula: 1 patient, spontaneously closed without surgical intervention
• Stricture: 5 patients. Two of these strictures were treated with buccal mucosa graft at the stricture site. One of those patients had a stricture recurrence, and ultimately underwent a perineal urethrostomy and secondary closure without buccal mucosa. The three other patients were treated with intermittent self-dilation following a single urethrotomy.

Dr. Esmonde frequently places tissue expanders into the scrotum three months after Metoidioplasty to enlarge the scrotum prior to putting in testicular implants. At least one month after completion of expansion, testicular implants are placed.

Dr. Esmonde operates at Legacy Good Samaritan in Portland, where he also performs Top Surgery and Phalloplasty.

Dr. Esmonde is a member of WPATH.

Surgery Costs
Exact pricing can only be determined following a consultation. The estimates below are out-of-pocket prices (for those not using insurance.) Pricing is all inclusive.

Surgery Requirements
Dr. Esmonde follows WPATH guidelines for surgery:

• You will need to provide two referrals from qualified mental health professionals for Metoidioplasty.
• One of your referral letters needs to include the length of time that you have been on hormone therapy, unless clinically contraindicated.
• Smoking cessation.

Financing & Insurance
Dr. Esmonde accepts cash, credit cards, medical financing and insurance. The Meltzer Clinic contracts with Kaiser Washington and has also worked successfully with Pacific Source, BCBS and Washington Medicaid (Apple Health). Single case agreements with other insurance companies can also be setup.

Booking a Consultation
Dr. Esmonde is available for in-person and telehealth consultations in Portland for a fee of $100. Contact his office to book your consultation.

Latest Metoidioplasty Research

Metoidioplasty using labial advancement flaps for urethroplasty [FULL TEXT]
Toby R. Meltzer, Nick O. Esmonde. Plast Aesthet Res. 2020;7:61.10.20517/2347-9264.2020.122
A variation of the ring metoidioplasty has been performed for masculinizing transgender surgery by the senior surgeon since 2010. It does not require buccal grafts or vaginal wall flaps. An excisional vaginectomy was completed in all patients. We sought to evaluate the urologic outcomes and complications for this technique. Further, we provide a detailed technical description of the technique, including ancillary masculinizing procedures.

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