Scrotoplasty for trans phalloplasty: How does a surgeon make a ball sack?

Scrotoplasty. Making a ball sack:
How does a surgeon do it?

There are multiple scrotoplasty techniques. Here, I drew a possible VY scrotoplasty. 🤓

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Transcription below for visually impaired individuals using screen readers and for people using translation tools.
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Poster images and text.

Visually impaired and translation image description follows

Text, How do they bake a cake? It depends on the cake. How do they make a ball sack? Here’s one way.
Transgender flag motif.

Title, Scrotoplasty.

A series of twelve drawings illustrating stages in a possible [scrotoplasty] surgery.

  1. Image, A pelvis showing a natal vulva sketched over with surgeon’s planning lines. Label, natal genital kit. Label, original recipe. Arrow pointing to genitals Labeled, Did not work out for me. I’d look down and think, Nope, nope, nope. I do not want to see this [set of genitals].
    I got phallo and scrotoplasty. This part is confusing to explain with just words. I’ll draw.
  2. Image, Lithotomy position vulva, trans masculine. Colored lines outlining regions around and within labia for incision. A semicircle and dot are drawn at the site where the phallo penis will land on the mind.
    Caption, The layout, all in one piece for now. Just marked up for scrotoplasty. Time for a remix.
  3. Image, the mons is opened up. The labia majora are disconnected into two flaps still connected nearer the natal glans. The flaps are also disconnected from the mucosal tissue of the labia minora, from the natal phalloclitoral organ, and from the area of the urethra and canal. These semi-connected flaps of tissue are called pedicles.
    Text, Doc cuts around the labia majors. Doc opens a spot on the mons.
  4. Image, the labia minora is spread very wide. An arrow points under a strip of intact flesh north of the natal glans. A label says, “go under,” indicating how the erectile disuse will be moved along the northbound path and buried at the phallus landing site. The image shows a catheter in the natal urethra.
    Caption, Doc spreads the labia minora. This patient is having urethral lengthening and burial now.
  5. Image, the opened mons. A surgical tool pulls flesh gown out of the way to view the area. A catheter now comes out of the mons, like a suprapubic catheter. Beside the catheter exit on the mons is the transposed erectile tissue against reorganized labia minora tissue from near the natal urethra. Beside both, I label it, “new address”.
    Caption, Doc uses the minora and a strip of the v* for the UL and hookup. Now the goodness is enthroned in another dimension. Aka, burial moved the natal glans up the mons, to be below the new construction.
  6. Illustration 6 of 12. Side view of the same images. Label, The pedicle is still linked to nerves an circulation.
    Caption, The majora are now only connected at the top. Fly away… Nature is healing…
  7. Image, the pedicle is turned upward, or inside out, to show the full shape of the partially detached pedicle. Label, underside of tissue. Arrows point from the furthest out vertices of the pedicle, toward the apex. The arrows indicate the direction of tissue folding. South of those actions, the area at the prior vulva no longer shows any exterior tissue. All tissue external there has been moved. Sutures along the new perineum indicate vaginectomy has just been performed.
    Caption, Doc stretched the majora stuff are partially still connected. This patient has vaginectomy now.
  8. Image, Three points on the pedicle are drawn together and joined. Arrows point that the perineum will be closed.
    Caption, It blows my mind every time. Now it is time to flip those tips up! Bring the dots together.
  9. Image, the sections of the scrotum and perineum are in place and are now seen together. The appearance is of a ball sack with incision lines. One incision line comes up the medial raphe. Each hemiscrotum bears a diagonal incision extending from the center front if the scrotum.
    Caption, And voila. The word vagina is written and scratched out. (The word labia is written and scratched out.) Text, Doc sews up the perineum and stitches the scrotum together. Yay!
  10. Image, another angle.
    Caption, Would you look at that mighty fine satchel. The phallo work commences.

11 Image labeled “Later”. Drawing of a healed, longer flaccid penis of typical natal appearance, resting across the thigh. The penis has a natural looking glans. There is a natural looking scrotum. It has a single pouch with a slight indentation from the medial raphe. The scrotum has bulk from internal fat, but it does not have the silhouette of implants.
Caption, Just waiting fir enough healing to get the erectile device and jewels. /(Jewels is the slang term for testes.) Sensation is growing. In quotation marks, “Ouch, ooh, aaaaah, unf.” (Sounds for a variety of sensations.)

12 Image of the healed penis with an erectile implant. One testicle in the scrotum is slightly higher than the other. The scrotum skin is flexible and looser. Label, “The sequel. Special edition. New and improved.” Label by higher testicle, “Bulb, erectile ball.” Label by lower testicle, “chillin’ ball”. That’s slang for relaxation.
Caption, the patient gets a pump erectile implant.
Small drawing of a poster with the words “Happily Ever After”.

Caption at the bottom of the whole poster, fine print.
Notes. This is the VY scrotoplasty technique sometimes called VY “According to Hoebeke”. There are many variations on VY. My drawings are based on the operating room photos of Stan Monstrey. However, many surgeons offer VY. Stating, sequence, and technique can be hugely variable along with elements of the plan.

Caption final paragraph. This set of drawings shows scrotoplasty beside phalloplasty. Questions regarding scrotoplasty frequently apply to metoidioplasty. The technique for this scrotoplasty stays (generally) similar without urethral lengthening, burial, or vaginectomy.

Signed, enbytex, version 1.2

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