Metaidoioplasty
Dr. Alter performs a metaidoioplasty (extend, straighten, and release the clitoris) but does not extend the urethra. He straightens the new penis, moves the labia majora lower to form a scrotum, and inserts testicle implants into the new scrotum at the same time. During the process excess pubic fat can be removed by liposuction or excision.
Dr. Alter does not do urethral extensions, which requires a hysterectomy, vaginectomy, etc, because it has a much higher complication rate. He also does not perform microsurgical free flap phalloplasty, such as making a penis from a forearm.
Secondary Genital Reconstruction
Dr. Alter performs secondary reconstruction of other phalloplasties to improve appearance and correct urinary problems. The scrotum is constructed by various techniques, including tissue expansion, insertion of testicle implants, muscle flaps, and grafts. Testicle implants made of saline or solid gel are available.