Scrotoplasty: Procedure, Benefits, Risks, Recovery and Alternatives

Scrotoplasty is a surgical procedure aimed at reconstructing, reshaping, or augmenting the scrotum—the pouch of skin that holds the testicles. While it’s traditionally performed to repair trauma, congenital defects, or disease-related issues, it has gained significant attention in recent years as an essential component of gender-affirming surgery for transgender men, as well as for cosmetic and functional concerns in cisgender men and boys. This article covers what scrotoplasty involves, its benefits, associated risks, the recovery journey, and alternative treatment options—backed by current clinical research.

Scrotoplasty: The Procedure

Scrotoplasty encompasses a variety of surgical techniques designed to reconstruct, repair, or enhance the scrotum. The specific approach depends on the underlying reason for surgery—ranging from congenital anomalies and trauma to gender-affirming surgery and cosmetic refinement.

Approach	Purpose	Patient Group	Source(s)
V-Y Advancement	Scrotal creation	Trans men, PSW repair	184
Local Flaps	Defect repair	Trauma, cancer, infection	26
Reduction	Size correction	Scrotomegaly (enlarged)	72
Minimally Invasive	Volume enhancement	Pediatric monorchia	10

Table 1: Common Scrotoplasty Techniques

Scrotoplasty in Gender-Affirming Surgery

For transgender men, scrotoplasty is a cornerstone of bottom surgery. Surgeons often use tissue from the labia majora to construct a natural-looking scrotum. Techniques such as V-Y advancement and rotational labial flaps are popular, often performed alongside phalloplasty and sometimes with testicular prosthesis implantation in later stages. The goal is an aesthetically pleasing and functional result, minimizing morbidity and maximizing erogenous sensation and position accuracy 13.

Repair of Congenital or Acquired Defects

Scrotoplasty is also used to correct congenital issues like penoscrotal webbing (PSW) or hemiscrotal agenesis. Procedures such as Heineke-Mikulicz (HM), V-Y, Z-plasty, or W-incision scrotoplasty are chosen based on defect severity and surgeon preference. For extensive tissue loss (as with trauma or infection), local pedicled flaps, skin grafts, or distant tissue flaps may be necessary 2468.

Cosmetic and Functional Procedures

An increasing number of adults seek scrotoplasty for aesthetic reasons, including scrotal reduction (for scrotomegaly) or lifting. These procedures aim to improve comfort, function, or self-image and are generally safe and effective when performed by experienced surgeons 72.

Pediatric and Minimally Invasive Techniques

In children with underdeveloped scrotums or after testicular loss, minimally invasive techniques such as hyaluronic acid gel injection offer volume enhancement until a definitive prosthesis can be placed at puberty 10.

Benefits and Effectiveness of Scrotoplasty

Scrotoplasty can offer substantial benefits, including improved appearance, psychological well-being, functional restoration, and increased patient satisfaction across diverse patient populations.

Benefit	Impact Area	Patient Satisfaction	Source(s)
Aesthetic Result	Appearance	High	12108
Sensation	Function	Positive	13
Repair/Restoration	Health	High	264
Psychological	Well-being	High	1710

Table 2: Key Benefits of Scrotoplasty

Restoration of Normal Appearance and Function

Scrotoplasty is highly effective at restoring a natural scrotal appearance, whether after trauma, disease, or as part of gender affirmation. Most patients experience significant improvements in self-esteem and body image 12310. In pediatric populations, both surgical and minimally invasive approaches are associated with high parental and patient satisfaction 108.

Enhanced Sensation and Functionality

Innovative surgical approaches, particularly in gender-affirming surgery, prioritize not only appearance but also sensation and function. Modified labial flap techniques can enhance both erogenous and tactile sensitivity, contributing to a more satisfying surgical outcome 13.

Psychological and Quality-of-Life Improvements

For many, especially transgender men and individuals with congenital or acquired defects, scrotoplasty leads to marked improvements in psychological well-being and quality of life, reducing gender dysphoria or distress related to body image 1710.

High Patient Satisfaction

Across various techniques and indications, scrotoplasty is associated with high rates of patient and/or parent satisfaction, provided complications are minimized and expectations are managed 12810.

Risks and Side Effects of Scrotoplasty

Like any surgical procedure, scrotoplasty carries risks, which can vary based on patient health, surgical technique, and the complexity of the case.

Risk	Severity	Key Risk Groups	Source(s)
Wound Dehiscence	Mild–Major	Diabetics, V-Y plasty	59
Infection	Moderate	All	25
Sensation Changes	Mild–Mod.	All	13
Need for Revision	Moderate	Children, complex	48

Table 3: Common Risks and Complications

Wound Healing Complications

Wound dehiscence (wound separation) is one of the most significant complications, particularly in diabetic patients and those undergoing V-Y plasty. Diabetics have been shown to have a 6- to 10-fold increased risk of wound dehiscence, which may range from minor issues healing on their own to severe cases needing re-operation 59. Proper patient selection and perioperative management are crucial.

Infection and Bleeding

As with any surgery, there is a risk of infection and bleeding, though these are generally uncommon in experienced hands. Prompt recognition and management are vital for a successful outcome 25.

Changes in Sensation and Cosmetic Dissatisfaction

Some patients may experience changes in tactile or erogenous sensation, particularly in complex reconstructive cases. While modern techniques aim to preserve or enhance sensation, outcomes may vary 13. Cosmetic dissatisfaction is rare but possible, especially if healing complications occur.

Need for Revision Surgery

In pediatric populations and complex repairs, a small percentage of patients require revision for issues such as excess skin ("dog-ear" tags), suture tract problems, or scar contraction. These are typically minor and easily addressed 48.

Recovery and Aftercare of Scrotoplasty

Recovery from scrotoplasty varies depending on the procedure's complexity, patient health, and any additional surgeries performed simultaneously.

Recovery Aspect	Timeline	Special Considerations	Source(s)
Healing	2–6 weeks	Longer with complications	1534
Pain/Discomfort	1–2 weeks	Generally mild	21
Activity Restriction	2–4 weeks	Avoid straining, trauma	124
Follow-up	Regular	Monitor for complications	594

Table 4: Recovery and Aftercare

Immediate Postoperative Period

Patients typically experience mild to moderate discomfort, swelling, and bruising for the first 1–2 weeks. Pain is usually manageable with oral medications 12.

Activity and Wound Care

• Rest and limited activity: Most surgeons recommend avoiding strenuous activity, heavy lifting, and sexual activity for 2–4 weeks.
• Wound care: Keeping the area clean and dry is essential. Patients are instructed on proper wound care to minimize infection risk 124.

Monitoring and Follow-Up

• Regular follow-up: Scheduled visits are crucial to check for wound healing, signs of infection, or early dehiscence.
• Special considerations: Patients with risk factors (e.g., diabetes) require closer monitoring 59.

Long-Term Recovery

Healing is generally complete within 4–6 weeks. If testicular prostheses are planned, these are often placed in a staged manner after initial healing 13. In rare cases, minor revisions may be needed for optimal cosmetic results 48.

Alternatives of Scrotoplasty

While scrotoplasty is often the preferred solution for scrotal reconstruction or enhancement, there are alternative approaches for specific situations.

Alternative	Indication	Benefit	Source(s)
Skin Grafts/Flaps	Large defects	Versatile	26
Hyaluronic Acid Gel	Pediatric volume loss	Minimally invasive	10
Observation/Delay	Mild cases, children	Avoids surgery	10
Prosthesis Only	Testicular absence	Simple, staged	103

Table 5: Alternatives to Scrotoplasty

Skin Grafting and Local Flap Reconstruction

For patients with large scrotal defects, such as after trauma, cancer surgery, or severe infection (e.g., Fournier’s gangrene), split-thickness skin grafts or distant tissue flaps may be used. These are generally reserved for cases where local tissue is insufficient 26.

Minimally Invasive Volume Enhancement

In prepubertal boys with monorchia or underdeveloped scrotum, hyaluronic acid gel injection is a minimally invasive way to provide temporary scrotal volume until a prosthesis can be placed at puberty. This approach offers high satisfaction and avoids multiple surgeries in growing children 10.

Observation and Non-Surgical Management

For minor congenital anomalies or cosmetic concerns, observation or delayed intervention may be appropriate, especially in young children where future growth may improve the condition naturally 10.

Testicular Prosthesis Placement Alone

In some cases of testicular loss or agenesis, placement of a testicular prosthesis can restore appearance without the need for scrotal reconstruction, particularly if adequate scrotal tissue is present 310.

Conclusion

Scrotoplasty is a versatile and evolving surgical field that addresses a wide spectrum of medical and aesthetic needs. Whether for gender affirmation, correction of congenital defects, trauma, or cosmetic refinement, the procedure offers high rates of satisfaction and functional restoration. However, as with all surgeries, there are risks that require careful patient selection, surgical expertise, and diligent postoperative care.

Key takeaways:

• Scrotoplasty techniques are tailored to individual patient needs, ranging from reconstructive to cosmetic and minimally invasive options.
• The procedure is highly effective for restoring normal appearance, function, and psychological well-being, especially in gender-affirming care and pediatric cases 1310.
• Risks include wound complications (notably in diabetics), infection, sensation changes, and occasional need for revision, but most are manageable with expert care 594.
• Recovery is generally smooth and rapid, but proper aftercare and follow-up are essential for best outcomes 125.
• Alternatives such as skin grafting, injectable fillers, observation, and prosthesis placement offer additional options for selected cases 2610.

Ultimately, scrotoplasty represents a highly individualized surgical journey. In partnership with skilled surgeons, most patients can expect excellent outcomes tailored to their goals and health needs.