Scrotoplasty

Scrotoplasty, also known as oscheoplasty, is surgery to repair or create a scrotum. (In plain English, the scrotum is the ball sack.) Some transgender men, intersex, and nonbinary people who were assigned female at birth may choose to have this surgery to create a scrotum, as part of their transition. This can be done together with closing the vagina (vaginectomy), having surgical changes made to their clitoris to make it more penis-like (metoidioplasty), and/or building a full-size penis (phalloplasty). It is possible to create a scrotum and keep the vagina, and there are trans people who have done so.

Procedure
Typically, when a trans man or transmasculine person has a scrotoplasty, the labia majora (the big lips of the vulva) are dissected to form hollow cavities, and united to into an approximation of a scrotum.

If there is not enough skin to make a scrotum, then the surgeon may use some sort of tissue expansion prior to the operation. This can be done by putting expanders under the skin. Over the course of a few months, more saltwater (saline) will be occasionally added to the expanders through a port on the outside. This helps the skin expand and grow more skin. Each expansion procedure is done in an outpatient hospital visit. The patient does not have to stay overnight in the hospital, but will have to stay near the hospital, and return several times.

Later, silicone prosthetic testicles can be put in. (In plain English, fake balls made of plastic.) These can be inserted through small cuts to fill the new scrotum. If expanders were used, they are no longer needed by this point. Then the skin is closed up around the artificial testicles.

Artificial testicles only give a shape, and they do not create semen, sperm, or hormones. With today's technology, it is not yet possible to create testicles that do so.

Complications
Known complications to scrotoplasty primarily deal with testicular implants. If they are too big, there is chance that the implants could feel uncomfortable, or be a cause of chronic pain. Another complication is that the implant could erode the skin of the scrotum. This can cause infection, or an unwanted hole (a fistula) where the implant may work its way outside the body.

Other complications are those that are typical for any surgery, such as blood loss, infection, or problems with anesthesia.

Cost
A scrotoplasty for a trans man or transmasculine person typically costs around USD$3,000 to $5,000. These costs can be covered by health insurance, though the patient must communicate a great deal with their insurance in order to make certain that it will.