Scrotoplasty is surgery to repair, reshape, or create a scrotum. It covers a wide range of procedures, from cosmetic lifts to full reconstruction as part of gender-affirming bottom surgery. The technique and complexity vary significantly depending on why you’re having it done, but the core goal is the same: a scrotum that looks natural, functions well, and feels comfortable.
Why People Get Scrotoplasty
The reasons fall into a few broad categories. Some are medical, some are cosmetic, and some are part of gender transition.
- Buried penis: Excess skin or fat tissue conceals the penis, making it difficult to urinate without leaking. Scrotoplasty can reshape the surrounding tissue and significantly improve daily quality of life.
- Penoscrotal webbing: Extra skin connects the underside of the penis to the scrotum, which can limit sexual function. Surgery releases this web and restores a more typical separation.
- Scrotal lift or reduction: A sagging or enlarged scrotum can cause discomfort or self-consciousness. A lift tightens and resizes the tissue, similar in concept to other body-contouring procedures.
- Trauma or infection repair: Injuries or severe skin infections (like Fournier’s gangrene) can destroy scrotal tissue. Reconstructive scrotoplasty rebuilds what was lost.
- Gender-affirming surgery: For transmasculine individuals, scrotoplasty creates a new scrotum (neoscrotum) using existing genital or surrounding tissue, often with testicular implants placed later for a natural appearance.
How Scrotoplasty Fits Into Gender-Affirming Surgery
For transgender men and transmasculine people, scrotoplasty is rarely performed alone. It’s typically one component of a larger bottom surgery plan that may include metoidioplasty (which uses hormonally enlarged existing tissue to create a small phallus) or phalloplasty (which builds a full-sized penis from a skin flap, usually from the forearm or thigh). Scrotoplasty is integrated into these procedures to create a complete genital reconstruction.
A common approach pairs a V-Y scrotoplasty with metoidioplasty. The surgeon rearranges local tissue using a V-shaped incision that’s closed in a Y pattern, creating a pouch that will eventually hold testicular implants. In cases involving a bifid scrotum (where the scrotal tissue is split into two separate halves), the repair involves repositioning the skin posteriorly and bringing it together in the midline to form a single, unified pouch. The penis or neophallus is simultaneously repositioned forward onto the abdominal wall.
Testicular implants are almost always placed in a separate, later surgery rather than at the same time as the initial scrotoplasty. This staged approach lets the tissue heal fully and the neoscrotum stretch to accommodate the implants without excessive tension on the incisions.
Testicular Implants
Testicular prostheses have been used since the 1940s and are a well-established part of scrotal reconstruction. They’re used not only in gender-affirming surgery but also for cisgender men who’ve lost a testicle to cancer, injury, or a condition like undescended testes.
Most implants available in the UK and internationally are saline-filled silicone shells, and they come in a range of sizes, typically from about 10 to 19 cubic centimeters. During surgery, the surgeon creates a pocket inside the scrotum, tests the fit (sometimes using packed gauze to estimate volume), and secures the implant with a stitch through a built-in suture loop. The goal is symmetry and a natural feel, and surgeons choose sizing based on the individual’s body proportions and the amount of available scrotal tissue.
Sensation After Surgery
One of the most common concerns about any genital surgery is whether you’ll retain feeling afterward. The evidence here is encouraging. Research on sensory recovery after genital reconstruction shows that nerves in this area regenerate faster and more completely than in almost any other part of the body. Erogenous sensation, including the ability to orgasm, is present in nearly all patients after several months of healing.
For gender-affirming scrotoplasty specifically, the neoscrotum is created from tissue that already has its own nerve supply. While sensation may feel different initially as nerves reorganize, tactile and pressure sensitivity typically develop over time. The scrotum itself isn’t the primary source of erogenous sensation in most people, so the preservation of nerve connections to the clitoris or neophallus matters more for sexual function. Still, having a scrotum with normal touch sensitivity contributes to body comfort and a sense of physical wholeness.
Risks and Complications
Scrotoplasty is generally considered safe, but like any surgery, it carries risks. The most common complications include hematoma (a collection of blood under the skin), infection, and wound healing problems. Hematoma rates in scrotal implant procedures range from about 0.2% to 9.6%, with higher rates in complex or revision cases compared to straightforward first-time surgeries.
For procedures involving testicular implants, there’s a small risk of the implant shifting out of position or, in rare cases, pushing through the skin (extrusion). Infection risk increases when a hematoma forms, so surgeons take care to minimize bleeding during the procedure. Scarring is inevitable but typically fades over time and is positioned along natural skin folds when possible.
Eligibility and Preparation
For reconstructive or cosmetic scrotoplasty (scrotal lifts, webbing correction, trauma repair), the path is relatively straightforward. You’ll need a consultation with a urologist or plastic surgeon, standard pre-surgical bloodwork, and medical clearance.
Gender-affirming scrotoplasty has additional requirements. Following widely used guidelines, genital surgery typically requires persistent, well-documented gender dysphoria, the capacity to give informed consent, and being the age of majority in your country. Two mental health assessment letters are standard: one from any licensed therapist and one from a doctoral-level provider (a psychologist, psychiatrist, or equivalent). These letters generally need to be written within 18 months of surgery. Hormone therapy is not a prerequisite, though many surgeons prefer that patients have been on testosterone for a period of time because it affects tissue characteristics.
Some surgical programs set body mass index (BMI) limits, commonly requiring a BMI under 30, 33, or 35. However, these thresholds are not part of official WPATH guidelines and are set at the discretion of individual programs. Growing evidence suggests that patients with a BMI above 30 don’t necessarily have worse surgical outcomes, and some centers evaluate higher-BMI patients on a case-by-case basis rather than applying a hard cutoff.
For gender-affirming scrotoplasty, permanent hair removal on the donor skin is often required before surgery. Since the tissue that forms the neoscrotum may have been hair-bearing skin, electrolysis or laser hair removal prevents hair from growing inside the scrotal pouch after reconstruction. This process can take months and should be started well in advance.
Recovery Timeline
Recovery depends on the scope of the procedure. A cosmetic scrotal lift is a relatively minor outpatient surgery with a recovery measured in days to a couple of weeks. Full scrotoplasty as part of bottom surgery involves a longer healing process because there’s more tissue rearrangement and the surgery is typically combined with other procedures.
In the first week or two, expect significant swelling and bruising. Surgical drains may be placed to prevent fluid buildup and are usually removed within the first week or so. Most people can return to desk work within two to four weeks, though this varies by the extent of surgery. Physical activity needs to be restricted, with heavy lifting and strenuous exercise off-limits for at least six weeks. Sexual activity is typically postponed for at least six to eight weeks, or longer if testicular implants were placed, to give the tissue time to heal securely around the implant.
If testicular implants are planned as a second stage, there’s usually a gap of several months between the initial scrotoplasty and the implant insertion. This allows the neoscrotum to fully heal and the skin to gain enough elasticity to accommodate the prostheses comfortably.