Pros and cons of the smooth look?

[neutrois (imported)]

Hi folks,

I've now seen the National Health Service urologist I was referred to for a bilateral orchiectomy and had a surgical consultation. I was a little nervous that he'd balk at doing the surgery on me once he'd talked to me, but I was honest about how I saw myself and why I wanted the operation and it was all fine. He asked a lot of questions making sure I knew that the surgery would be permanent and might make it difficult to have GRS later or any other genital reconstructive surgery that needed to use scrotal skin. I'm certain I don't want those, so that was fine.

My operation's going to be in the next two or three months. He explained that he wouldn't go through the abdomen in my case. That's only considered when it might be cancer or when the appearance of the scrotum is important. Instead he'll cut down the 'seam' in the middle of my scrotum, remove the testicles, remove the tubes at the neck of the scrotum and then sew up the incision, burying the stitches under the skin. The stitches will be the dissolvable type and won't need to be removed separately.

It's usual to have one night in hospital but if I have an early time slot and everything goes well I could be discharged before night. I forgot to ask if it was local or general anesthetic but I'm guessing local if there's any chance of not being an overnight admission.

I was told it'll need two weeks minimum off work and up to six weeks before I can do heavy lifting or strenuous exercise again. I'll be encouraged to move around rather than being bed ridden but I'll probably find it painful to sit for at least a week and I should have someone at home looking after me for that time. I'll need a daily bath and dressing change and I'll be on paracetamol and ibuprofen painkillers. There's the risk of internal oozing of blood which might make it look bruised and swollen and could possibly mean another operation to drain clots. There's a risk of infection which might mean antibiotics.

I wasn't expecting to be given any choice over the outcome but it turned out that he'd treated someone like me before. Without me saying anything about it, he asked if I'd like to be given a 'smooth look' and said that's what the other patient had called it. Basically instead of cutting down the 'seam' and then sewing up the cut, he'd cut two curves on either side of the 'seam', so he'd be cutting out a sort of leaf or eye shape of scrotal skin which would be a three or four centimetres across at the widest part and pointed at the ends. The idea is he'd sew the two curved edges together so it should heal into a straight line but there wouldn't be as much loose scrotal skin hanging and it should heal up to look a lot smoother.

The surgeon has done the operation that way once before and thinks he could achieve a smooth look with me using that method. He examined me and said I have considerably less scrotal skin than the other patient who was twice my age. Obviously he's done the standard version many many more times, it's routine for him.

I hadn't thought about whether I'd want a smooth look at all so couldn't answer at the time but I've been told I can think about it and decide as late as the day of the operation if necessary. I've signed a consent form for "removal of testicles +/- excess scrotal skin". I asked a lot of questions to try to find reasons why one or other choice is more practical, but I was told that both will have the same length of cut and number of stitches. It shouldn't have any effect on healing time or painfulness. It shouldn't make erections tighter or painful once healed. In the surgeon's opinion it's entirely down to the appearance of the end result and what my preference is.

What I could really do with is help to understand how the normal result and the 'smooth look' result will turn out so I can make the right decision. Ideally I'd like to see pictures of both, especially a 'smooth look' achieved by cutting out a leaf or curved diamond shape. I've found a couple of examples of 'scrotectomy' results using Google Image Search but they all seem to have been achieved using cuts that extend some way up the penis and have sideways cuts under the root of the penis too so it looks more like a cross shape of sewn up incisions rather than a single line. I think what I'm being offered is more of a scrotum reduction rather than a complete scrotectomy. Also I've heard it said that the scrotum will probably shrink down to almost nothing once the testicles are removed. If that's true does anyone have pictures of that? How long does the shrinkage take and how does it look different to the smooth look I've been offered?

It would also be helpful to talk to other people who had either type so they can tell me their own perspective on what the pros and cons are for each. Does the penis feel more obvious without the scrotum hanging behind it or is the flap of empty scrotum skin more of a distraction? Will the empty scrotum be more likely to get caught in things? Mine already gets caught in underwear elastic when I'm tucking. Could the smooth look make erections become tighter and painful even though the surgeon said no? Could removing more skin affect sensation more than a simple incision? Might I loose feeling in any part of my genitals? Is it really no longer to heal or any more painful to have the smooth look? Are there any down sides to the smooth look option I'm not thinking of?

I've been thinking about this for a few days now and I think if there was genuinely nothing in it and the choice was solely my preference then I would absolutely want to have less material overall and end up without the empty scrotum. My testicles are really small these days and are often in my abdomen instead of in the scrotum, so I can see what my empty scrotum looks like. I really can't say I like having a wrinkly turkey neck of skin hanging down there. I think unless there are going to be some really serious downsides, like pain when aroused, loss of sensation or it actually looking worse for some reason, then I'd go for the smoother option.

The only niggling thought is that I'd be permanently removing the option of having some kind of other reconstructive surgery down there in the future but that honestly isn't something I want. This is my end point. I just have to put more weight on any decision that's permanent and rules out other choices in the future. It's more reason to want to know as much detail as possible about what the end results might be. If I choose the smooth look then it's for the rest of my life. If I don't go through with that now then it's never going to be offered to me like this again. It's never going to be done for free during another operation I'm already doing, already getting leave for and already recovering from. That probably means that not doing it might as well be forever too.

That's my dilemma. I'd be grateful for any advice, perspectives, experiences and pictures you can give me or point me in the direction of.

Thanks in advance!

[Mac (imported)]

If it was me and since GRS would not be a future consideration, I would want total removal of everything with urethra relocation. The only option might be to use some of the scrotal skin for labia like folds.

[Sweetpickle (imported)]

I think you have to integrate that decision into how you plan to present yourself (sexually) after the operation.

That is, think of what sort of relations do you plan to have, and what will work to further that goal.

Good Luck.

[smoothie36 (imported)]

I did not think it would matter, but the saggy skin empty sac look is not nice. As my plastic surgeon said, skin does not ungrow. So I had it cut off and now have the smooth look and much prefer it.

[eunuch2001 (imported)]

If you really will not seek reconstructive surgery in the future I would recommend the smooth option, and it seems that your surgeon will take care to ensure you end up with a visually pleasing result.

My testes and scrotum were removed in hospital in an emergency operation after they had been irretrievably damaged by banding. I was left with a crooked scar which remains ugly even after more than ten years. The surgeon insisted on leaving a small flap of scrotum in case I wanted cosmetic surgery in the future to reconstruct a scrotum and insert artifical testes. I didn't want that at the time and have never once wanted it since.

I wish you every success with the surgery, and whatever you choose I hope you will be pleased with the result.

[raymar2020 (imported)]

My vote would be for the smooth look. I have very little scrotum, but even that on a warm day can be saggy and very unattractive. I am having it removed this year. If you can accomplish both at once, that is what you'll be happiest with I assure you.

Raymar

[neutrois (imported)]

I think you have to integrate that decision into how you plan to present yourself (sexually) after the operation.

That is, think of what sort of relations do you plan to have, and what will work to further that goal.

Good Luck.

Hmm. There will be no difference to how I present myself now. I'm transgender with a non-binary gender. My potential partners know I have some sort of transsexual past but don't know what I was born with or if I've had any kind of surgery. I guess if anything the smooth look would be closer to what people are possibly assuming but I wouldn't want to be with someone who was making choices about me based on my genitals anyway.

[neutrois (imported)]

I did not think it would matter, but the saggy skin empty sac look is not nice. As my plastic surgeon said, skin does not ungrow. So I had it cut off and now have the smooth look and much prefer it.

That's interesting so is all the stuff about it shrinking a myth? I guess it makes sense it wouldn't shrink, only maybe get less elastic as it isn't stretched out so often.

So did you loose any sensation going to the smooth look? If you can get erect, does that hurt now? Did your surgeon use the cross of four lines of stitches method or was it 'closing an eye' like my surgeon described? How long did it take to heal up after?

Sorry for asking so many questions

[neutrois (imported)]

My vote would be for the smooth look. I have very little scrotum, but even that on a warm day can be saggy and very unattractive. I am having it removed this year. If you can accomplish both at once, that is what you'll be happiest with I assure you.

Raymar

Thanks, that's interesting to hear that it will be saggier when warm. Mine is tiny when cold and appears to be much larger when warm right now. So that will continue even without testicles?

Thanks for your perspective!

[JessJames1968 (imported)]

I was left with a crooked scar which remains ugly even after more than ten years.

Just my two cents, but I've been told "Mederma" is good to reduce the appearance of scars. I think that's the name.