I perform a metaidoioplasty (extend, straighten, and release the clitoris) but do not extend the urethra. I will straighten the new penis and insert testicle implants into the labia majora at the same time. I often remove excess pubic by liposuction or excision. I don't do a urethral extension, which requires a hysterectomy, vaginectomy, etc, because it has a much higher complication rate. I also do not perform microsurgical free flap phalloplasty, such as making a penis from a forearm. Surgery is performed as an outpatient.