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Phalloplasty

Phalloplasty is the first and largest step of penis/phallus reconstruction. It is often performed with or without:

  • Urethral lengthening (UL)

  • Vaginectomy

  • Scrotoplasty/perineal reconstruction

The most common surgery is phalloplasty with urethral lengthening, vaginectomy, scrotoplasty, perineal reconstruction, and associated procedures (skin graft harvest, suprapubic tube insertion, and others). However, some patients do not need or want UL, and some do not need or want vaginectomy. Others may not want a pouchlike scrotum. We recognize that surgical goals vary from patient to patient and that there are resultant combinations that better meet a patient's individualized surgical goals. Consultations with the surgeon are required to discuss the advantages and disadvantages of each unique combination. 

Further reconstruction of the penis is sometimes required due to variations in anatomy and healing. Examples include:

  • Monsplasty (for prominent prepubic skin leading to perineal or inferior positioning of the phallus/scrotum)

  • Scrotoplasty or neoscrotal revisions

  • Glansplasty (for glans atrophy/flattening or penises that do not have a glans)

  • Penis liposuction/plication (for penises with too much girth)

  • Penis reposition (for asymmetric scarring or off-midline healing) 

  • Penile length reduction (for penises that are too long)

  • Penile Implants

The two most common donor sites used for phalloplasty are the radial forearm (RF) and the anterolateral thigh (ALT) flaps. These donor sites have a reliable blood supply and offer a higher chance of tactile and erotic sensation over time. RF flaps used for phalloplasty have the highest chance of achieving phallus sensation. Abdomen and musculocutaneous latissimus dorsi (MLD) flaps generally don't have sensation and require multiple stages for urethral lengthening. 

"Staged" Phalloplasty: 

  • For phalloplasty, there are two main options: single stage vs staged phalloplasty.

  • Staging is a confusing term because it has different definitions for different patients and surgeons. 

  • "Single stage" phalloplasty involves the creation of a neophallus, UL, vaginectomy, scrotoplasty, and perineal reconstruction in one surgery.

    • Benefit: one major recovery, aesthetic male genitalia and UL for standing micturition​

    • Disadvantage: potential for more complications 

  • Staged phalloplasty is the general separation of the urologic surgical components of the operation from the microsurgery/donor site components. Therefore, stage 1 of staged phalloplasty may be similar to a metoidioplasty.  Alternatively, phalloplasty may be performed first followed by the metoidioplasty related procedures (vaginectomy, UL, scrotoplasty, and perineal reconstruction).

    • Benefit: less intense surgery with potential for fewer complications

    • Disadvantage: two major recoveries

  • Staging details should be reviewed with your surgeon during a consultation.

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