Penis Reconstruction

Metoidioplasty and Phalloplasty are the first and largest steps of penis or 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. However, some patients do not need or want UL, and some do not need or want vaginectomy. In these individualized cases, we can offer phalloplasty without UL, but with everything else; or phalloplasty without vaginectomy, but with everything else. There are other combinations that better meet a patient's surgical goals, and these will need to be discussed with your surgeons to discuss the pros and cons of each unique combination. 

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

  • Majora fold reduction (for metoidioplasty patients with prominent upper majora folds)

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

  • Scrotoplasty or neoscrotal revisions

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

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

  • Penis reposition (for asymmetric scarring) 

  • 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). These donor sites have a reliable blood supply and offer a high chance of tactile and erotic sensation over time. With respect to radial forearm and anterolateral thigh phalloplasties specifically, the reconstructive urologist is Dr. Chen, and the microsurgeons are Drs. Buntic, LinSafa, and Watt from The Buncke Clinic

"Staged" Phalloplasty: 

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

  • "Single stage" is what we usually call "phalloplasty", and it involves the creation of a neophallus, urethroplasty (aka urethral lengthening), vaginectomy, scrotoplasty, and perineal reconstruction.

  • 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 is similar to a metoidioplasty. The main difference, is that a complex scrotoplasty is not performed until stage 2, when the neophallus is created. The remainder (vaginectomy, urethroplasty to tip of native phallus, simple scrotoplasty, with and without hysterectomy) are all done at the same time. 

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