ALT Phalloplasty Photographs
Please note that intraoperative photos are included and may be uncomfortable to view for some. Also, please remember that the flap portion of phalloplasty (urethra within phallus, phallus itself, and glansplasty) is performed by the microsurgeons (Drs. Buntic, Lin, Safa, and Watt from The Buncke Clinic) at time of single stage phalloplasty; the genital, scrotal, and urethral reconstruction is performed by the reconstructive urologist. Delayed glansplasties (glansplasties done about 6 months after initial phalloplasty) are performed by plastic or urologic surgeons.
Patient A has ideal anatomy: thin, pliable skin with minimal adipose tissue
The ALT phallus with UL will look more anatomic and proportional in patients with ideal thigh anatomy
About 1 year after right ALT phalloplasty with UL and scrotoplasty with testis implants inserted 6 months after phalloplasty and scrotoplasty
Immediate postop photo after inflatable implant insertion. L testis implant is removed to make room for the pump component of the inflatable penile implant
Pt did not have ideal thigh anatomy and therefore opted for no UL. This allowed us to make a more physiologic sized penis. This photo is nine months postop penis girth reduction and glansplasty.
Immediate Postop photo: patient had penis plication, urethroplasty, and glansplasty
Immediate Postop photo: patient had penis plication, urethroplasty, and glansplasty
Immediate Postop photo: patient had penis plication, urethroplasty, and glansplasty
The "ideal" ALT donor site has minimal underlying fat. The patient demonstrates less than a 1/2 inch pinch anterior to his thigh muscles.
Note the multitude of dressings and drains. There is a SP tube in the lower abdomen, a urethral catheter, the wound vac drain (black sponge on right thigh), a wrapping on the left thigh (site of STSG harvest to cover the right donor site thigh), and phallus support towel.
The phallus developed more swelling over time, decreasing blood flow to the phallus. The small dark blue stitches mark where the doppler signal for phallus blood flow is located.
The incision on the underside of the phallus was opened to accommodate the swelling. This was required to improve blood flow to the phallus and prevent phallus (or flap) loss. The black-gray-yellow patch is a piece of a dressing that was placed on the open phallus wound. This eventually sloughs off.
About 1 month postop from phalloplasty. Despite the patient's ideal anatomy, he developed an 8 inch girthed phallus due to swelling and the need for opening the underside of the phallus.
The ruler is hard to see from the photo, but it is about 6 inches long. Over time, ALT phalluses can lengthen, shrink, or remain similar in length.
3 months postop. The swelling is still present, although mostly at the distal half (towards the tip) of the phallus due to gravity. Swelling can take 3-6 months, and sometimes even longer, to resolve.
6 months postop. There is a more cylindrical appearance to the phallus as the wound under the phallus has healed further.
The vascular pedicle (blood flow source to the ALT phallus) can sometimes pull the phallus asymmetrically.
About 9 months after initial phalloplasty, the patient underwent phallus plication (aka girth reduction) and testis implant insertion. There is a suture line on the underside of his penis as well as a scrotum that is more full.
About 1 month after surgery, the swelling has improved and there is more skin laxity around the testicular implants.
Due to the patient's elastic skin, the genitals ended up in a more inferior position. Therefore, a monsplasty was done to lift the phallus/scrotum and glansplasty was performed using the skin graft from the mons lift.
1 week postop. The glans ridge appears mostly well healed except for a dark area on the patient's left side. There is good STSG take behind the glans ridge. Note the well healed right thigh donor site.
4 weeks postop. The ridge and STSG has healed well and the suture lines have dissolved.
6 years postop glans revision; photo taken after IPP replacement
Patient is now about 2 yrs removed from ALT phalloplasty. He had a semi-rigid implant inserted with larger testis implants and glans revision. Glans revision is rarely undertaken with implant surgery, except in special circumstances.
Patient is now about 2 yrs removed from ALT phalloplasty. He had a semi-rigid implant inserted with larger testis implants and glans revision. Glans revision is rarely undertaken with implant surgery, except in special circumstances.