Phalloplasty Surgery Information
Phalloplasty is a type of gender reassignment surgery for female to male transsexuals. Phalloplasty surgeons are able to construct a phallus and achieve successful before and after results.
Phalloplasty is a genital reconstructive procedure that creates sensate male genitalia. Phalloplasty has drastically evolved and patients are now able to retain erotic sensation.
The success rate of phalloplasty has increased substantially over the last several years. Patients are now able to achieve a sensate phallus that retains erotic sensation. Although results vary by surgeon, the appearance of the neophallus (new penis) looks remarkably realistic.
Female to male transsexuals account for the largest population of phalloplasty recipients. Although phalloplasty was initially created for biological males, it is now mainly performed on patients seeking gender reassignment surgery.
The neophallus is usually constructed from a skin graft of tissue taken from a donor site. The graft may be taken from the arm, abdomen, hip, or torso, which qualify as graft sites because they are large enough to provide a large amount of tissue that has a higher density of nerve endings.
Results may vary by surgeon.
Phalloplasty may be accompanied by other genital surgical procedures. These may include vaginectomy, urethoplasty, scrotoplasty. Patients may opt to have an erectile prosthesis implanted after the initial reconstruction (or construction for FTMs) of the phallus. The erectile prosthesis is intended to allow the recipient to achieve an erection with their neophallus, which may satisfy the patients desire to achieve penetration of their sexual partner. More information about Erectile Implants.
In addition, patients may need to undergo electrolysis prior to the procedure to remove hair from the graft site.
A user posted a clip from a documentary on YouTube, that shows a female-to-male transsexual demonstrating the results of phalloplasty:
Types of Phalloplasty
Radial Artery Phalloplasty (Forearm Free-Flap Phalloplasty)
The radial artery phalloplasty uses a graft from the skin to create the neophallus. The skin on the forearm is used because it is the thinnest, most reliable, and easiest to harvest of the possible graft areas. In addition, a forearm graft allows for a large graft of skin to be harvested, which gives the surgeon more material to work with when developing the neophallus. This is particularly important if the patient desires a sizable phallus or if the patient desires to void while standing.
A flap from the forearm is formed into a tube and transplanted to the genital area. Uses advanced microsurgical techniques, phalloplasty surgeons connect the arteries, veins, and nerves from the arm to the newly created phallus. In addition, the radial artery from the forearm is also transplanted to the phallus so that it can receive an arterial blood supply, thus increasing the success rate and sensation from the procedure. Over time, the neophallus increases in sensation as the nerves heal and redevelop. Dr. David Ralph from the UK has reported that approximately 50% of his patients achieve sensation in the tip of the penis following phalloplasty.1
The pubic phalloplasty is less common than the radial artery phalloplasty because it does not allow the patient to achieve the same level of results for urinating standing up. However, a benefit of the pubic phalloplasty is that it allows for more flexibility in size and use of the phallus for penetration.
A disadvantage of the pubic phalloplasty is that it may result in an abnormally thick phallus. Furthermore, pubic phalloplasty typically results in a phallus with less sensation than the forearm-flap phalloplasty. Due to complications with extending the urethra, there have been reported difficulties in achieving successful results with an extended urethra and the surgery may be performed leaving a hole on the underside of the phallus for the patient to void through.1
The pubic phalloplasty uses a skin graft from the lower abdomen, that is then formed into a tube to create the structure of the phallus.
- The easiest to perform phalloplasty operation involves taking a graft of skin tissue from the forearm. The advantages of using the forearm as a graft site is that it results in good skin sensation. About 3/4 of patients report satisfaction with the appearance. the forearm flap does not remove muscle from the arm and reports of loss of function have been rare.
There are several disadvantages to using the arm as a graft site: 1) the cosmetic desirability of a graft from this site is low, since the scarring on the arm is permanently visible post-op. 2) Another concern of taking a graft from the arm is that it can result in complications that may cause loss of function in the arm, and 3) patients may need to undergo electrolysis to remove hair from the new phallus.
- More recent phalloplasty techniques have used a graft of skin tissue from the side of the chest, near the armpit area. Grafts from the side of the chest have several advantages over the forearm graft: 1) skin color is closer to the donors skin tone, 2) good sensation, 3) scar is not visible during daily activities, 4) the need for electrolysis to remove hair is lower, 5) lower rate of complications.
- Phalloplasty techniques that use a graft from the leg are similar to the forearm graft. An advantage of taking a graft from the leg is that it is not readily visible. A disadvantage is that there is likely to be a need for electrolysis to prevent the new phallus from having hair.
- A public area flap involves grafting the tissue from the pelvic area around the belly button. Disadvantages include 1) concern regarding aesthetic appearance when shirtless, 2) less natural appearance, and 3) electrolysis is often necessary.
A glansoplasty is performed following a pedicle flap or groin flap phalloplasty to contour the head of the penis. It is intended to give a more realistic appearance to the head of the phallus. The procedure is optional since it is for aesthetic purposes. It is rarely covered by insurance because it is a cosmetic procedure.
The procedure may be done in two stages to preserve blood supply. If done in two stages, the glansoplasty is usually performed under local anesthesia. A semi-circular incision is made around the head of the penis and sutured to create the head. Discomfort is minimal with medication and swelling takes 2-4 weeks to subside.
Minor complications occasionally occur. Major complications are rare.
The goal of scrotoplasty is to create the appearance of a scrotum. Scrotoplasty may be performed at the same time as the metoidioplasty procedure.
Prior to scrotoplasty, select patients may be required to use tissue expanders in the labia majora. Tissue expanders are inflatable balloons that patients gradually expand at home. This is beneficial because it provides the surgeon with enough tissue to insert prosthetic testicles and reduces problems with the prosthetic testicles. Placement of the expanders is usually not very painful and may be performed under local anesthesia. Due to the location of the expanders, patients may need to have a friend or partner help them when inflating the balloons.
Permanent prosthesis can be placed in the expanded scrotum after 3-6 months of expanding. Patients can then return home the same day. Although this requires two operations, the results are frequently better. Patients who chose not to use expanders may have to return at a later date to adjust their prosthesis so that they fall evenly (one may rise above the other due to the constricted space).
Patients may be required to wait 3-6 months after urethral lengthening to have expanders or prosthesis placed. An MRI requires their removal but a CAT scan does not.
Online Phalloplasty Photos and Information
see left sidebar for more up-to-date listings
Online photo archives of older phalloplasty procedures (pre-2003)
Phalloplasty Photographs – Photos of the phalloplasty surgical procedure (graphic)
Phalloplasty Photographs – Dr. Hass, Canada
Phalloplasty Photographs – Dr. Neil Wilson, Michigan
Phalloplasty Photographs – Dr. Paul Daverio, Germany
Phalloplasty Results – Unknown Surgeons
1. Dr. David Ralph. The Patients’ Guide to Phalloplasty. http://andrology.co.uk/downloads/Patient-Guide-To-Phalloplasty.pdf