Definition & Overview
Phalloplasty is a surgical procedure used to reconstruct the male genitalia. The goal of this procedure is to achieve erotic sensation and rigidity for sexual intercourse as well as retain the capability of urinating while standing up.
There are two techniques to perform this procedure; one is the pedicled or local flap phalloplasty, which uses a skin flap that has one end transposed to another location while the other end is still attached to the donor site and the free flap phalloplasty that uses a skin graft taken entirely from another part of the body.
Phalloplasty has become quite popular in recent years, not just for penis enlargement but also for gender reassignment.
Who Should Undergo & Expected Results
Phalloplasty is recommended for those born with a congenital disorder called aphallia, a rare type of condition in which a boy is born without a penis. Typically performed on children entering puberty, it can also be taken advantage of by those born with micropenis or severe penile inadequacy as well as those with ambiguous genitalia, hypospadias, and bladder exstrophy.
Those who have experienced mutilating trauma involving their genitals are also advised to undergo phalloplasty, especially those who have lost sensation in their penis due to accidents or blast injuries. Self-inflicting injuries like penile amputation can also be considered for phalloplasty but only after the patient is determined to be mentally capable of undergoing such surgical procedure.
Those diagnosed with gender identity disorder may also be offered phalloplasty. In some rare instances, phalloplasty is performed on those whose penises are injured following a circumcision ortumour excision.
The results of phalloplasty largely depend on the type of surgery performed, the extent of injury or damage, and whether or not the nerves and other affected body parts like the urethra are successfully reconnected. However, this procedure has generally positive patient outcomes. Children who undergo phalloplasty report good functional and cosmetic results even after several years following the procedure. Those who undergo penile enlargement also report the same or even improved levels of sexual performance following surgery.
This procedure requires several weeks of recuperation and rest, as well as avoidance of strenuous activities for a few months after surgery.
How Does the Procedure Work
There are several techniques used for phalloplasty, one of which requires graft tissues taken from specific body parts like the arm, side of the chest, leg, pubic area, or the abdomen.
The procedure is completed in several stages that are spaced at least three months apart. As such, phalloplasty is usually completed within 12 to 18 months, depending on the extent of the procedure and any complications that might occur.
The first stage is the formation of the phallus, which involves the removal of the graft tissue from the donor site and transferring it to the genital area. A flap is formed into a tube and will become the neourethra. A larger flap is then wrapped around it to form an outer tube and the whole tissue is transplanted. If necessary, a skin graft will be made from other parts of the body (usually from the buttocks) to fill the area where the graft tissue is taken.
The second stage of the procedure is the formation and joining of the neourethra to allow the passing of the urine. After the urinary tract has been connected, the third stage will commence with the surgeon adding the prostheses, especially for those undergoing penis enlargement. Depending on the patient’s unique circumstances, the implantation of testicular prostheses is also done at this stage. This is also where the surgeon performs steps necessary to shape the glans and clean up any scars in the genitals.
Stage four involves the insertion of penile prostheses. The body will then form a fibrous capsule around the inserted material.
Possible Complications and Risks
There are risks of perioperative bleeding and adverse reaction to anaesthesia during a phalloplasty. Infection could also set in the operative site and cause for the whole process to fail. There is also the possibility of blood accumulating under the surgical site that could lead to bruising and swelling. If there is insufficient blood supply to the area, necrosis or tissue death may also occur. Additionally, the inserted prostheses are prone to infections and corrosion over time.
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Nair R, Sriprasad S. 1129 Sir Harold Gillies: Pioneer of phalloplasty and the birth of uroplastic surgery. J Urol. 2010;183(4):e437.
What is Phalloplasty: Overview, Benefits, and Expected Results
Phalloplasty is a surgical procedure that aims to create a functional and aesthetically pleasing penis for individuals who were assigned female at birth or have concerns about the appearance or function of their current genitalia. It is one of the options available for gender-affirming surgeries and is often chosen by transgender men or individuals looking to enhance their masculinization.
Phalloplasty involves the construction of a penis using various techniques, depending on the goals and preferences of the individual. The procedure typically consists of several stages and may take place over the course of several months or even years. It begins with the harvesting of donor tissue, usually from the forearm, thigh, or abdomen. This tissue is then shaped into the desired size and shape of the phallus.
Depending on the desired outcome and the patient’s requirements, additional procedures may be performed during the different stages of phalloplasty. These may include urethral lengthening, scrotoplasty, erectile device implantation, and glansplasty, among others. Each step requires careful planning and coordination between the patient and the surgical team to ensure the best possible outcome.
Benefits of Phalloplasty
Phalloplasty offers numerous benefits for individuals seeking to align their physical appearance with their gender identity or improve their quality of life. Some of the key benefits include:
- Improved self-confidence: For many individuals, having a penis that aligns with their gender identity can significantly improve their self-esteem and overall well-being.
- Enhanced sexual satisfaction: Phalloplasty can provide functional benefits such as enhanced sexual sensation and the ability to achieve erections.
- Urinary function: In many cases, urethral lengthening during phalloplasty allows individuals to urinate while standing, which can contribute to a greater sense of gender affirmation and convenience.
- Increased options for gender presentation: Having a phallus can offer individuals increased flexibility in presenting themselves to the world in a way that aligns with their gender identity.
Expected Results and Recovery
The results and recovery process of phalloplasty can vary depending on the individual, the specific techniques used, and any additional procedures performed. However, there are some common expectations and considerations to keep in mind:
Immediate post-operative period:
Following the surgery, patients typically experience swelling, bruising, and discomfort in the operated area. Drainage tubes may be temporarily inserted to prevent fluid buildup. Pain management medication is prescribed to help alleviate any discomfort. It is important to strictly follow the surgeon’s instructions for wound care and hygiene during this initial healing phase.
The complete recovery process may take up to a year or longer, with each stage of phalloplasty having its own healing timeline. During this time, patients will need to attend follow-up appointments to ensure proper healing and address any concerns. It is vital to communicate openly with the surgical team and adhere to any recommended activity restrictions or rehabilitation exercises.
While individual results may vary, many individuals report high levels of satisfaction with the outcome of their phalloplasty surgeries. The newly constructed phallus typically retains the ability to achieve erections, either naturally or with the assistance of an erectile device implantation. Sensation can also be expected in the phallus, although the degree may vary.
It is important to note that phalloplasty is a complex surgical procedure that carries potential risks and complications, as with any surgical intervention. These may include infection, bleeding, scarring, and unsatisfactory aesthetic or functional outcomes. It is crucial to thoroughly discuss these risks with a qualified surgeon and ensure that all necessary pre-operative evaluations are conducted.
Phalloplasty is a surgical procedure that aims to create a functional and aesthetically pleasing penis for individuals seeking gender affirmation or improved quality of life. It offers various benefits, including improved self-confidence, enhanced sexual satisfaction, and increased options for gender presentation. The recovery process may take time, but many individuals report high levels of satisfaction with the results. However, it is essential to carefully consider the potential risks and complications associated with the procedure. To make an informed decision, consult with a qualified surgeon who specializes in gender-affirming surgeries.