Phalloplasty / FTM Bottom Surgery in Bangkok, Thailand
Female-to-male gender affirmation surgery changes the appearance of female genitals to that of a male's. This has a profound and confirming effect on transmen as they can have the body that they were meant to have: They can urinate standing up and can achieve erections with many procedures, will no longer have a vagina, and if a hysterectomy is performed, will also no longer menstruate.
There are two main methods for creating a new penis. These include changing the clitoris into a penis or using a skin flap from the patient's forearm or thigh to create a penis. A person will typically have taken male hormones for at least a year before undergoing either type of surgery. During the procedure, the surgeon also removes the vagina in a vaginectomy, and a hysterectomy is often performed at the same time.
Phalloplasty is a surgical procedure in which a penis is created. During the procedure, surgeons take one or more "flaps" of skin and other tissues from a donor site on the body, such as the arms, thighs, or abdomen, and use them to form a penis and urethra.
Phalloplasty in Female-to-Male Gender Confirmation Surgery
A good candidate for phalloplasty should have the qualities as follows:
1. The patient must be at least 20 years old. For minors under 20, consent from parents or legal guardians is required to complete the surgery.
2. The patient must have continuously taken male hormones for at least one year.
3. The patient must have lived a life as a man for at least one year.
4. The patient must have undergone a psychiatric evaluation and been declared mentally stable and fit by a psychiatrist.
5. The patient must be physically fit.
6. The patient must have undergone mastectomy and total hysterectomy-oophorectomy for at least six months prior to phalloplasty.
Since 1997, Dr Kamol has performed over 10,000 procedures on transgender patients and over 5,000 sex reassignment surgeries (SRS). Recognized and respected throughout the medical community as one of the most experienced surgeons working in gender reassignment surgery in the world, Dr. Kamol currently performs more than 500 male-to-female sex reassignment surgeries each year. He is the chief plastic surgeon at Kamol Cosmetic Hospital in Bangkok, Thailand, where he leads the team in male-to-female and female-to-male sex transitions and face feminization.
See more of Dr. Kamol's Profile.
Benefits of Phalloplasty include
- Patients are more likely to be able to penetrate their partners sexually.
- The phallus is significantly larger than those created through metoidioplasty, although sensation is significantly lower.
- People feel that this surgery creates more natural-looking genitalia.
Phalloplasty Techniques
Kamol Cosmetic Hospital offers the options for phalloplasty as follows:
1. Anterolateral Thigh Pedicle Flap (ALT-Phalloplasty)
This is the primary option for phalloplasty in Kamol Hospital.
Due to the individual desire variation, we offer the surgical options for ALT-phalloplasty as follows;
- Full phalloplasty with urethral lengthening: the process starts with prefabricating the urethra. The surgery is a two-stage technique with urethral prefabrication and total vaginectomy for at least 6 months before ALT-flap phalloplasty. The skin, with its pedicle containing nerves and vessels from the front and outer part of the thigh, is used to reconstruct the new penis. The urethra and sensory nerves are anastomosed at once.
- Phalloplasty with metoidioplasty: in case of metoidioplasty was done earlier, the new ALT-phalloplasty can be done on top of the micropenis. The sensory nerves are shared with the micropenis and the ALT penis. The patient can be standing to urinate through the micropenis at the base of the ALT penis. With this technique, the patient does not hesitate to address urethral issues such as urethral stricture or urethral fistula.
- Phalloplasty without urethral lengthening is the most simple phalloplasty without urination concerns. The surgical scar is at the bottom of the penis, and the patient urinates through the original urethra
- This is a non-vessel anastomosis technique; thus, the risks of vascular thrombosis are very low
Donor skin preparation and the options for the ALT phalloplasty;
- The patient should have hair removal at the front and side of the thighs to avoid the hair growing at the shaft of the new penis.
- The thigh skin thickness must be thin to avoid an oversize penis. Skin fold at the mid-front thigh must be less than 1.5 cm. In the thick thigh skin, the patient needs to lose weight, exercise, or have liposuction before surgery.
- The donor site at the thigh is covered with a split-thickness skin graft from the adjacent area.
- In order to avoid the skin graft, the patient may have pre-expanded ALT-phalloplasty with the tissue expansion technique. In this technique, the patient must stay 1-2 months for the thigh skin expansion before the flap surgery.
- The vaginectomy, hysterectomy, and oophorectomy must be done at least 6 months before the penile reconstruction.
References
- van der Sluis WB., Ronkes BL., Steensma TD., Al-Tamimi M., van Moorselaar., Bouman BM., Pigot Garry LS. Comparison of surgical outcomes and urinary functioning after phalloplasty with versus without urethral lengthening in transgender men. Int J Trans health. https://doi.org/10.1080/26895269.2022.2110548
- Colebunders SD., Stillaert F., Monstrey S. Pre-expanded Anterolateral Thigh Perforator Flap for Phalloplasty. Clin Plast Surg. 44(1):129-141. https://doi.org/10.1016/j.cps.2016.08.004
Advantages of ALT Phalloplasty
- Good skin color match
- Larger girth than RFF Phalloplasty
- Some natural rigidity
- Less obvious donor site, concealable with clothing
- Decreased surgical time with Pedicled ALT
- Good sensation
- Good potential for urethroplasty
Disadvantages of ALT Phalloplasty
- More difficult in patients with thicker skin and more subcutaneous thigh fat
- In some patients, girth can be excessive
- Less predictable perforator layout adds complexity
- Sensation is reportedly less than RFF Phalloplasty
Picture 1: ALT-Pedicle Flap
Picture 2:ALT phalloplasty creation
How to prepare the ALT donor site?
1. Mark the site at the nondominant Thigh 15x18 cm as shown in the video clip
2. Hair Removal in this area
3. Check the skin's quality and ensure the skin pinch is less than 1.5-1.8 cm. In case of over-thickness, the patient can do liposuction and then wait for 6 months to one year to make the skin softer. We can create phalloplasty. If the patients need to do urethral prefabrication, they can do it a few months after liposuction. If the patient does not need urethral with phalloplasty, they can do phalloplasty after preparing the donor site. After 1-2 years after phalloplasty, they can do the implant
 |
 |
 |
| Donor site | Skin Pinch | Urethral Preflabriation |
Picture 3: How to prepare the ALT donor site
ALT Phalloplasty Without Urethral Integration
Phalloplasty, also known as male genital reconstruction surgery, is a surgical procedure that aims to reconstruct or construct a functional and aesthetically pleasing penis for individuals who were born with ambiguous genitalia, have suffered from traumatic injuries, or have undergone gender reassignment surgery.
“The standard phalloplasty procedure typically involves the creation of a neophallus (artificial penis) and the integration of a urethra, allowing for urinary function. However, some individuals may choose to undergo a variation of this procedure known as "ALT Phalloplasty Without Urethral Integration."
What is ALT Phalloplasty Without Urethral Integration?
ALT Phalloplasty Without Urethral Integration is a type of phalloplasty procedure involving creating a neophallus without integrating a urethra. This means that the individual will not be able to urinate through the neophallus and will instead need to use alternative methods such as a urinary catheter or stoma bag. This type of phalloplasty is typically recommended for individuals who have medical conditions that make it difficult to connect the urethra to the neophallus or for those who are not interested in undergoing urethral integration.
How is ALT Phalloplasty Without Urethral Integration performed?
The ALT Phalloplasty Without Urethral Integration procedure typically involves the following steps:
Anesthesia: Before the procedure, the patient is given general anesthesia to ensure that they are completely unconscious and pain-free during the surgery.
Donor Site Selection: The surgeon will select a donor site for the tissue that will be used to construct the neophallus. This can be taken from the patient's own body (autograft) or a donated source (allograft).
Tissue Harvesting: The selected tissue is harvested and prepared to construct the neophallus.
Neophallus Creation: The surgeon will then use the harvested tissue to construct the neophallus, taking care to shape it in a manner that resembles a natural penis.
Closure: After the neophallus has been constructed, the incisions are closed, and the patient is moved to the recovery room.
Benefits of ALT Phalloplasty Without Urethral Integration
There are several benefits to undergoing ALT Phalloplasty Without Urethral Integration, including:
Improved Aesthetic Appearance: The neophallus constructed during this procedure can be shaped to resemble a natural penis, enhancing the individual's overall appearance and increasing their confidence.
Lower Risk of Complications: By avoiding the integration of the urethra, there is a lower risk of complications such as urethral strictures or fistulas.
Shorter Recovery Time: The absence of urethral integration typically means a shorter recovery time, allowing the patient to return to normal activities more quickly.
Conclusion
ALT Phalloplasty Without Urethral Integration is a variation of the standard phalloplasty procedure that involves creating a neophallus without integrating a urethra. This procedure is recommended for individuals with medical conditions that make it difficult to connect the urethra to the neophallus or for those who are not interested in undergoing urethral integration.
2. Alternate options of phalloplasty in Kamol Cosmetic Hospital
2.1 Radial forearm free flap (RFF): The skin at the front side of the forearm is used to reconstruct the new penis under the microsurgery technique.
Radial forearm free flap (RFF) technique:
We provide two techniques, as follows;
A. Two-stage technique: The two-stage radial forearm free flap technique involves urethral prefabrication for six months before the main step (phalloplasty). This technique is suitable for those with small forearms.
B. One-stage technique: The one-stage radial forearm free flap involves reconstruction of the neo penis and neo urethra in one stage under the microsurgery technique.
Advantages of RFF
- The skin in this area tends to be thinner.
Disadvantages of RFF
- Donor sites can be challenging to conceal.
- Partial skin graft loss
- Decreased sensitivity,
- Possible motion issues with the hand
Picture 2: Radial Forearm Free Flap
Picture 3: Radial Forearm Free Flap
2.2 Fibula Free Flap (FFF)
The skin, nerves, and some parts of the fibula bone are used as the neophallus (penis) under the microsurgery technique.
Fibula Free Flap (FFF) technique:
The skin, a piece of fibula bone, and nerves are used for the neo-penis in one stage under the microsurgery technique. The neo urethra is being pre-laminated in situ for six months before the main step of neo penis reconstruction.
Advantages of FFF
- Length of the flap's blood supply
- Less prominent scarring;
- Natural rigidity for penetration with the use of the fibula bone
Disadvantages of FFF
- Rigid appearance of the phallus.
- Potential bone resorption
- Potential curving and fracture of autologous bone transplants
Picture 4: Fibula Free Flap
2.3 Musculocutaneous Latissimus Dorsi (MLD) Flap
The skin island containing nerves and vessels is moved to the genital area to reconstruct the neo-penis under the microsurgery technique.
Musculocutaneous Latissimus Dorsi (MLD) free flap technique:
The skin paddle containing nerves and vessels is moved from the area behind the arm to the genital area using the microsurgery technique to reconstruct the neo in the first stage. The neo-urethra is constructed in the second stage
Advantages of MLD
● Less conspicuous donor site.
● Relatively hairless donor site
● Good aesthetic outcomes.
● Possibilities for penetrative sex.
Disadvantages of MLD
● Poor sensitivity of the phallus
● Phallus can be large, requiring additional debulking procedures
Picture 5: Musculocutaneous Latissimus Gorsi (MLD)
Urethral Reconstruction of Phalloplasty
Comparison of different Phalloplasty techniques
|
Flap technique |
Size of neo penis |
Donor scar |
Sensation |
Self-stiffness |
|
ALT |
Medium-to-Large |
Thigh |
Yes |
No |
|
MLD |
Medium-to-Large |
Side of Torso |
Yes |
No |
|
Radial forearm |
Small -to-medium |
Forearm |
Yes |
No |
|
Fibula |
Small |
Leg |
Yes |
Yes |
Preparation of Phalloplasty
After a phalloplasty procedure, it is important for the patient to follow their surgeon's postoperative care instructions carefully in order to minimize the risk of complications and optimize the healing process. This may include taking medications as prescribed, keeping the incision site clean and dry, and avoiding strenuous activities. In some cases, physical therapy may be recommended to help improve the function of the newly constructed penis.
Risks and Complications for Phalloplasty
1. Infection: As with any surgery, there is a risk of infection following a phalloplasty procedure. This can be serious and may require additional treatment, such as antibiotics.
2. Bleeding: There is also a risk of bleeding during or after the surgery. This may sometimes require a return to the operating room to control the bleeding.
3. Scarring: Scarring is a common complication of phalloplasty. The extent of scarring will depend on the specific technique used and the patient's healing process.
4. Problems with skin flaps: The skin flaps used to construct the penis during a phalloplasty procedure may not heal properly or may not have a satisfactory appearance. In some cases, additional surgery may be needed to correct these issues.
5. Nerve and blood vessel damage: During a phalloplasty procedure, there is a risk of damage to the nerves and blood vessels in the area. This can result in decreased sensitivity or impaired blood flow to the newly constructed penis.
6. Failure to achieve desired results: Patients should have realistic expectations about the outcome of a phalloplasty procedure. In some cases, the results may not be as expected, and additional surgery may be needed to achieve the desired outcome.
Getting to Know for Phalloplasty Surgery
How to prepare for phalloplasty donor site
Preparing for phalloplasty donor site surgery is an important step in ensuring a successful procedure and a smooth recovery.
How to detransition from MTF to Male?
Detransitioning is the process of reversing a gender transition. In the case of MtF detransitioning, individuals who have undergone
Comparision between ALT and MLD phalloplasty
There are several techniques available for phalloplasty, including Anterolateral Thigh (ALT) Phalloplasty and Musculocutaneous Latissimus Dorsi (MLT) Flap Phalloplasty.
Reviews for ALT Phalloplasty
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Video : Testimonials of Phalloplasty
Why is Kamol Cosmetic Hospital famous for Phalloplasty?
Kamol Hospital is a popular choice for phalloplasty surgery for several reasons, including its expertise and experience, state-of-the-art facilities, comprehensive pre and post-operative care, patient-centered approach, and reputation for excellence in gender affirmation surgeries.
Expertise and Experience:
One of the critical reasons Kamol Hospital is famous for phalloplasty surgery is the expertise and experience of its surgical team. The hospital has a team of highly skilled and experienced surgeons who specialize in gender affirmation surgeries, including phalloplasty. They have performed numerous successful surgeries, and their expertise in this field is widely recognized.
State-of-the-art Facilities:
Another factor that makes Kamol Hospital popular for phalloplasty surgery is its state-of-the-art facilities. The hospital is equipped with modern and advanced surgical equipment and facilities that ensure the highest safety and quality of patient care. The hospital also has advanced imaging technology for surgical planning and patient education.
Comprehensive Pre- and Post-operative Care:
Kamol Hospital provides comprehensive pre and post-operative care to ensure patients receive the best possible outcome and experience. Before surgery, patients undergo a thorough medical evaluation and counseling to ensure they are physically and mentally prepared for it. After surgery, patients receive follow-up care, including counseling and support services, to aid in their recovery.
Patient-Centered Approach:
Kamol Hospital takes a patient-centered approach to care. This means that they work closely with patients to understand their individual needs and preferences and tailor the treatment plan accordingly. The hospital's staff is highly trained to provide compassionate care, prioritizing patient comfort and satisfaction throughout treatment.
Reputation:
Kamol Hospital has built a reputation for excellence in gender affirmation surgeries, including phalloplasty. Many patients undergoing surgery at Kamol Hospital have shared positive feedback and experiences, contributing to its popularity. The hospital's commitment to patient-centered care, state-of-the-art facilities, and experienced surgical team have earned it a reputation as a top choice for phalloplasty surgery.
Why Thailand is a plastic surgery destination?
Thailand is a top destination for plastic and cosmetic surgery. The high quality and specialist skills of the surgeons, the first-class hospital treatments, and the affordable cost all add up to a satisfying all-around package. There is also the added temptation to recover post-procedure in luxury hotels or recovery service apartments.
