What is Phalloplasty?
Phalloplasty is a surgical procedure that creates a penis for individuals transitioning from female to male (trans men). It is a significant gender-affirming surgery that helps individuals achieve a body that aligns with their gender identity. After surgery, many trans men can:
- Stand to urinate.
- Achieve erections with the help of implants.
- No longer have a vagina or menstruate (if a hysterectomy is performed).
Before undergoing phalloplasty, most candidates have taken testosterone for at least one year.
There are two main methods for creating a penis:
- Metoidioplasty: Enlarging the clitoris, which grows due to testosterone therapy, to create a smaller penis.
- Skin Flap Phalloplasty: Using skin and tissue from areas like the forearm, thigh, or groin to construct a larger penis.
The surgery often involves removing the vagina (vaginectomy), and some patients may also have a hysterectomy during the same procedure.
What to Expect During and After Surgery
Phalloplasty uses skin flaps (donor tissue) to create a penis and urethra. These flaps are taken from specific parts of the body, such as the forearm, thigh, or back.
Risks include:
- Infection, bleeding, or scarring.
- Complications with skin flaps, like poor healing or unsatisfactory appearance.
- Nerve or blood vessel damage, potentially reducing sensitivity or blood flow.
After surgery, patients must closely follow their surgeon’s instructions to minimize risks and promote healing. This includes taking prescribed medications, keeping incisions clean, and avoiding strenuous activities. Physical therapy may also help with functionality.
Who is Eligible for Phalloplasty?
Candidates typically meet these criteria:
- Age: At least 20 years old (parental or guardian consent required for those under 20; surgery is not recommended for anyone under 18).
- Hormone Therapy: At least one year of testosterone treatment.
- Living as a Man: For at least one year.
- Mental Health Clearance: A psychiatric evaluation confirming mental stability.
- Physical Health: Non-obese and physically fit.
- Previous Surgeries: Completed mastectomy and hysterectomy/oophorectomy at least six months before phalloplasty.
Dr. Kamol Pansritum and his team
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 and more than 300 female-to-male 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.
Current Phalloplasty Techniques Available at Kamol Cosmetic Hospital
Kamol Cosmetic Hospital offers the options for phalloplasty as follows:
1. Anterolateral Thigh Flap (ALT-Phalloplasty):
- Uses thigh skin to create the penis.
- Options include:
-
Full phalloplasty with urethral lengthening.
-
Phalloplasty following metoidioplasty.
-
Phalloplasty without urethral lengthening (simpler surgery; patient continues to urinate sitting down).
-
Pros:
- Larger girth and length (13-14 cm).
- Some natural rigidity.
- Concealable donor site.
Cons:
- May not suit patients with thicker thigh skin.
- Girth may be excessive for some.
Picture 1: ALT-Pedicle Flap Phalloplasty
Picture 2: How to prepare the ALT donor site
2. SCIP Flap Phalloplasty:
- Uses a groin skin flap to create the penis.
Pros:
- Subtle donor site scarring.
- Relatively hairless donor area.
Cons:
- Small size penis (length 10-12 cm).
- Fair sensation.
Picture 3: SCIP Phalloplasty
3. Radial Forearm Free Flap (RFFF):
- Uses forearm skin to create the penis.
- Two approaches:
- Two-stage technique: Prefabricates the urethra six months before the main surgery. It suitable for those who has mid-forearm circumference less than 20 cm.
-
One-stage technique: Constructs the penis and urethra in one surgery. It suitable for those who has mid-forearm circumference more than 20 cm.
Pros:
- Thin skin for better aesthetics.
- Medium-sized penis (11-13 cm).
- Good sensation.
Cons:
- Visible donor site scars.
- Potential hand sensitivity issue.
Picture 4: Radial forearm Phalloplasty
4. Musculocutaneous Latissimus Dorsi (MLD) Flap:
- Uses skin and muscle from the back to create the penis.
Pros:
- In torso scarring.
- Hairless donor site.
- Good appearance.
Cons:
- Less sensitivity.
- Requires a second surgery for urethral construction.
- Risks of microsurgery technique.
Picture 5: MLD Phalloplasty
Preparing for Phalloplasty
- Consultation: Discuss goals, health conditions, and surgical options with your surgeon.
- Lifestyle Changes: Stop smoking and alcohol use at least two weeks before surgery.
- Medication Adjustment: Avoid medications that affect blood clotting, such as aspirin.
Donor Skin Preparation:
- Hair removal is essential to prevent hair growth on the penis.
- Patients with thick skin or excess thigh fat may need weight loss, exercise before surgery.
- In some cases, a pre-expanded skin technique is used, requiring 1–2 months of preparation.
Neo-urethra Reconstruction
The risks and complications associated with neo-urethra reconstruction, such as urethral stricture and fistula, are generally high. However, shorter urethras tend to have fewer complications. For individuals concerned about urethral complications, the following options are available:
- Phalloplasty without urethral reconstruction (sitting urination): No risk of urethral complications.
- Partial urethral reconstruction (standing urination from the base of the penis): Lower risk of complications.
- Full urethral reconstruction (urination from the tip of the penis): Higher risk of complications.
Picture 6: Phalloplasty without urethral reconstruction
Picture 7: Phalloplasty with partial urethral reconstruction
Picture 8: Phalloplasty with full urethral reconstruction
Risks and Complications
Phalloplasty carries potential risks, including:
- Infection or bleeding.
- Scarring and poor wound healing.
- Nerve or blood vessel damage.
- Skin flap complications, like inadequate healing.
- Dissatisfaction with results, possibly requiring revision surgery.
Getting to Know for Phalloplasty Surgery
วิธีการเตรียมต้นขา เพื่อสร้างอวัยวะเพศชายแบบ ALT
การสร้างอวัยวะเพศชายแบบ ALT ที่ต้องการท่อปัสสาวะ และแบบที่ไม่ต้องการท่อปัสสาวะ ต้องเตรียมต้นขาข้างใดข้างหนึ่งให้มี ความหนาของผิวหนังและเนื้อเยื่อไม่เกิน 2 ซม.
ผ่าตัดแก้ไขแปลงเพศชายเป็นหญิง ให้เป็นเพศชายเหมือนเดิม
บางท่านเคยผ่าตัดแปลงเพศจากชายเป็นหญิง (MTF)มาแล้ว แต่วันเวลาเปลี่ยนไปพบว่าตัวเองไม่ใช่หญิงข้ามเพศจริงๆ รู้ว่าอยากเป็นเพศชายเหมือนเดิม จะทำได้หรือไม่?
เปรียบเทียบวการสร้างอวัยวะเพศชายแบบ ALT และแบบ MLD
การสร้างอวัยวะเพศชายมีหลายวิธี เช่น การใช้ผิวหนังและเนื้อเยื่อจากต้นขาด้านนอก ALT และการใช้เนื้อจากแขนด้านใน
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.
Frequently Asked Questions (FAQs)
A: Phalloplasty is a surgical procedure used to construct a neophallus (new penis) for transgender men or individuals with certain medical conditions. It's a key component of female-to-male (FTM) bottom surgery, which aims to create male-typical genitalia.
A: Several techniques are used in creating a new penis, each with its own advantages and disadvantages:
- Anterolateral Thigh Flap (ALT): This is the most common technique, using skin and tissue from the thigh. It offers a good skin color match, the potential for sensation, and a less noticeable donor site.
- Radial Forearm Free Flap (RFF): Uses skin from the forearm. It provides thinner skin, but the donor site scar can be more visible.
- Fibula Free Flap (FFF): Employs skin, nerves, and a portion of the fibula bone (lower leg). It offers natural rigidity due to the bone graft but may have a less natural appearance.
- Musculocutaneous Latissimus Dorsi Flap (MLD): Uses skin and muscle from the back. It provides a less conspicuous donor site but may result in a larger phallus requiring further refinement.
A: The procedure offers several benefits:
- Improved Body Image and Self-Esteem: Aligns the body with gender identity, thus leading to increased confidence and self-acceptance.
- Sexual Function: Enables standing urination and, with certain techniques, the potential for penetrative intercourse.
- Appearance: Creates more natural-looking male genitalia.
A: As with any surgery, the procedure carries potential risks:
- Infection
- Bleeding
- Skin Flap Problems: May include partial or complete flap loss, requiring revision surgery.
- Urethral Complications: Strictures, fistulas, or difficulty urinating.
- Nerve Damage: This can lead to numbness or decreased sensation in the neophallus.
- Scarring
- Unsatisfactory Aesthetic Outcome
A: Generally, good candidates for the procedure:
- Are over 20 years old (or have parental consent if younger).
- Have been on hormone therapy for at least one year.
- Have lived as a male for at least one year.
- Are in good physical and mental health.
- Have realistic expectations about the surgery's outcome.
A: The procedure creates a neophallus (new penis) that resembles a penis in appearance and allows for standing urination. However, achieving full sexual function, including erections and orgasms, often requires additional procedures like penile implants.
A: Urethral reconstruction is a crucial part of creating a new penis. It involves creating a new urethra within the neophallus, allowing for urination through the penis. Different techniques can be used, including skin grafts or flaps from various donor sites.
A:
- One-stage: The neophallus and urethra are constructed in a single operation.
- Two-stage: Often involves creating the urethra first (urethral prefabrication) and then constructing the neophallus in a separate surgery, at a later date.
A: A penile implant is a medical device surgically placed inside the penis to help achieve erections. It's typically considered after the initial phalloplasty has healed, often 1-2 years later.
A: Recovery varies depending on the specific technique used. It typically involves:
- Hospital Stay: A few days to a week.
- Pain Management: Medications to manage discomfort.
- Wound Care: Keeping the incisions clean and dry to prevent infection.
- Activity Restrictions: Avoid strenuous activity and heavy lifting for several weeks.
- Compression Garments: May be used to help reduce swelling.
- Follow-up Appointments: Regular check-ups with the surgeon to monitor healing.
A: The results of female-to-male penis surgery are generally permanent. While refinements or revisions may be needed in some cases, most individuals experience significant improvement in body image, self-esteem, and quality of life.
A: The total cost of phalloplasty can vary significantly, depending on the required surgical technique, your surgeon's fees, the relevant hospital charges, and your geographical location.
Rest assured your surgeon can provide you with a detailed breakdown of the costs involved during the consultation phase.
A: Insurance coverage for phalloplasty varies. Some insurance plans may indeed cover female-to-male penis surgery as part of gender-affirming care, while others may not.
We advise you to check with your insurance provider to understand your coverage before making any final commitments.
A: Choosing a qualified and experienced surgeon is crucial. Consider the following:
- Board Certification: Make sure your chosen surgeon is board-certified in plastic surgery or a related field.
- Experience: Look for a surgeon with extensive experience in phalloplasty and FTM bottom surgery.
- Reviews and Testimonials: Look at before and after photos of previous procedures, read plenty of reviews and testimonials from previous patients.
- Communication: Choose a surgeon who listens to your concerns and answers your questions clearly.
A: Some important questions to ask during female-to-male penis surgery consultation:
- What techniques do you specialize in?
- What are the potential risks and complications specific to my case?
- What are the realistic expectations for the outcome?
- What is the estimated recovery time?
- What are the costs involved?
- Can I see before-and-after photos of your previous patients?
Asking these questions and having an open discussion with your surgeon will empower you to make an informed decision about whether phalloplasty is indeed right for you, and choose the best approach for your individual needs and goals.
