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?
- 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).
Advantage:
- Larger girth and length (13-14 cm).
- Some natural rigidity.
- Concealable donor site.
Disadvantage:
- May not suit patients with thicker thigh skin.
- Girth may be excessive for some.
Picture 1: ALT-Pedicle Flap Phalloplasty
2.SCIP Flap Phalloplasty:
- Uses a groin skin flap to create the penis.
Advantage:
- Subtle donor site scarring.
- Relatively hairless donor area.
Disadvantage:
- Small size penis (length 10-12 cm).
- Fair sensation.
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 is suitable for those who have a mid-forearm circumference less than 20 cm.
- One-stage technique: Constructs the penis and urethra in one surgery. It is suitable for those who have a mid-forearm circumference more than 20 cm.
Advantage:
- Thin skin for better aesthetics.
- Medium-sized penis (11-13 cm).
- Good sensation.
Disadvantage:
- Visible donor site scars.
- Potential hand sensitivity issue.
4.Musculocutaneous Latissimus Dorsi (MLD) Flap:
Uses skin and muscle from the back to create the penis.
Advantage:
- In torso scarring.
- Hairless donor site.
- Good appearance.
Disadvantage:
- Less sensitivity.
- Requires a second surgery for urethral construction.
- Risks of microsurgery technique.
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
- 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.
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.
