FTM Phalloplasty Surgery:

Flap Technique

What is Phalloplasty?

Phalloplasty is a female to male plastic surgery performed to construct or reconstruct the penis. Phalloplasty may also refer to penis enlargement, or other cosmetic procedures. Phalloplasty surgery is common among patients who are undergoing female to male sex reassignment surgery (SRS), transsexual patients, patients who have lost their penis, and patients with rare types of malformation of the penis such as epispadias, hypospadias, and micropenis, who seek penis enlargement.

How is Phalloplasty Performed?

There are many different techniques for FTM phalloplasty. Dr. Schechter performs Radial Forearm Phalloplasty, Anterolateral Thigh Phalloplasty (ALT), and MLD Phalloplasty. The forearm flap technique uses the The choice of technique depends upon the individual’s body habitus and goals. Each of the techniques has certain advantages and disadvantages, including the choice of donor site (location from where the flap is harvested).

Radial Forearm Flap is the most popular choice of phalloplasty for patients with a larger body habitus. Grafting from the forearm is the easiest to perform but results in scarring of the arm. With the radial forearm flap technique, a complete urethra can be constructed as well as the entire phallus. Afterwards, a testicular and penile implant can be made. Although radial forearm phalloplasty does not necessarily guarantee orgasm, most patients do achieve erogenous sensation.

Anterolateral Thigh Phalloplasty (ALT) is similar to radial forearm flap except the grafting location is around the leg or thigh. ALT phalloplasty produces less scarring than forearm grafting, making it an ideal choice for patients who prefer less scar visibility. Skin grafts may be used to cover the donor site (Radial Forearm or ALT) and are usually taken from the thigh.

Musculocutaneous Latissimus Dorsi (MLD) Flap (MLD) uses part of the back muscle for grafting. This technqiue creates a long, linear scar that runs from under the arm (side of the chest) down to the lower back. MLD phalloplasty is a relatively new technique and offers many advantages over the traditional forearm technique including: inconspicuous scarring, no need for hair removal (hairlessness), and improved color or appearance.

Microsurgical Approach: Blood vessels from the flap (either Radial Forearm or MLD) are attached to blood vessels in the groin.

Complete FTM genital transformation is performed in stages. Typically, the first stage includes a vaginectomy, phalloplasty, scrotoplasty, and urethral lengthening (for specifics, please see the techniques described below). Shaping of the glans may be performed at the time of the initial procedure (or as a secondary procedure depending on the choice of flap). Testicular implants and a penile prosthesis are placed at a second, and, sometimes, third stage.

More details about Phalloplasty Surgery Itinerary.

What are the Advantages of Phalloplasty?

Phalloplasty is often combined with urethral lengthening (although it may be performed without urethral lengthening). Most often, the goal of phalloplasty is the ability to urinate while standing and the ability for penetrative intercourse. Depending upon the technique, sensory nerves from the clitoris and/or groin area may be attached to nerves in the flap. The clitoris is usually buried beneath the base of the penis. Because of this, tactile sensation is usually retained.

What are the Risks of Phalloplasty?

Common complications include infection, hematoma (bruising), arterial ischemia (shortage of blood supply), blood clotting, loss of phallus or death of parts of the penis (necrosis), and erectile complications. Phalloplasty procedures have improved over the last decades, but secondary revision surgeries may occur to repair incorrect healing. Dr. Schechter recommends that a hysterectomy be performed at least 3 months before the phalloplasty.

Phalloplasty Recovery

Phalloplasty surgery duration varies based on the exact procedure but most operations require a hospital stay of four to five days.

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