Phalloplasty Procedures

Radial Forearm (RFAFF): The procedure may be combined with vaginectomy, urethral lengthening, and scrotoplasty at the first stage. Typically, testicular implants and penile prosthesis are placed at a second and/or third surgical setting.
Urethra: The RFAFF has the advantage of lengthening the urethra using a “tube-within-a-tube” technique. The urethral hook-up is performed at the initial surgical setting. A suprapubic tube is utilized, and a stent is placed in the reconstructed urethra.
Sensation: Nerves from the forearm are attached to one nerve from the clitoris and one nerve from the groin.
Glans: The shaping of the glans may be performed at the initial surgery.
Donor site: The donor site from the forearm is covered with a skin graft from the thigh.
Hospital course: The typical hospital stay is approximately 2 weeks. This requires an initial period of bed rest (approximately 7-10 days) and flap monitoring. During this period, the flap is assessed for its healing and blood supply.

MLD: The procedure may be combined with vaginectomy and scrotoplasty at the first stage. In addition, the fixed portion of the urethra may be created, and a skin graft or buccal mucosal graft may be placed on the MLD flap at this time. However, the urethral hookup is performed at a second (or third stage). If a skin graft or buccal mucosal graft was placed on the flap at the initial stage, the second stage may involve tubularization of this graft and a urethral hookup (the urethral hookup may be performed at a third stage). Typically, testicular implants and penile prosthesis are placed at a third stage.
Urethra: The MLD uses a skin graft or buccal mucosal graft to reconstruct the urethra. The urethral reconstruction is performed in stages. A suprapubic tube is utilized, and a stent is placed in the reconstructed urethra.
Sensation: A nerve (thoracodorsal nerve) from the Latissimus muscle may be connected to a nerve in the groin. However, sensation in the tissue is unpredictable.
Glans: Shaping of the glans is typically deferred to the second stage.
Donor Site: Preoperative preparation of the donor site may be required. This may include preoperative massage or a separate surgical procedure to place tissue expanders (inflatable balloons) at the donor site (back or chest).
Hospital course: The typical hospital stay is approximately 2 weeks. This requires an initial period of bed rest (approximately 7-10 days) and flap monitoring. During this period, the flap is assessed for its healing and blood supply.

Pedicle Technique: Blood vessels from the thigh are left attached to the blood vessels in the groin. The tissue from the thigh used to create the penis is transferred to the pubic region.

ALT: The procedure may be combined with vaginectomy, urethral lengthening, and scrotoplasty at the first stage. Typically, testicular implants and penile prosthesis are placed at a second and/or third surgical setting.
Urethra: The ALT flap may lengthen the urethra using a “tube-within-a-tube” technique. However, the tissue from the thigh is often too thick to allow this. In these situations, the urethra may be reconstructed with a second flap (either a flap from the groin or a radial forearm flap). The urethral hook-up may be performed at the initial surgical setting. A suprapubic tube is utilized, and a stent is placed in the reconstructed urethra.
Sensation: One or two nerves from the thigh are attached to one nerve from the clitoris and one nerve from the groin.
Glans: Shaping of the glans may be deferred to a second surgical setting.
Donor site: The donor site from the thigh is covered with a skin graft from the opposite thigh.
Hospital course: The typical hospital stay is approximately 2 weeks. This requires an initial period of bed rest (approximately 7-10 days) and flap monitoring. During this period, the flap is assessed for its healing and blood supply.

Additional Procedures:

Testicular Implants: Generally placed at a second or third stage

Penile Prosthesis: The prosthesis is typically placed at a second or third setting. Generally, hydraulic (both two and three piece) prostheses are utilized. The pump may be placed on one side of the scrotum, and the reservoir may be placed in the abdominal region. One or two cylinders may be placed in the penis.