Phalloplasty is a term that you often hear along with nonbinary or transgender people. As the name indicates, it is a medical process, which constructs a penis. This is actually a gender confirmation surgery that helps Genderqueer as well as trauma, cancer, or congenital defect patients for penis construction.
The objective of this surgery is to build a cosmetic penis, which is of a suitable size and is capable of sensations and urination. It is an extremely complicated procedure and may need multiple surgeries.
Phalloplasty is a subdivision of plastic surgery and urology.
For now, the gold standard procedure for phalloplasty is called radial forearm free-flap (RFF) phalloplasty. It involves using a flap of skin from the forearm to build the penile shaft.
How to perform phalloplasty?
For phalloplasty, doctors will remove a flap of your skin from any part of the body. Most of the times this donor area is forearm. This tissue helps to construct urethra and shaft of the penis. It is constructed like a tube in a tube manner. The bigger tube is rolled around the smaller tube.
Normally a female urethra has a smaller size than the male urethra. As a part of phalloplasty, the surgeons elongate urethra so that the urination flow makes up to the tip of the penis. The clitoris is left at the base of the penis and to your surprise, the clitoris can still stimulate even after the surgery. It is possible for people to have orgasms even after this surgery.
When doctors coin the term phalloplasty, it usually refers to create phallus from a flap of skin. But in reality, phalloplasty contains a number of procedures all of which end up to penis construction.
Some of the procedures in phalloplasty include the following.
- Hysterectomy- a procedure to remove the uterus
- Oophorectomy- a procedure to remove the ovaries
- Vaginectomy- a procedure to remove the vagina
- Phalloplasty- a procedure to construct donor skin into a phallus
- Scrotectomy- a procedure to construct scrotum from labia-majora that may or may not require testicular implants
- Urethroplasty- a procedure to increase the length of the urethra and placing it inside the new phallus
- Glansplasty- a procedure to cosmetically sculpt an uncircumcised tip on the penis
- Penile implants- to cause erections
There is no standard order for all these procedures. Not everyone needs all these procedures. A doctor will evaluate every case and recommend some of them. Also, many times people like to get them all together while others prefer to take a gap between them. a cosmetic surgeon alone cannot perform all these surgeries. All of these procedures require surgeons with specialization in gynecology, urology, and cosmetology.
These surgeons may work in a team. If you are concerned about fertility and impact of phalloplasty on sexual function, feel free to talk to your doctor about it.
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What are the donor sites?
There are many phalloplasty techniques in use and many of them are selected on the basis of donor skin’s location. Also, the method to attach and detach this donor skin is of special importance. Some of the common sites for donor skin are
Techniques in phalloplasty
Some of the common techniques in phalloplasty are as follows.
Radial forearm free-flap phalloplasty
The radial forearm free-flap (RFF or RFFF) phalloplasty the latest procedure for genital reconstruction. It completely removes the donor skin keeping its blood vessels and nerves intact.
Now, with the help of microsurgical precision, these blood vessels and nerves are attached again, which initiates a natural blood flow. When this movement of blood becomes smooth, the new phallus starts functioning.
This is a preferred method because it adds sensitivity and an extremely aesthetic result. It is constructed on a tube in tube manner hence it facilitates urination. Also, there is room for implants for erection.
The risk of mobility damage is minimum in this procedure. However, skin grafts to the forearm may leave a moderate to severe scar. For someone who is sensitive about the scar, this procedure may not be ideal.
Anterior lateral thigh pedicled flap phalloplasty
The anterior lateral thigh (ALT) pedicled flap phalloplasty is another technique that is followed is cosmetic genital construction. But it is not a preferred choice of surgeons. It may end up with a low-level physical sensitivity in the penis.
In this procedure, the donor skin is separated from the site without blood vessels and nerves. The urethra made from thus donor skin is able to urinate at a standing position. Also, there is space for an implant for erection.
People who select this type of surgery are generally happy with it. However, they experience a low-level erotic sensitivity. It may cause urinary infections later on and grafts of the skin may leave noticeable scars too.
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Abdominal or suprapubic phalloplasty is the third type of genital construction procedure. It is suitable for trans men who do not need a vaginectomy or a restructured urethra.
Their urethra doesn’t makeup to the penis tip and they require urinating in a seating position. This procedure doesn’t involve microsurgery, so it is less expensive than the rest.
The new phallus is tactile but lacks erotic sensations. The clitoris is kept as it is or buried but it can still experience stimulation. This procedure leaves a huge hip-to-hip scar but it is hidden under the clothes. As it is not related to the urethra, it has fewer complications.
Musculocutaneous latissimus dorsi flap phalloplasty
A musculocutaneous latissimus dorsi (MLD) flap phalloplasty uses donor skin from underarm. It requires a larger skin portion as compared to the other procedures. This process is popular because it allows a person to have a huge penis.
The flap of skin used in this procedure includes blood vessels and nerve tissue. But it is less erotically sensitive than other procedures. The donor site heals in less time and is not much visible.
Future complications of phalloplasty
Like all other surgeries, phalloplasty may bring infections and health risks too. The procedures involving urethra usually have more complications. Some of the possible phalloplasty complications are
flap failure and loss
No or less sensation
prolonged need for drainage
The donation site may also suffer from complications such as
- bruising or wound
- tissue granulation
- no mobility or sensation
Recovery from phalloplasty
The recovery from phalloplasty takes 4-6 weeks and requires bed rest. Avoid all physical activities particularly that involve lifting weights in the first few weeks. For the first few weeks, the doctor will place a catheter in place. The patient can start normal urination through the phallus after two-three weeks.
This whole process of phalloplasty may be divided into steps. A person can go step-by-step keeping every process at least three months between the first and second procedure and wait for one year for the final stage of a penile implant.
Depending on which type of procedure you go through, the erotic sensation in new phallus may be less or more. The nerve tissues take a long time to heal. A person may have to wait longer for an erotic sensation. Complete healing from phalloplasty can take up to two years.
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The final word
Phalloplasty uses different techniques as per different cases. There is no standard procedure and every case requires an individual procedural approach. The latest research is contributing to introduce more and better ways to cosmetically construct a penis.
The best is to talk to a doctor about which type of surgery is suitable for you. There are plenty of procedures with different risk levels and severity. Choose the one that your doctor finds best for you.