Phalloplasty is a delicate masculinization surgery that often raises many questions and uncertainties for trans men considering this operation as part of their transition. It’s important to thoroughly educate yourself before taking this step and ensure all your doubts are addressed. In this article, we’ll explain key things you need to know before undergoing phalloplasty.
Choosing the right plastic surgeon
Selecting the right plastic surgeon is crucial for the success of a phalloplasty procedure. Trans patients should seek out a surgeon with extensive experience and training in gender-affirming genital surgeries, particularly phalloplasty. Researching the surgeon’s credentials and experience with similar procedures is essential. Reviews from other patients and recommendations from trans support organizations can also be helpful.
At IM GENDER, we have over 25 years of experience in gender-affirming surgeries, with internationally renowned specialists in various techniques and procedures.
When choosing a medical team, it’s also important to feel comfortable and be able to openly discuss your expectations and concerns. Building this trust allows you to address any doubts about phalloplasty and approach the surgery with full understanding.
Phalloplasty technique
Phalloplasty, or trans phalloplasty, uses tissue from other areas of the body—typically skin, fat, and blood vessels from the forearm—to create a phallus. The surgeon sculpts a penis of appropriate anatomical dimensions, which is then transplanted to its final location. Advanced microsurgery techniques are used to reconnect arteries, veins, and nerves, aiming for both tactile and erogenous sensitivity.
To extend the urethra, the surgeon uses tissue from the anterior vaginal wall and a skin flap from the labia minora. This is then sutured to the urethra created in the phallus.
During the same surgery, the labia majora are repositioned dorsally and joined in the midline to form a new scrotum. Silicone testicular implants may be placed at this stage or in later surgery, based on the surgeon’s judgment.
Post surgery sensitivity
One of the key aspects of phalloplasty is achieving erogenous sensitivity in the new phallus. This is done by connecting a nerve from the clitoris to a nerve in the new penis through a microsurgical technique called nerve anastomosis. This precise connection allows the nerves to communicate and function together.
The original clitoris is not removed during genital masculinization surgery. Instead, it is positioned under the new penis, preserving its sensitivity and linking it to the nerves of the new phallus. This enables the individual to experience tactile and erogenous sensations in their new organ.
While the phallus can be functional and anatomically accurate post-surgery, erections are not possible until a penile prosthesis is implanted, which usually takes place about a year after phalloplasty.
How is the recovery process after surgery?
After phalloplasty, you’ll need to stay in the hospital for at least a week. This allows the medical team at the IM GENDER’s Gender Unit to closely monitor your recovery.
You’ll begin moving lightly about 48 hours post-surgery, gradually regaining normal mobility over the following days.
Although hospital discharge typically occurs a week after surgery, you will need to use a urinary catheter for at least 21 days. In some cases, a suprapubic catheter may be placed to ensure urine bypasses the urethra, keeping it dry during the early stages of healing.
Recovery from phalloplasty is a long process and can be physically and emotionally demanding. Follow your surgeon’s and medical team’s advice to make the recovery as smooth and comfortable as possible.
After phalloplasty, you will need to stay in hospital for, at least, a week. This is important so that the medical team at IM GENDER’s medical team can follow your recovery closely and make sure that everything is going well.
Potential complications after phalloplasty
Like any major surgery, phalloplasty carries risks and potential complications. Proper post-operative care and thorough knowledge are essential to minimizing these risks.
Your medical team will provide guidance on how to prevent complications and manage any that arise. However, if you have concerns about your recovery, contact your doctor immediately.
Common complications include:
- Urinary infections (burning, discomfort, or reddish urine)
- Urine leakage through areas near the neophallus
- Fever
- Urinary retention
- Wound dehiscence (incision opening)
- Redness of the phallus
- Increased pain
Long-term outcomes and quality of life
Phalloplasty results often lead to improved quality of life and emotional well-being. Most patients report a high level of satisfaction with their bodies and can enjoy fulfilling sexual lives after surgery.
Aesthetic touch-ups after phalloplasty
Using skin and fat from the forearm for phalloplasty may leave the genital area with a different coloration. Several aesthetic treatments are available post-phalloplasty to address this:
- Micropigmentation: Used to recreate anatomical structures like the basal vein of the penis, enhancing its natural appearance.
- Lipofilling: Corrects scarring on the donor site (forearm) by grafting body fat into the area.
- Laser Treatment: Improves the appearance of the donor site.
Maintaining realistic expectations and open communication with your medical team is crucial throughout the process.
If you believe there’s more you need to know about phalloplasty, don’t hesitate to contact the IM GENDER team.
