GENDER AFFIRMATION SURGERY

Phalloplasty

Phalloplasty is a surgery that allows the reconstruction of a functional, sensitive neopenis that will allow bipedal urination and erogenous sensitivity. This surgery is usually completed with penile and testicular prostheses.

What is phalloplasy?

Phalloplasty is a surgical technique that allows the reconstruction of a phallus (penis). To achieve this, tissue from other parts of the body is used, most commonly skin and fat from the forearm, although tissue from the thigh or abdomen, among others, can also be used.

This neopenis has a very anatomical appearance, allows bipedal urination (urinating while standing up) and has tactile and erogenous sensitivity. It is important to clarify that in order to allow sexual penetration, it will require a prosthesis that will have to be implanted in a second surgical procedure.

 

Phalloplasty results

It is important that you know the results of the phalloplasty performed by the IM GENDER team. This way you can have a clear idea of what to expect from your genital affirmation surgery.

PHALLOPLASTY SURGERY

Admission

For some trans men, phalloplasty is a natural and important step, while for others it is an unnecessary procedure. Therefore, each trans person must make personal decisions that best suit their individual needs.

Before undergoing phalloplasty, the medical team will assess the suitability of this surgery in each case, taking into account your state of health, your medical history and evaluating all possible options.

Hormone treatment for a phalloplasty

Before undergoing phalloplasty surgery, it is necessary to undergo hormone treatment aimed at increasing the size of the clitoris. The surgeon together with the IM Gender medical team will advise you on how and when to undergo this treatment.

If you have a lot of hair on the inside of your forearm, it is also advisable to undergo a hair removal treatment to remove this hair, as this area will form part of the neopenis’s urethra.

FAQS ABOUT PHALLOPLASTY RECOVERY

What is phalloplasty surgery like?

The phalloplasty technique uses tissue from other parts of the body, usually skin and fat from the forearm. Using these tissues, the surgeon can recreate a penis of anatomical dimensions which, once modeled, will be transported to its final position. Once there, thanks to advances in microsurgery, the arteries and veins are sutured, which will provide the blood and nerves that will allow it to have tactile and erogenous sensitivity. To extend the urethra for the first few centimeters, the surgeon will use tissue from the anterior wall of the vagina (about 5 centimeters long and 2–3 centimeters wide) and a flap made from the skin of the labia minora. It is then sutured to the urethra previously created in the phallus.

During the same operation, the labia majora are mobilized dorsally and joined in the midline to form a new scrotum. Once the scrotal pouch has been created, silicone testicular implants are inserted. The implantation of the testicular prosthesis can be performed during the same surgical procedure or postponed to a second procedure, depending on surgical criteria.

Is hospital admission necessary for phalloplasty?

For phalloplasty, you will be admitted to IM GENDER on the same day as the surgery. During the hours prior to the operation, the team will carry out the necessary monitoring. Phalloplasty is always performed under general anesthesia and usually takes 10 to 12 hours.

Is there sensitivity with phalloplasty?

To achieve erogenous sensitivity in phalloplasty, the surgeon anastomoses a nerve from the clitoris to one of the nerves of the neopenis and also to the clitoris itself, which will remain buried under the phallus.

FAQS ABOUT THE POSTOPERATIVE PERIOD IN PHALLOPLASTY

Will I have to be admitted to the ward after the phalloplasty?

After the phalloplasty, the patient must remain in hospital for at least a week in order for the IM Gender Unit medical team to better monitor the patient’s evolution, while offering both the patient and his companion the necessary setting and comfort to make a speedy recovery.

Forty-eight hours after surgery, the patient will be allowed to move around.

When will I be able to go home after phalloplasty?

Although you will be discharged from hospital one week after the phalloplasty, you will need to wear a bladder catheter for at least 21 days. Occasionally, at the surgeon’s discretion, a suprapubic catheter may be inserted. This allows the bladder to empty by preventing urine from flowing through the urethra, keeping it dry in the early stages of recovery.

Can there be complications in the postoperative period of phalloplasty?

A member of the medical team will tell the patient how to avoid possible complications and how to act if a complication should arise. Regarding any doubts or anomalies after the operation, the patient should consult their doctor so that they can diagnose the patient and provide a solution.

Complications that may arise include:

      • Infection
      • An episode of bleeding may occur during or after the procedure.
      • Extrusion of the testicular prosthesis.
      • Urethro-cutaneous fistula – communication of the urethra with the scrotal skin.
      • Urethral stricture – a decrease in the urethra’s diameter.
      • Vesico-vaginal fistula – communication between the bladder and the vagina.

Any doubts or discomfort that may arise should be discussed with your referring surgeon or with the patient care team. You have a phone number available 24 hours a day for any queries you may have.

FAQS ABOUT PHALLOPLASTY RECOVERY

What is the phalloplasty recovery like?

It is important to follow the advice of the IM Gender medical team throughout the postoperative period, as well as attending all post-phalloplasty visits and to contact the medical team if you have any doubts about your progress. Only they can correctly assess your phalloplasty recovery. Usually, once you have been discharged from hospital, you will be given an appointment for the following post-operative check-ups and treatment. The same occurs for the following medical check-ups, which will be more or less one month after the phalloplasty, at three months, six months and one year. At all times, the patient will have a phone number to call for support during the postoperative period.

What is the result of phalloplasty?

After phalloplasty and your recovery, you will have a penis that is functional, anatomically and aesthetically similar to that of any man. While you will have to wait a few months after surgery for a penile prosthesis to allow penetrative sex, you will have erogenous sensation.

TIPS AFTER PHALLOPLASTY

Diet

You will eat a normal diet after surgery. But it is important that it is rich in fiber, since the first days it is common for constipation to appear. If so, you can also take a laxative.

Urinary catheter

You will need to carry a urinary catheter for approximately 4/6 weeks. It is important to alternate the leg on which the tube will be attached each day.

RELATIVE REST

You will have to do a relative rest, that is, you can take short walks, but you should avoid efforts and you should not overload your legs.

DOUBTS

If the microsurgical flap technique has been used in your phalloplasty, you must keep the wrist of the donor arm elevated and you will wear a compression garment on the arm.

PLAYING SPORT AGAIN

You should avoid playing sports until recommended by your surgeon. Afterwards, the medical team will tell you what type of activity you can introduce and which sports to avoid until your full recovery.

 

POST-OPERATIVE VISITS

It is very important you do not miss any visits after your surgery. The treatment will be personalized depending on each case and the technique used. The external points of the genital area will fall on their own.

IM GENDER Team

At IM GENDER we have been specialising in the care of transgender people for more than 20 years. Two decades of experience, professionalism, research and training endorse our medical team and staff.

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