For some transgender people, gender affirmation surgery can play an important role in their transition. For transgender men, one of the most common surgical options is phalloplasty, a procedure designed to create male external genitalia. But what does phalloplasty involve?

In this article, we will explore what phalloplasty involves and what you should consider if you are thinking of having this surgery.

Phalloplasty, also known as the creation of a neophallus, is a surgical procedure that aims to create a new phallus on a transgender man’s body. 

There are different techniques and approaches used by surgeons, and the choice depends on the patient’s individual needs and preferences, as well as the patient’s medical history and background. The most common method is to use the person’s own tissue, such as a radial flap from the forearm or, in some cases, from the thigh.

Preparation for phalloplasty

Before surgery, you will have a series of consultations with your plastic surgeon and medical team. You will be given physical examinations and health tests and your expectations and goals will be assessed. You will also be informed about the risks and benefits of the procedure, and about the recovery process. 

It is important that you feel comfortable and sure before making the decision to proceed. It is therefore very important that you ask all the questions you need to resolve any doubts you might have and be clear about the whole procedure. 

How is phalloplasty performed?

In phalloplasty surgery, the surgeon uses microsurgery to create a penis with an adequate size and width, and with sufficient sensitivity for satisfactory sexual relations.

Before undergoing surgery, it is important that you take certain considerations into account.

Things to consider before phalloplasty

Phalloplasty surgery is an operation that can change your life. It is therefore important that you take into account certain considerations, for example:

  • Phalloplasty is a complex procedure and is not without risk. It is essential to discuss possible outcomes and complications with your surgeon before making a decision.
  • Genital surgery can have implications for your sex life. Be sure to address all your concerns and questions with your medical team.
  • Phalloplasty has significant repercussions on your reproductive life. If you plan to become a parent in the future, it is important that you discuss your options with your medical team.
  • Supportive counselling or having supportive people around you (friends, relatives, a partner, etc.) before and after surgery is always beneficial to help you cope positively with the emotional changes associated with gender transition.

Phalloplasty surgery

phalloplasty surgery

The phalloplasty technique uses tissue from other parts of the body, such as the forearm, thigh or back. IM CLINIC’s extensive experience has shown that the radial arm flap allows great versatility in achieving a very proportional size in both length and width. 

Using skin and fat from the forearm, the surgeon recreates a penis of anatomical dimensions, which, once modelled, is transported to its final position. Once it is there, the arteries and veins are sutured using microsurgical techniques, to provide a blood supply. The flap used to create the new phallus usually incorporates three nerves in order to provide tactile sensitivity (temperature, vibration, pain, etc.) and erogenous sensitivity.

To extend the urethra in the first few centimetres, the surgeon uses tissue from the anterior wall of the vagina (approximately 5 centimetres long and 2 to 3 centimetres 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 mobilised dorsally and joined at the midline to form a new scrotum. The procedure usually takes about 7 hours, is performed under general anaesthesia and usually requires at least a week’s stay in hospital. 

Aesthetic appearance of the phallus after phalloplasty

It should be taken into account that the new penis is created using skin from the arm, so it will have the same colouring as this area. To improve the appearance of the phallus, IM GENDER offers a series of aesthetic treatments after phalloplasty aimed at achieving a phallus with a more appropriate colouring and vein structures. One of the most popular treatments is often phallus micropigmentation, which imitates the aesthetic structures of a natural penis.

You can see phalloplasty results and the results of post-phalloplasty aesthetic refinements by clicking on the links.

Testicular prostheses and penile prostheses

The IM GENDER team does not recommend inserting testicular prostheses at the same time as the phalloplasty, as it is preferable to wait for the area to fully recover from the inflammation caused by the surgery. 

Insertion of the first testicle is performed three to four months after the phalloplasty surgery. The second is inserted four to five months later. In IM GENDER’s experience  it is not advisable to insert both prostheses at the same time, as oedema and pressure from the implants can lead to extrusion of the prostheses. When inserted in this way, the testicular prostheses, which are inserted into the labia majora, adapt better to the anatomy and movement of the legs. 

Finally, a hydraulic penile prosthesis, which allows the patient to have and maintain erections, is fitted once a year has passed since the phalloplasty without any complications. Whether or not to have one fitted is a decision to be made by the patient in consultation with the medical team.

Phalloplasty recovery

After surgery, you will have a recovery period that can last several weeks or months (especially for the donor site). 

During this time, it is essential to follow your surgeon’s instructions to ensure proper recovery. This may include the use of bandages or dressings, medication to control discomfort and regular follow-ups with your medical team. You may also need to make adjustments to your lifestyle and daily activities during the recovery process.

Remember that phalloplasty is a surgical option for transgender men who wish to have male external genitalia. If you are thinking about having a phalloplasty, talk to an experienced, board-certified plastic surgeon and carefully consider your options and expectations before making a decision.

If you have more questions about what phalloplasty involves, make an appointment with the IM GENDER team and we will inform you.