Phalloplasty

Phalloplasty is a surgical procedure employed to construct a penis or to reconstruct a penis that may have been damaged due to trauma or disease. It is commonly used in sex reassignment surgery for transgender men and in congenital disorders such as micropenis and ambiguous genitalia.

Phalloplasty-Artificial male genitals on grey background

History and Evolution

The first documented attempts at phalloplasty were made in the early 20th century, and the techniques have evolved significantly since. The procedure has seen advancements from simple tube-in-tube techniques to complex microvascular procedures. Today's methods prioritize functional and aesthetic outcomes, improving the patient's quality of life.

Step 2 of the phalloplasty with Gillies technique

Indications and Techniques

• Phalloplasty is indicated in several scenarios, the most common being gender dysphoria in transgender men. It's also used in treating congenital conditions or damage due to trauma or disease.
• Several surgical techniques have been developed over the years:
• Radial forearm flap (RFF): This method uses a flap of skin, fat, tendons, nerves, and blood vessels from the forearm to create the phallus. It provides good aesthetic and functional outcomes, but it leaves a significant scar on the forearm.
• Musculocutaneous latissimus dorsi flap (MLD): This technique uses a flap from the back, reducing the visible scarring but possibly offering less sensation than the RFF.
• Anterolateral thigh flap (ALT): This method takes a flap from the thigh. The scar is hidden, but the thickness of the thigh skin may result in a bulkier phallus.

Postoperative Care and Potential Complications

• Postoperative care involves pain management, wound care, and careful monitoring for complications. The patient may also need additional surgeries for urethral lengthening, glansplasty, and implantation of erectile and testicular prostheses.
• Complications can include wound dehiscence, necrosis of the flap, fistula formation, urethral stricture, and prosthetic complications. Psychological support and counseling are essential components of care, before and after surgery.

Psychological and Social Considerations

The decision to undergo phalloplasty involves complex psychological and social considerations. Comprehensive preoperative counseling, including discussions about surgical risks, potential complications, and realistic outcome expectations, is crucial.

References

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• Monstrey S, Hoebeke P, Selvaggi G, et al. Penile reconstruction: is the radial forearm flap really the standard technique?. Plast Reconstr Surg. 2009;124(2):510-518. doi:10.1097/PRS.0b013e3181aeeadd
• Hage JJ, De Graaf FH. Addressing the ideal requirements by free flap phalloplasty: some reflections on refinements of technique. Microsurgery. 1993;14(9):592-598. doi:10.1002/micr.1920140910

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