Phalloplasty

What is a phalloplasty?

Phalloplasty is the surgical technique that enables the reconstruction of a phallus (penis) of anatomical dimensions. To achieve it, tissue from other parts of the body is used, commonly skin and fat from the forearm though tissue from the thigh or abdomen may also be used. This neophallus displays a highly anatomical appearance, enables bipedal urination (standing up) and offers tactile and erogenous sensitivity. It is important to clarify that to enable sexual penetration a prosthesis is required that must be implanted in an ensuing operation.

The preparations

Before undergoing the operation it is necessary to receive hormone treatment so as to increase the size of the clitoris. Your surgeon will advise you how and when to begin this treatment.

Likewise, it is recommendable, in the event of having copious hair on the internal forearm, to undergo hair removal treatment to remove it since this area will form part of the urethra of the neophallus.

Admission

The patient will be admitted to the hospital centre on the same day as the operation. Before the operation the pertinent controls will be conducted and afterwards the patient will remain admitted for a week after the operation.

The operation

The phalloplasty uses tissue from other parts of the body, habitually skin and fat from the forearm, to recreate a penis of anatomical dimensions. Once modelled, it will be transported to its final position where, thanks to advances in microsurgery, suture of arteries and veins will be undertaken, providing the member with blood. It will also retain its nerves, giving it tactile and erogenous sensitivity. The latter is achieved thanks to a nerve in the clitoris that is grafted onto one of the nerves in the neophallus and, in parallel, onto the clitoris itself, which remains hidden under the neophallus.

This technique is always performed under general anaesthesia and usually lasts ten to 12 hours.

To lengthen the urethra in the first few centimetres, the surgeon will use a graft from the anterior wall of the vagina (with a length of about five centimetres and a girth of two to three centimetres) and a flap using the skin of the labia minora. Then it is sutured to the urethra created earlier in the phallus.

During the same operation, the labia majora are dorsally mobilised and joined on the centre axis to form a neoscrotum. Once the scrotal pouch has been created, silicone testicular implants are inserted. Implantation of the testicular prosthesis may be undertaken during the same surgical operation or postponed for a second operation, depending on surgical criteria.

Recovery

After the first 48 hours, the patient may be moved.

Despite being discharged a week after the operation, the patient must use a urinary catheter for at least 21 days. Sometimes, on the surgeon’s criteria, a suprapubic catheter may be attached. This allows the bladder to be emptied while avoiding urine flow through the urethra, keeping it dry for the initial stages of recovery.

Possible complications

The complications that may most frequently appear are:

  • Infection
  • Bleeding: The patient may experience an episode of bleeding during or after the operation.
  • Extrusion of the testicular prosthesis.
  • Urethrocutaneous fistula: an opening between the urethra and the scrotal skin.
  • Urethral stenosis: a narrowing of the diameter of the urethra.
  • Vesicovaginal fistula: an opening between the bladder and vagina.