A phalloplasty is a cosmetic surgical procedure that aims to construct, or reconstruct a penis as well as alter a penis through the surgery to help improve the life of transgender men.
This is a purely aesthetic procedure and is often termed as a ‘penis enlargement’ surgery.
Who can Have a Phalloplasty?
A patient’s penis can be constructed completely or altered for who have birth defects such as micropenis, epispadias or hypospadias, those who have lost their penis as well as transgendered men who desire to have a sex-change surgery as part of their gender-change.
There are mainly four different methods for performing a phalloplasty. All these methods require sourcing an auto-graft tissue from the patient themselves and using it as an extension for the urethra.
The extension of the urethra is the most complicated step in the phalloplasty procedure. A phalloplasty procedure will require an erectile prosthesis to achieve an erection. This erectile prosthesis surgery is usually performed after the urethra extension has healed.
Erectile prosthesis come in many varieties including those made from malleable metal that allow the pseudo-penis to get erect or flaccid.
The urethra may also be lengthened by releasing the suspensory ligament which attaches it to the pubic bone, so that the penis may be shifted till outside the body.
The surgery requires the surgeon to make a horizontal incision in the pubic region where the pubic hair can conceal the incision line. There is no incision required to be made on the penis.
The surgical procedure remains the same while the choice for the donor site for the graft varies according to different types.
Graft From the Arm
In this method the graft is sourced from the forearm and is one of the easiest to perform although it results in a visible scar on the forearm. In case the donor site does not heal completely there may be a risk of arm function being affected.
The sensation in the pseudo-penis is retained through the clitorial tissue at its base and the surgeon may try to attach the graft nerves from the clitoris or its nearby region.
The surgery requires the administering of general anesthesia to the patient as the forearm is prepared to source the graft tissue from. After the graft is taken out from the forearm another graft may be used to reconstruct the forearm. The skin of the graft is cut to expose the veins and the nerves. A part of the vein going to the patient’s groin is used to facilitate the joining of the graft with the present tissues.
The vein is attached to the femoral artery and the blood supply from the vein and the flap connected to the femoral artery is resumed. The surgeon will remove the clitoral hood and the ligament while the nerve bundle is shifted aside for the duration.
In case the urethra has been extended the surgeon will attach a catheter to it for a few weeks to allow it to heal. Else, the skin is sutured.
Graft From the Side of the Chest
This is a comparatively new technique for grafting and requires sourcing the graft from the side of the chest under the armpit. The rest of the surgical procedure is the same, however there are several advantages of this grafting technique as the skin-tone of the graft is same to the receiver site, tactile sensation is able and it leaves a nearly-invisible scar as well as having lower risk of complications arising after the complete procedure.
Graft From the Leg
This graft sourcing procedure is similar to a forearm graft procedure with the added advantage of having the scar easily covered with clothes and being hidden from view.
What are the Risks And Complications Associated With a Phalloplasty?
As the medical techniques are improving the risks and complications from a phalloplasty have also been significantly reduced. However, there might be a rare need to perform a revision surgery to repair incorrect healing.
These are the other rarely seen complications after a phalloplasty procedure:
- Blood clot
- Loss of pseudo-penis due to disease or insufficient blood supply
- Shortage of blood supply
- Anesthetic reaction
- Limited necrosis
The cosmetic surgeon will take every possible precaution to ensure that the complications are prevented.