Definition & Overview

Phalloplasty is a surgical procedure used to reconstruct the male genitalia. The goal of this procedure is to achieve erotic sensation and rigidity for sexual intercourse as well as retain the capability of urinating while standing up.

There are two techniques to perform this procedure; one is the pedicled or local flap phalloplasty, which uses a skin flap that has one end transposed to another location while the other end is still attached to the donor site and the free flap phalloplasty that uses a skin graft taken entirely from another part of the body.

Phalloplasty has become quite popular in recent years, not just for penis enlargement but also for gender reassignment.

Who Should Undergo & Expected Results

Phalloplasty is recommended for those born with a congenital disorder called aphallia, a rare type of condition in which a boy is born without a penis. Typically performed on children entering puberty, it can also be taken advantage of by those born with micropenis or severe penile inadequacy as well as those with ambiguous genitalia, hypospadias, and bladder exstrophy.

Those who have experienced mutilating trauma involving their genitals are also advised to undergo phalloplasty, especially those who have lost sensation in their penis due to accidents or blast injuries. Self-inflicting injuries like penile amputation can also be considered for phalloplasty but only after the patient is determined to be mentally capable of undergoing such surgical procedure.

Those diagnosed with gender identity disorder may also be offered phalloplasty. In some rare instances, phalloplasty is performed on those whose penises are injured following a circumcision ortumour excision.

The results of phalloplasty largely depend on the type of surgery performed, the extent of injury or damage, and whether or not the nerves and other affected body parts like the urethra are successfully reconnected. However, this procedure has generally positive patient outcomes. Children who undergo phalloplasty report good functional and cosmetic results even after several years following the procedure. Those who undergo penile enlargement also report the same or even improved levels of sexual performance following surgery.

This procedure requires several weeks of recuperation and rest, as well as avoidance of strenuous activities for a few months after surgery.

How Does the Procedure Work

There are several techniques used for phalloplasty, one of which requires graft tissues taken from specific body parts like the arm, side of the chest, leg, pubic area, or the abdomen.

The procedure is completed in several stages that are spaced at least three months apart. As such, phalloplasty is usually completed within 12 to 18 months, depending on the extent of the procedure and any complications that might occur.

The first stage is the formation of the phallus, which involves the removal of the graft tissue from the donor site and transferring it to the genital area. A flap is formed into a tube and will become the neourethra. A larger flap is then wrapped around it to form an outer tube and the whole tissue is transplanted. If necessary, a skin graft will be made from other parts of the body (usually from the buttocks) to fill the area where the graft tissue is taken.

The second stage of the procedure is the formation and joining of the neourethra to allow the passing of the urine. After the urinary tract has been connected, the third stage will commence with the surgeon adding the prostheses, especially for those undergoing penis enlargement. Depending on the patient’s unique circumstances, the implantation of testicular prostheses is also done at this stage. This is also where the surgeon performs steps necessary to shape the glans and clean up any scars in the genitals.

Stage four involves the insertion of penile prostheses. The body will then form a fibrous capsule around the inserted material.

Possible Complications and Risks

There are risks of perioperative bleeding and adverse reaction to anaesthesia during a phalloplasty. Infection could also set in the operative site and cause for the whole process to fail. There is also the possibility of blood accumulating under the surgical site that could lead to bruising and swelling. If there is insufficient blood supply to the area, necrosis or tissue death may also occur. Additionally, the inserted prostheses are prone to infections and corrosion over time.

References:

  • Bogoraz NA. On complete plastic reconstruction of a penis sufficient for coitus [in Russian] Sov Surg.1936;8:303–9.

  • Nair R, Sriprasad S. 1129 Sir Harold Gillies: Pioneer of phalloplasty and the birth of uroplastic surgery. J Urol. 2010;183(4):e437.

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