Phalloplasty

Phalloplasty or “phallo” is a transmasculine genital surgery that constructs a phallus from the patient’s own donor site, typically from the forearm known as the radial forearm free-flap (RFFF) or thigh area, or anterior lateral thigh (ALT). Phalloplasty occurs over multiple surgical stages that are grouped together according to your personalized surgical plan and goals. Surgeons recommend one year minimum on testosterone.

Patients may find it beneficial to discuss surgical goals with their primary care provider and navigator prior to surgical consult.

POSSIBLE SURGICAL PROCEDURES:

Phalloplasty

• Phalloplasty is the creation of a phallus from your donor site

Glansplasty

• Glansplasty is sculpting the head of the phallus

Vaginectomy

• Vaginectomy is the removal/partial removal of vagina

Monsplasty

• Monsplasty is the removal of excess skin and tissue from the pubic bone area

Urethroplasty

• Urethroplasty is urethral lengthening through the tip of phallus

Scrotoplasty

• Scrotoplasty is the creation of a neo-scrotum

Testicular implants

• Testicular implants can be placed in the neo-scrotum to augment fullness and appearance

Penile implant

• Penile implant can be surgically placed for more mechanically functional penetrative sex

POSSIBLE GOALS & BENEFITS

• Internal and external congruency of one’s gender identity
• Preservation of tactile & erogenous sensation
• Standing to urinate
• Penetrative sex with a penile implant

TIMING

Since phalloplasty occurs over multiple stages, patients should expect to complete phalloplasty within 3 to 5 years. A robust support system and stable housing are essential to maintain throughout the surgical process.

FERTILITY

• Phalloplasty is a sterilizing procedure that includes a hysterectomy—the removal of the uterus and ovaries.
• Having a family planning and fertility discussion with your care team is an important step in your surgery process.

SCARRING

Patients are their own donor, scarring of the forearm or thigh area is possible to obtain the donor flap to create a phallus.

During consultation, surgeons perform a skin test and recommend a donor site. Once confirmed, patients start required surgical site hair reduction.

SIZE

The length and girth of a phallus depends on the amount of tissue harvested from donor site.

Patients find it helpful to use soft packers prior to surgery to experience how it feels to have a phallus and try different sizes comfortably.

SEXUAL HEALTH

Change in sex drive and sexual functioning will occur after surgery. It is possible to have an orgasm after phalloplasty. Sensation may depend on the individual and recovery times.

Patients who understand the surgical procedures for Phalloplasty often have a more successful consultation experience.

Your navigator will provide surgical education and help you prepare for consult. Talking through your expectations, desired outcome, and concerns can be helpful practice prior to seeing a surgeon.

It is essential that you and your surgeon agree on a surgical plan that will be gender affirming to you. 

It is important to note that desired outcomes may not be surgically possible due to anatomy and surgical limitations, please discuss possible limitations with surgeon for best understanding.

Bring a list of questions to ask your surgeon at the consultation to help you plan for your surgery and set expectations. If you don’t understand something, it’s okay to ask your surgeon to repeat or explain it in a different way.

Expectations

• How is a donor site determined and what are the main differences between forearm and thigh donor sites?
• Are there other donor sites that can be used?
• How will my phalloplasty be staged based on my goals?
• Will I have sensation, both tactical and erogenous?
• How likely are complications and how are they managed?
• What are some possible changes to my sexual health?
• I’m interested in having penetrative sex, what are penile implant options and how do they work?

Planning

• What choices do I have in surgery procedures and what is best for me? 
• What should I be doing to get the best surgical results? 
• Where will my surgery take place and how long will it take?
• How long will I need to take off work/school?
• When can I resume physical activity or go back to work? 
• What medications, supplements, and hormones do I need to alter or stop before surgery?

Your PCP, surgeon, and Gender Health Navigator can help you achieve optimal surgical outcomes by actively preparing for your surgery and making sure expectations are surgically possible.

PHYSICAL HEALTH

• Maintain a healthy body weight, high body weight can increase complications and interfere with wound healing.
• Although there is not a strict Body Mass Index (BMI) requirement, your surgeon may discuss specific anesthesia risks or considerations, depending on your BMI. It is beneficial to reach your own personal sustainable goal weight prior to surgery

MENTAL HEALTH/WELLNESS

• Having surgery takes both physical and mental preparation.  Surgery is stressful, some people feel an increase in depression or anxiety after surgery. 
• If you notice any changes in your mood or sleep, especially with anesthesia, please discuss with your care team.
• If you struggle with mental health, reach out to your mental health provider or navigator for support.

SMOKING

• Nicotine intake by smoking, patches, chewing gum, or vaping may interfere with wound healing. If you use nicotine, you should discuss a quit date with your PCP and surgeon. Surgeons require patients to stop nicotine prior to surgery and may test for confirmation.
• If you inhale cannabis, it’s important to find another way to use it, for example, topical, edibles, and tinctures, or to stop altogether.

SUPPORT

Build your network of support with providers, family, and community to help you plan and organize your recovery prior to and after surgery

• Transportation to and from appointments 
• Meal planning and preparation
• Providing a calm and supportive healing space

Everyone heals differently.  Patients will experience:

• different levels of pain,
• bruising, swelling, and
• fluid drainage at incision sites.

Each aftercare recovery plan is catered to a patient’s unique medical needs. You will receive post-op care instructions from your surgeon, make sure to review these instructions with your surgeon, PCP, and navigator as needed.

For optimal results and to help avoid complications, it is essential to follow post-op directions and engage in follow-up care appointments as scheduled. Your surgeon will cover post-surgery topics, such as:

• Hormone changes and effect on hormone therapy
• When to resume exercise, physical, and sexual activity 
• Healing process & pain management 
• Complications

• Medicare A&B
• Full Scope Medi-cal
• San Francisco Health Plan (Medi-cal, Healthy Workers and Healthy Families)
• Anthem (Medi-cal)
• Healthy San Francisco (Health Access Program)