Phalloplasty

Urogenital Surgery

MTF Surgery

FTM Surgery

News

Phalloplasty is surgical procedure of creating a neophallus from an extra genital tissue that provides male-like and functional penis.

Major indications for phalloplasty can be divided in two groups: male patients with penile insufficiency, and female to male transgender patients. Penile insufficiency can be caused by congenital anomalies (penile agenesia, micropenis, failed epispadia and hyposapdia repair or disorders of sex development) and acquired conditions such as iatrogenic or accidental injuries.
For some of these patient phalloplasty can be performed even in pediatric age in order to prevent profound psychological problems related to body dysmorphia. In female to male gender reassignment surgery phalloplasty presents a major surgical step.

Ideal phalloplasty must gratify both cosmetic and functional requirements. Created neophallus should have aspect of normal male penis, with acceptable scarring of donor site. Voiding must be feasible in standing position. Neophallus have to be huge enough to enable inserting of penile prosthesis which can obtain satisfactory rigidity and hence provide penetration during sexual intercourse.

There are many alternatives for extragenital tissue tht can be used for creation of neophallus (groin flap, forearm flap, rectus abdominis flap, fibular flap, musculocutaneous latissimus dorsi flap). The musculocutaneous latissimus dorsi flap is an acceptable choice for phalloplasty in all these groups of patients because it has a reliable and suitable vascular anatomy, large surface area, giving an excellent penile size, large enough to allow creation of the urethra and implantation of a penile prosthesis. Moreover, the penis can be constructed to the size desired by the patient. The donor site can be closed directly in most patients, with a satisfactory outcome if it is prepared appropriately by superficial skin massage using anti-scar ointment to improve skin elasticity. Hidden donor site is additonal advange in comparison to other more exposed donor sites. The latissimus dorsi total phalloplasty can entirely meet the esthetic and functional requirements of penile reconstruction.

Case 1 Total phalloplasty (click image for larger view)