Phalloplasty : Penis Reconstruction : Techniques

Definition
Phalloplasty refers to the construction (or reconstruction) of a penis or, sometimes, artificial modification of the penis by surgery, often for cosmetic purposes. It is also occasionally used to refer to penis enlargement.

A complete construction or reconstruction of a penis is done on:

  1. Patients with congenital anomalies such as micropenis, epispadias, and hypospadias,
  2. Patients who have lost their penis,
  3. Female-to-Male transsexual patients.

Different Techniques

There are four different techniques for phalloplasty. All of the techniques involve taking a graft of tissue from a donor site and extending the urethra. A penis of up to 7 inches (14–18cm) long with a circumference up to 5.9 inches (11–15cm) can be created with each of the methods.

Surgery on cisgender men is more simple than on trans men, because the urethra requires less lengthening. The urethra of a trans man ends near the vaginal opening and has to be lengthened considerably. The lengthening of the urethra is when most complications occur.

With all types of phalloplasty in trans men, scrotoplasty can be performed using the labia majora (vulva) to form a scrotum where prosthetic testicles can be inserted. If vaginectomy, hysterectomy and/or oophorectomy have not been performed, they can be done at the same time.

Unlike metoidioplasty, phalloplasty requires an implanted erectile prosthesis to achieve an erection (and enable sexual penetration). This is usually done in a separate surgery to allow time for healing. There are several types of erectile prostheses, including malleable rod-like medical devices that allow the neo-penis to either stand up or hang down. Penile implants require a neophallus of appropriate length and volume in order to be a safe option.

The long term success rates of implants in constructed penises are less than the success rates of reconstruction in cisgender men. Good sensation in the reconstructed penis can help reduce the risk of the implant eventually eroding through the skin.

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