Phalloplasty

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

Complete (re-)construction

A complete (re-)construction of a penis is done on both cisgendered men who have lost their penis through either illness or accidents, and transmen, that is, female-to-male transgendered or transsexual people.

The basic procedures are the same, although surgery on cisgendered men is usually a lot simpler, since the urethra still ends in the front of the genital area, whereas the urethra of transmen ends near the vaginal opening and has to be lengthened considerably. The lengthening of the urethra is the most difficult part of phalloplasty, and also the one where most complications occur.

With all types of phalloplasty in transmen, the labia (see vulva) are united to form a scrotum, where prosthetic testicles can be inserted.

An erectile prosthesis can be inserted into the neo-phallus to replace the erectile tissue and enable sexual penetration. This is usually done in separate surgery for healing reasons. There are several types of erectile prostheses, ranging from simple rods that have a hinge so that the neo-penis can either stand up or hang down, to elaborate pumping systems.

Basically, there are three different techniques for phalloplasty:

Using a free graft from the arm or leg

This technique involves using a free graft of tissue, usually from the inner side of the forearm, sometimes from the upper arm or the leg. This tissue is removed from its original place, rolled up, with a part of it forming the new urethra, and grafted to its new place between the thighs.

For transmen, the urethra up to this point is formed from the inner labia. Often, this is done in a separate procedure, sometimes a full-scale metoidioplasty is done a few months before the actual phalloplasty to prevent complications or make intervention easier when they occur.

Sensation is retained through the clitoris which is at the base of the neo-phallus; also, often a large nerve in the graft is connected to nerves either from the clitoris or other nearby nerves. Also, nerves from the graft and the tissue it has been attached to usually connect after a while, thereby allowing additional sensation.

This is by far the most common surgical technique for phalloplasty today, and also the one which produces the best results in both function and aesthetics.

Using a muscle from the belly

Using fatty tissue from the belly

Another option for transmen is metoidioplasty, where a small penis is created from the clitoris that has been enlarged by hormone replacement therapy.

Modifying an existing penis

References

"Straight Talk About Surgical Penis Enlargement" by Gary M. Griffin, ISBN 187996712X.
"Penis Enlargement Methods: Fact and Phallusy", Gary M. Griffin, ISBN 1879967014.
From peniplastica totalis to reassignment surgery of the external genitalia in female-to-male transsexuals" by J. Joris Hage.

Andrology | Genital modification | Gender transitioning | Penis