Pre- and Post-operative Care With Associated Intra-operative Techniques for Phalloplasty in Female-to-male Patients

Shane D. Morrison, MD, MS; Marcelina G. Perez; Cayden K. Carter; Curtis N. Crane, MD


Urol Nurs. 2015;35(3):134-138. 

In This Article

Abstract and Introduction


Phalloplasty, or creation of the penis, is one of the steps in gender confirming surgery for a female-to-male patient and for males with absence or malformation of the penis. Here, the most common techniques for phalloplasty, along with the pre-operative and post-operative care are discussed.


Numerous phalloplasty techniques exist for construction of the penis in transgender males electing to undergo sex reassignment surgery, and in cisgender males with penile malformation or absence secondary to trauma, malignancy, or congenital abnormality (Babaei, Safar ine jad, Farrokhi, & Iran-Pour, 2010; Salgado, Chim, Tang, Monstrey, & Mardini, 2011; Selvaggi & Bellringer, 2011). The primary goals of phalloplasty include creating a functional and aesthetically similar phallus as that of a natal male, retaining erogenous and tactile sensation, and facilitating standing micturition and penetrative sexual intercourse (Garaffa, Christopher, & Ralph, 2010; Monstrey et al., 2009). Creation of the phallus to meet the primary goals has been difficult because there are, as of yet, no optimal replacement tissues for both the urethra and muscles composing the shaft. Still, plastic surgeons and urologists have developed approaches to create a functional phallus.

The radial forearm free flap and anterior lateral thigh flap are the most commonly used phalloplasty methods. Using these techniques, the flap is harvested with the associated neurovascular supply to construct a phallus that maintains erogenous and tactile sensation (Felici & Felici, 2006; Ma, Cheng, & Liu, 2011; Monstrey et al., 2009; Selvaggi et al., 2007). Favorable functional and aesthetic outcomes after phalloplasty using the radial forearm free flap or anterior lateral thigh flap are well documented (Garaffa et al., 2010; Monstrey et al., 2009; Morrison et al., 2014; Rubino et al., 2009). In this article, we discuss our approach to the radial forearm free flap and anterior lateral thigh flap techniques for phalloplasty in female-to-male transsexual patients, along with pre-operative and post-operative care.