Phalloplasty
Legend
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Phalloplasty |
The surgery and surgical techniques |
What is a Phalloplasty?
What a phalloplasty entails, how to prepare for the operation, and what to expect afterwards are explained below. This includes information about the procedure itself, the risks of surgery, the postoperative period, and any possible corrective procedures (secondary corrections). At the Gender Clinic, a phalloplasty is performed without urethral lengthening, using skin from the flank, in combination with a scrotoplasty.
Information about the Phalloplasty Procedure
A phalloplasty is a surgical procedure in which a penis (phallus) is constructed using tissue taken from another part of the body, for example the arm, leg, or flank. The choice of surgical technique depends on the patient’s physical characteristics and personal preferences.
The phallus can be created with or without urethral lengthening. Phalloplasty with urethral lengthening carries a higher risk of complications (approximately 50%) compared to surgery without urethral lengthening (approximately 5%). Furthermore, a lengthened urethra does not guarantee the ability to urinate while standing.
Intake and Consultation
Preparation for Surgery
Prior to surgery, a consultation with the plastic surgeon takes place. During this appointment, the patient’s wishes are discussed, information is provided about risks and possible complications, and a physical examination is performed.
Physical Examination
The plastic surgeon evaluates the skin and determines which donor site (for example, the forearm or flank, the area between the armpit and pelvis) is most suitable for penile construction.
Patient Preparations
- It is important to have a BMI between 18 and 30 in order to reduce the risk of complications.
- Smoking must be stopped completely. Nicotine constricts blood vessels and negatively affects wound healing. If smoking is detected before surgery, the procedure may be postponed or cancelled. A smoking test may be performed if necessary.
- Before the recovery period, it is advisable to have the following items at home:
- Tight-fitting underwear to support the surgical area and allow the penis to be positioned downward
- Paracetamol (acetaminophen) for pain relief
Non-Medical Alternatives
Physical transition does not necessarily require surgery. Non-medical options are also available to alleviate gender dysphoria. More information can be found on the GenderAid website.
Hormone Use
Hormone therapy may be continued without changing the dosage.
Hospital Admission
On the day of surgery, the patient is admitted to the nursing ward. Please note that rooms are shared; single or double rooms are not available.
Preoperative Examination When Using Flank Skin
If flank skin is used, an ultrasound is performed beforehand to map the arteries and nerves beneath the skin. This process helps to determine the most suitable tissue for construction and tests sensitivity in the area.
Blood Thinners
In order to prevent thrombosis (blood clots), daily injections of blood thinners are administered during hospitalization.
Preoperative Instructions
- Normal food intake is allowed until 8 hours before surgery.
- Clear fluids may be consumed until 2 hours before surgery (water, coffee or tea without milk, juice without pulp, lemonade and soft drinks).
Before surgery, a nurse will escort you to the operating room. No clothing may be worn under the surgical gown. Jewellery, piercings, and dental prostheses must be removed.
The Surgery and Surgical Techniques
The standard procedure takes just over three hours. In most cases, the procedure is completed in a single surgical session. The phalloplasty is performed by a plastic surgeon together with a urologist.
At the Gender Clinic, only the technique without urethral lengthening is performed, which involves positioning the urinary opening behind the scrotum.
Urethral lengthening carries a significantly higher risk of complications and does not guarantee the ability to urinate while standing. Patients interested in this technique may be referred to Amsterdam UMC.
Start of Surgery
The urologist prepares the existing genital area in order to allow attachment of the new phallus. The plastic surgeon simultaneously harvests tissue from the donor site (forearm, thigh, or flank).
A urinary catheter is inserted to drain urine during and after surgery.
Formation of the Scrotum
In the procedure without urethral lengthening, the clitoris and inner and outer labia are detached. The outer labia and mons pubis skin are then joined and sutured to form the scrotum. The urethra exits below the scrotum.
Formation of the Phallus Shaft
The shaft can be constructed using tissue from one of the following:
- Free Radial Forearm Flap (FRFF) – forearm
- Anterolateral Thigh Flap (ALT) – thigh
- Superficial Circumflex Iliac Artery Perforator Flap (SCIP) – flank
The Gender Clinic exclusively uses the ALT and SCIP techniques.
Complications and Risks
Although surgery is performed carefully, complications may occur. Without urethral lengthening, the average complication risk is approximately 5%.
Possible complications include:
- Bleeding during and after surgery
- Reopening of wounds
- Delayed wound healing
- Tissue necrosis
- Infection
- Urinary problems (urethral narrowing/stenosis, fistula formation, leakage)
- Reduced sensation or changes in orgasm abilit
Please note:
Complications may also occur at the donor site.
Hospital Recovery
Day 1
Bed rest. Remain lying on the back as much as possible. Daily wound cleaning. Pain medication and stool softeners will be provided.
Day 2
Assessment and possible removal of drains.
Days 3–4
Gradual increase in mobility.
Day 5
Bandages removed. Supportive underwear applied.
From Day 6
Full mobility allowed. Discharge when independent and medically stable.
Discharge
You will be given the following items:
- Prescriptions (pain medication, bladder spasm medication)
- Wound care supplies
- Home care instructions
- Follow-up appointments
Outpatient Follow-Up
- Urologist: evaluation of urinary function
- Plastic surgeon: assessment of healing and appearance
Additional visits may be required if complications occur.
Aftercare and Recovery
Wound care and smoking
Follow instructions carefully. Do not smoke for at least three months.
Activity restrictions
Weeks 1–2
Rest, limited activity, short showers only.
Weeks 1–6
No heavy lifting or sports.
Support
Wear tight underwear or supportive garments for six weeks.
Sexuality
Sexual activity is usually possible approximately three months after surgery. Sensation and orgasm may differ from before. Most people will still experience arousal and orgasm. Penetration will usually require aids such as an erectile prosthesis.
Sexual health will be discussed with a psychologist and endocrinologist throughout treatment.
Questions and Contact
If you have any questions, you can contact the clinic during office hours:
Gender Clinic
Phone: +31 88 891 00 19
Email: info@genderclinic.nl
A patient portal is also available.
Health insurance coverage
Phalloplasty is currently covered by health insurance if the criteria are met. Secondary procedures (corrections, prostheses) vary from one insurer and year to another. Please contact your insurer for further details. A statement from the Gender Team confirming completion of the social and hormonal phase may be required.