Phalloplasty is a gender-affirming procedure that constructs a phallus using tissue transferred from another part of the body. It is a complex operation that may be performed in stages, and the surgical plan should be individualized according to anatomy, goals, health history and donor-site options.
What can phalloplasty involve?
Depending on the patient’s goals and surgical plan, phalloplasty may include construction of the phallus, urethral lengthening, scrotoplasty, glans construction, vaginectomy or other procedures. Erectile and testicular implants, when desired and appropriate, are generally considered separately after healing.
Common donor sites
Donor tissue may be taken from areas such as the forearm or thigh. Each donor site has different considerations for tissue thickness, blood supply, sensation, scarring and donor-site recovery. The most suitable option depends on individual anatomy and priorities.
Is phalloplasty always done in one operation?
No. Phalloplasty is often staged. The number and sequence of operations can vary depending on the technique, whether urethral lengthening is planned, healing, complications and whether later implants are desired.
Urethral lengthening
Some patients want to urinate while standing and may choose urethral lengthening. It is not required for every phalloplasty. Urethral procedures can have complications such as fistula or narrowing, so goals and risks should be discussed in detail.
Sensation and sexual function
Sensation can develop over time when nerve connections are performed, but the degree and timing vary and cannot be guaranteed. Orgasmic potential depends on preserved nerves, anatomy, healing and the procedures performed. An erectile implant may be considered later if penetrative rigidity is a goal.
Preoperative planning
Planning may include medical assessment, review of medicines, smoking or nicotine cessation, donor-site evaluation and fertility discussion where relevant. Hair removal may be recommended for selected donor-site areas when hair-bearing skin could be used to line a reconstructed urethra, but it is not a universal requirement for every patient or technique.
There is no universal BMI cutoff or identical documentation requirement for every phalloplasty program. Eligibility and preparation should follow the treating team’s assessment and applicable clinical or institutional requirements.
Possible risks
Risks can include bleeding, infection, wound-healing problems, flap complications, donor-site issues, urethral fistula or stricture, changes in sensation, implant-related problems and the need for additional or revision surgery. The exact risk profile depends on the technique and procedures included.
Recovery
Recovery may involve a hospital stay, catheter care, wound and donor-site care, activity restrictions and several follow-up visits. Healing continues over time, and later stages are generally planned only after adequate recovery.
Learn more about phalloplasty surgery, scrotoplasty and the broader FTM / transmasculine surgery pathway.
This article is for general education and does not replace an individualized surgical consultation.
