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Phalloplasty Surgery

What is Phalloplasty?

Content warning: the content below uses some anatomy/biological terms where it is important to be precise

Phalloplasty, also known as masculinising genital surgery, refers to a general anaesthetic surgical procedure to create a penis in a transmasculine individual. There are various techniques:

Radial forearm flap (RFF)
ALT (thigh) flap (+/- Radial forearm urethra)
SCIP Groin flap (+/- Radial forearm urethra)
Pubic (lower abdominal) Phalloplasty

The technique used is based on the level of penile function required and the suitability of the available donor sites (other parts of the body we can make the penis from). You can find more information about each technique in the corresponding patient information leaflets.

Hysterectomy and Salpingo-Ooperherectomy

This is removal of the uterus (hysterectomy), fallopian tubes (salpingectomy) and one or both ovaries (oophorectomy). This is normally performed before we start the phalloplasty process.

Urethroplasty (urethral lengthening and hook-up)

A full urethroplasty involves urethral lengthening - creation of a urethra (tube you pass urine through) that runs through the neo-phallus (new penis) and is joined to your existing urethra (hook-up). This is offered if you would like to pass urine through the tip of your neo-phallus and urinate in a standing position.

Vaginectomy

Vaginectomy is removal of the vagina. In this procedure we remove part of the vagina and ablate (burn away) the remaining vaginal lining. You can choose to keep your vagina if preferred. However, vaginectomy is usually advised if undergoing urethral hookup to reduce the risk of urethral fistulae.

Scrotoplasty

Scrotoplasty is a surgical procedure which creates a scrotum from existing genital tissue. The procedure involves using pedicled flaps (skin flaps from a nearby area that are still connected to their original blood supply) which are created from the labia majora. The flaps are joined to create a single scrotal sac below the neo-phallus.

Clitoral burying

During phalloplasty surgery the clitoris is relocated to the base of the penis with the potential to provide erogenous sensation. You may wish for the clitoris be covered by skin so that it is not visible (clitoral burying).

Fashioning of the Glans and scrotal implants

The new penis is made as a straight tube with no indentation to distinguish the glans from the shaft. In a second operation, roughly 6 months after the initial phalloplasty surgery, we will surgically create a groove to give the appearance of the glans (coronoplasy or glansplasty).

Scrotal implants can also be inserted during this stage.

Erectile Devices

A prosthetic erectile device may be placed into the neo-phallus in order to allow the penis to become erect. Two main types of devices are used:

Inflatable device – a 3-piece device consisting of a pair of cylinders placed into the neo-phallus connected to a pump placed in the scrotum and a fluid-filled reservoir in the abdomen. Erection is produced by squeezing the pump which moves fluid (saline) from the reservoir to the cylinders. The erection can be stopped by pressing a small button on the pump which moves the fluid from the cylinders back into the reservoir.

Malleable device – involves placing two flexible rods into the penis to give a permanent erection, which can be concealed by bending the rods to change the position of the penis. This is simpler than the inflatable device with less risk of mechanical issues and does not require the manual dexterity needed to activate a pump.

Your surgical pathway

We offer patients an individualised consultation with a Clinical Nurse Specialist (CNS) with the aim to collect a detailed holistic history of the patient, and to identify potential matters that require referral to other services (e.g. dietician, endocrinology, physiotherapy, and psychologist). An appointment with one of our lead surgeons is then arranged. This will provide an opportunity for patients to ask any questions they may have regarding their surgery. The surgical case will then be discussed at our multi-disciplinary team (MDT) meeting where the outcome will determine whether the patient is fit for surgery.

If the outcome determines that the patient is not fit for surgery this will be communicated to the patient via telephone or via a virtual clinic with their surgeon. A second virtual surgical consult will take place following on from the MDT, where a clear understanding of the implications, risks, cosmetic and functional outcomes of the chosen surgical procedure will be discussed with the patient prior to their surgery date. Once a TCI (To come in) date for surgery has been provided to the patient, they can be expected to be admitted to the Surgical Admissions Lounge (SAL) on the day of surgery within the main hospital. Depending on which type of surgery the patient undergoes will depend on their length of admission and recovery, all details will be explained within our CNS and surgeon consultations.

Risks and complications

If you are accepted for surgery, your consent form will explain the potential risks and complications of your surgery. Details of this will also be discussed in your surgical consultations and you can also view the all of the risks in the patient leaflet.

Supporting people who need additional help with appointments or when coming into hospital:

Patient passport