Phalloplasty is a surgery that entails creating a full sized adult male penis through grafting tissues from other areas of the body. The most common donor sites are the forearm, the groin area, and the lower abdomen, although the thigh and back are also used. Many surgeons perform urethral lengthening as part of the phalloplasty, allowing the ability to stand to pee. A vaginectomy (removal/closure of the vagina) is often part of the procedure, and a few surgeons will even simultaneously perform a hysterectomy if the patient hasn’t had one prior.
With all types of phalloplasty, the labia are united to form a scrotum, where prosthetic testicles are inserted. An erectile prosthesis can be inserted into the phallus to enable sexual penetration, which is usually done in a separate surgery. There are several types of erectile protheses, ranging from simple rods to elaborate pumping systems. These are the same prostheses that are used for men with erectile dysfunction. However, many men do not opt for erectile implants, as they carry a risk for rejection, and they find other methods (such as self-adhesive wrap with a condom) to be adequate for achieving sexual penetration.
Phalloplasties vary in their cosmetic outcome, with some remaining the same shape and circumference along the entire length (giving more of a “tube” like appearance), while other surgeons are able to create a convincing looking head by creating a glans and coronal ridge. Some patients will pursue electrolysis or laser hair removal either before or after surgery in order to have a hairless penis. Most men who have received phalloplasties would say that they pass the “locker room test” but their penises are able to be distinguished from non-trans male penises when looked at up close.
The major advantage to having a phalloplasty is the result of having a full sized adult male penis, which can be anywhere from 4 to 9 inches long, and 5+ inches in circumference. Erotic sensation in the length of the phallus is variable, depending on the type of phalloplasty performed. However, despite many rumors to the contrary, practically all patients retain the ability to orgasm. The major disadvantages to phalloplasty are the large scars that occur on donor sites, the high cost, and the intensity of the surgery and recovery.
Complications most often occur from urethral lengthening, and they most often include either a fistula (hole in the urethra) or a stricture (blockage of the urethra). Sometimes these complications can resolve on their own, but they commonly require surgery to correct. Other complications include infection, tissue death (either parts of the phallus or the entire phallus itself), unsatisfactory aesthetic result, testicular or erectile implant extrusion, failure to regain sensation, and complications associated with the donor site; all of which can often require further surgery.
written by jakedgreenbeer
- Radial Forearm Free Flap
This technique involves using a graft of tissue that is taken from most of the circumference of the non-dominant forearm. The tissue is rolled up to form a “tube within a tube,” with the inner part of the forearm forming the new urethra, and the outer forearm forming the outside of the phalloplasty. The forearm donor site is then covered with a skin graft from the upper thigh.
The grafted urethra is connected to the native urethra using tissue from the vaginal wall and/or the inner labia. This is usually done as part of the initial procedure. This technique involves microsurgery, where grafted nerves are connected to the existing clitoris, which results in erotic sensation throughout the length of the entire phallus. It may take up to a year for nerve sensation to regenerate; however, sensation from the buried clitoris is always retained.
The major disadvantage to this procedure is the scar that results on the forearm, which is a deal-breaker for many transmen. It should be noted that one study found no long term functional damage to the forearm in any of the 125 participants who received radial forearm phalloplasties. However, this is the only procedure where one does not have to compromise on full adult size nor erotic sensation. This is usually a two stage surgery; one stage for the creation of the phallus, urethral hook up, vaginectomy, and initial scrotoplasty, and a second stage for the erection implant and permanent testicular implants.
Recently, some radial forearm phalloplasty surgeons have combined forearm flaps with flaps from other areas (such as the thigh or groin) in order to retain erotic sensation while trying to minimize the area of the forearm scar.
written by jakedgreenbeer
- Pedicle Pubic/Groin/Abdominal Flap
This procedure creates a tube out of either the suprapubic lower abdominal area, or the hip/flank area adjacent to the native genitals (usually running from the groin to the edge of the pelvic bone). The exact location of the donor site as well as name of procedure varies. However, the main difference between this method and the radial forearm method is that the tissue used to create this type of phallus is never completely detached from the body. A flap of skin and tissue is raised to create a tube that is initially attached on both ends (this procedure was formerly referred to as the “suitcase handle” technique for this reason). This procedure may also utilize grafted skin from the thigh area to wrap around the outside of the pedicle flap, mimicking the loose outer skin of the penis. One end of the flap is detached, swung down and connected to the clitoral area, and finally the other end is detached in order to allow the phallus to hang freely.
A urethral extension may by created using tissue from the labia or vaginal wall, or simply from creating an "inside-out" inner tube from the donor area. The clitoris is left intact, either buried in the base of the phallus, or just below it. This operation is performed in anywhere from one to twelve stages (the latter of which takes over a year to complete).
This method produces a penis that retains tactile, but not erotic sensation, as no microsurgery is performed. The aesthetic appearance of the penis is also sometimes less realistic than radial forearm phalloplasties, however, this varies among surgeons and individual patients, and many pedicle flap phallos are exceedingly good looking. The major advantage to this procedure is an adult sized penis without any major visible scarring, as the scar most often left is usually just a line that is easily hidden below clothing.
written by jakedgreenbeer
- Musculocutaneous Latissimus Dorsi (MLD) Flap
This is a relatively new type of phalloplasty, currently performed by only two surgeons. As noted on one of the surgeon’s websites, “The latissimus dorsi used in this phalloplasty is the broadest muscle of the back comprised of a pair of flat, triangular-shaped muscles across the middle and lower back.” This procedure involves a free tissue flap transfer, leaving a long, linear scar which runs from the underarm down to the lower back, which is considered preferable and less conspicuous to many transmen. Microsurgery is performed to connect nerves, and the erotic sensation is generally better than with pedicle flaps, but less than with radial forearm flaps.
written by jakedgreenbeer
- Scrotoplasty
Scrotoplasty is the creation of a scrotum, usually accomplished by hollowing out the labia majora and inserting silicone testicular implants. Often this can result in a single, unified scrotal sac, but occasionally the scrotoplasty results in the appearance of two sacs, each with one implant. Some surgeons will insert testicular expanders; these are ports implanted into the labia majora where saline is injected over a period of time in order to increase the size of the scrotum before implantation of the silicone testicular implants. Complications can sometimes occur where the implants can extrude or sit too high or unevenly in the newly created scrotal sac.
written by jakedgreenbeer
Male-to-female/MtF/Procedures for male-assigned bodies
Chest Surgeries
- Breast Implant / Augmentation Mammaplasty
Breast augmentation, or augmentation mammoplasty, is a surgical procedure designed to increase the size of a woman's breasts. If a transwoman is not taking estrogen or is unsatisfied with her results, she may opt to undergo surgery in order to reach a larger breast size; this may also be done in order to achieve a more natural or symmetrical shape.
Bottom/Genital Surgeries
- Orchiectomy
Orchiectomy, or gonadectomy, is commonly known as castration or by the abbreviations "orch," "orchi," "orchy," and "orchie." Bilateral orchiectomy involves removal of both testicles, which eliminates the sources of androgen production.
Because it is considerably less expensive than vaginoplasty, orchiectomy may be a good intermediate step for those with limited finances. It eliminates the need for antiandrogens and allows patients to take lower doses of feminizing hormones. However, it can affect the amount of tissue available for vaginoplasty over time and leaves small scars which may affect a later vaginoplasty result.
Adapted from http://www.tsroadmap.com/physical/orchiectomy/index.html
- Vaginoplasty
This surgery aims to create a functional vagina and clitoris from the original penis and scrotum.
In the penile inversion technique, the testicles are removed, and a vaginal space is created below the urethra. Skin from the phallus is used to create the vagina, and the clitoris is formed from the glans of the penis. The clitoris will therefore continue to have sensation, including sexual sensation. The labia are formed using elements of the former scrotum; however, many women may choose to undergo a labiaplasty in a later surgery in order to 'perfect' the appearance of the labia.
Facial Surgeries
- Forehead
Some surgeons emphasize surgical change of the forehead as a key part of facial "feminization." The surgical options include a brow shave, which grinds down the upper edge of the eye sockets to remove brow bossing, a forehead implant, utilizing synthetic bone-filler to round out a flat forehead, forehead reconstruction, which removes part of the skull, reshapes, and replaces it, a brow lift, raising the eyebrows, and/or scalp advancement, which brings the scalp and hairline forward.
Adapted from www.vch.ca/transhealth/resources/library/tcpdocs/consumer/surgery-MTF.pdf
- Trachea
Chondrolaryngoplasty (commonly called tracheal shave) is a surgical procedure in which the thyroid cartilage is reduced in size by shaving down the cartilage through an incision in the throat, generally to aid transwomen in achieving a passable female appearance, and occasionally on cisgender men and women who are uncomfortable with the girth of their Adam's apple.
After an anesthetic (local or general, depending on whether or not it is the only surgery to be performed) is administered to the patient, a small, horizontal incision is made on the bottom of the Adam's apple. The muscles in the throat are then held apart with forceps, and the protruding cartilage is shaved down with a scalpel, thus making the throat appear smoother and less angular. The incision is then closed with sutures, and a red line will mark the incision for about six weeks. Little scarring occurs in most cases because the surgeon will usually make the incision in one of the minuscule folds of skin that cover the Adam's apple.
The average time for complete recovery is about two weeks, though sometimes it takes longer than that depending on pre-existing medical conditions.
From http://en.wikipedia.org/wiki/Chondrolaryngoplasty
- Jaw/Chin
Chin and jaw surgery is done through the mouth, via incisions around the lower gums. The surgical changes to the chin and jaw that can be done as
part of facial feminization surgery include removing bone from the back corner of the jaw, possibly with removal of part of the masseter muscle to make it less prominent, removing bone from the chin and reshaping it so it looks more tapered, less square, and shorter, using implants or bone-filler paste if the chin is receding, surgical rotation of the jaw: clockwise rotation pushes the chin and back corner of the jaw back, making them look smaller, and/or liposuction under the chin to make the lower part of the face lookless heavy
Adapted from www.vch.ca/transhealth/resources/library/tcpdocs/consumer/surgery-MTF.pdf
- Nose
Rhinoplasty is a surgical procedure which is usually performed by either an otolaryngologist-head and neck surgeon, maxillofacial surgeon, or plastic surgeon in order to improve the function (reconstructive surgery) and/or the appearance (cosmetic surgery) of a human nose. Rhinoplasty can be performed to meet aesthetic goals or for reconstructive purposes to correct trauma, birth defects or breathing problems. It can be combined with other surgical procedures such as chin augmentation to enhance the aesthetic results.
Adapted from http://en.wikipedia.org/wiki/Rhinoplasty#Reconstructive_rhinoplasty
- Ears
Ear surgery - also known as otoplasty - can improve the shape, position or proportion of the ear. It can correct a defect in the ear structure that is present at birth, that becomes apparent with development or it can treat misshapen ears caused by injury.
Ear surgery creates a natural shape, while bringing balance and proportion to the ears and face. Correction of even minor deformities can have profound benefits to appearance and self-esteem.
From http://www.plasticsurgery.org/Patients_and_Consumers/Procedures/Cosmetic_Procedures/Ear_Surgery.html
- Facelift
A facelift, technically known as a rhytidectomy (literally, surgical removal of wrinkles), is a type of cosmetic surgery procedure used to give a more youthful appearance. It usually involves the removal of excess facial skin, with or without the tightening of underlying tissues, and the redraping of the skin on the patient's face and neck.
From http://en.wikipedia.org/wiki/Rhytidectomy
- Skin Resurfacing
Coming soon!
- Injections/Lips
The surgical changes to the lips that can be done as part of FFS include removing skin from between the nose and top lip to raise the upper lip, angling the section of skin between the nose and upper lip back slightly, and/or using implants to make the lips look fuller.
Some women may also use injections to reduce wrinkles on the face.
Adapted from www.vch.ca/transhealth/resources/library/tcpdocs/consumer/surgery-MTF.pdf
- Facial Implants
Cheek Augmentations are placed to improve the prominence of the cheekbones and to create facial feature harmony or to enhance genetically smaller cheekbones.
This is accomplished by the surgical implantation of a pliable synthetic implant that varies in size and shape for each patient's face.
Initial swelling is usually moderate and gradually disappears over a month or two. Sutures in the mouth dissolve and do not need to be removed. Sutures or staples in the scalp are removed in approximately 7-10 days.
Adapted from http://www.pai.co.th/services/services.asp?services_id=57
Chin implants may also be used.
- Laser Hair Removal