Phalloplasty is a surgical procedure that involves the creation or restoration of the penis. This is also called penile enhancement surgery. Phalloplasty is a common surgical option for transgender men, cisgender- males who were born without genitals or to those males who lost their penis by accident, trauma, or cancer. Penile enhancement surgery is performed by a plastic surgeon or urologist, or both. For transgender men, it may require another doctor-gynecologist to remove some female reproductive organs.
The objective of phalloplasty is to create a physically appealing and efficient penis for sexual intercourse and urination while standing.
What Happens during Phalloplasty/ Penile Enhancement Surgery
Penile enhancement surgery is done by obtaining a large flap from the forearm, lattisimus dorsi, super pubic region, or thighs. Some techniques in phalloplasty will include the preservation of the nerves and blood vessels because this is essential in the sensation of the penis. The flap will be rolled and formed as a penis and urethra, a tube within a tube procedure. The urethra formed will be connected to the urethra of the patient to lengthen it, allowing standing upon urination. The clitoris will be left intact, in which it can be stimulated. The donor site will be grafted.
Phalloplasty is done by a team of a plastic surgeon, a urologist, and a gynecologist. Phalloplasty may include one or more of the following surgical procedure and can be done in one or separated surgeries:
- Hysterectomy: The surgical removal of the uterus
- Salpingo-oophorectomy: The surgical removal of ovaries and fallopian tubes.
- Vaginectomy: Surgical removal of all or a part of the vagina.
- Phalloplasty: To make a phallus from a donor flap.
- Scrotoplasty: Creating a scrotum using the labia majora, with or without testicular implants.
- Urethroplasty: Surgical reconstruction or replacement of the urethra.
- Glansplasty: The creation of the glans penis.
- Insertion of the penile implant: Optional and is usually done when the penis is healed. The penile implant used can be the inflatable penile prostheses or semi-rigid or bendable implants.
Risks and Complications
Post-phalloplasty patients have chances of developing risks and complications. It also depends on the technique used by the surgeons and how well you took care of yourself at home.
Here are possible risks and complications of a post penis enhancement surgery patient can experience:
- Surgical site infections: Caused by bacterial or fungal infections, can be treated with antibiotics and anti-fungal medications.
- Loss of phallus: The death of flap due to blood supply problems, infection, and disease.
- Wound breakdown: This occurs when different wound sutures meet. It is managed by proper wound care and healing takes place through secondary intention- healing of open wound starting from the inside layer going out by new tissue formation.
- Urethral fistula: A hole in the urethra, corrected with surgery.
- Urinary catheter problems: Make sure there are no kinks in the catheter to prevent urine in the catheter to go back the urethra and up, to avoid urinary tract infections. If bladder spasms occur it is usually managed with anti-spasmodic (anticholinergics).
- Bleeding or pain in the pelvic area: Managed by placing drains on the wound.
- Bladder or Rectal injury: Accidental laceration or cauterization on the bladder or rectum, happens rarely.
- Urethral strictures: Caused by a possible obstruction in the urethra due to tissue growth or scarring, can cause a slow flow of urine or strain while urination.
- Wound contraction and scarring: Varies from one person to another, some develop mild scars while others develop ugly scars. Wound contraction is a normal part of the healing process but it can cause deformity on the nearby tissues.
- Formation of granulation tissue: A normal part of the healing process, where new tissues are formed and usually develop on donor site and graft site. This appears pink or dark red, wet, puffy, it bleeds easily and sometimes can be painful.
- Corona flattening: Happens occasionally can be revised along with the second stage of phalloplasty, where penile implants are placed.
Here are some important considerations after penile enhancement surgery:
- In the first few days, swelling and pain are normal but medications are given to minimize discomfort and pain.
- Blood-tinged urine is also expected to those who underwent urethroplasty.
- Perform walking exercises and avoid exercises that require strength for the first few weeks after the procedure.
- Elevate the phallus on a regular basis to avoid swelling and promote circulation.
- Do not put pressure on the phallus.
- Wear supportive underwear.
- Keep the dressing and drains clean and dry, and change the dressing as ordered. A sponge bath can be done in the surrounding area.
- Watch out for bleeding, pain, redness, tenderness, and unusual odor or discharges coming out from the surgical site.
- Take showers on when the doctor advised you to do so.
- Erogenous sensations, if included in the type of surgery, can be felt after complete healing which takes about 1-2 years to allow nerves and blood vessels to heal and function well.
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