Phalloplasty is a complex plastic surgery, the purpose of which is not only to correct the cosmetic defects of the penis, but also to restore its functionality in men, the absence of which leads to a significant deterioration in their quality of life. Phalloplasty has a number of features and complications, which, if the operation is performed incorrectly or due to other reasons, can lead to a violation of sensitivity, a decrease in the size of the penis, its rejection, and other dangerous consequences. This article is a description of the main types of this surgical operation, indications for its implementation, techniques and complications after phalloplasty.
The first sex reassignment phalloplasty was performed by Dr. Harold Gills in 1946 on transgender Michael Dillon. This was the creation of the first neophallus.
Complete or partial change of the penis is performed according to certain indications:
- patients with congenital anomalies such as micropenis, epispadias and hypospadias;
- patients who have lost their penis due to an accident;
- in the case of transsexuals, when an artificial sex change is made.
The purpose of such an operation is to normalize the act of urination and enable men to live a full sexual life. The chances of a successful phalloplasty have increased significantly over the past few years. Patients can now receive a sensual phallus that retains erotic sensations. Although the results of the operation are very dependent on the skill of the surgeons, the neophallus (new penis) looks remarkably realistic in real life.
Neophallus is usually constructed from a skin flap taken from a donor site. The graft can be created from the skin of the arm, abdomen, thigh, or torso, as they are large enough to provide the required amount of tissue with a high density of nerve endings.
There are four methods of phalloplasty that involve the use of a donor site tissue graft with urethral dilatation.
Penis reconstruction surgery is relatively simpler than transgender surgery, as men generally do not require urethral lengthening. In all cases, surgery on transsexuals is performed with the creation of a scrotum (scrotoplasty). The scrotum is formed from the labia majora with prosthetic testicles. In the same parallel, several other operations are performed, such as vagectomy, hysterectomy and oophorectomy.
In phalloplasty, an erectile prosthesis is implanted to achieve an erection (with possible sexual penetration). This is usually done as a separate operation to allow time for recovery.
Lengthening can be achieved by a procedure that releases the ligaments of the pubic bone to which the penis is attached, thereby allowing it to be extended outward from the body. The procedure is performed through a small horizontal incision located in the pubic region.
Types of phalloplasty
Phalloplasty of the radial artery (forearm Free-flaps)
In radial phalloplasty, a skin graft is used to create a neophallus. The skin of the forearm is the thinnest, most reliable and simplest of all possible areas of the body. The forearm graft allows the use of a large part of the skin, which gives the surgeon a wide opportunity to create a prosthesis. The flap from the forearm is formed into a tube and transplanted into the genital area. Using advanced microsurgical techniques, phalloplasty surgeons connect arteries, veins, and nerve endings from the hand to the newly created phallus, thereby increasing the success rate of the procedure. Dr. David Ralph from the UK reported that approximately 50% of his patients achieve sensation at the tip of the penis shortly after surgery.
Pubic phalloplasty
Pubic phalloplasty uses a skin flap from the lower abdomen, which is then shaped into a tube to create the structure of the phallus. Pubic phalloplasty is less common than radial artery phalloplasty because it does not allow the patient to achieve standing voiding results. However, there are also benefits to pubic phalloplasty. It lies in the fact that such plasticity allows more flexible use of the phallus for penetration.
Circumcision
Circumcision is a type of phalloplasty surgery in which the foreskin of the penis is cut off. This is done both for the sake of an aesthetic effect, and for medical purposes, for example, with balanitis.
Complications of phalloplasty
This operation may be accompanied by certain complications, due to which the risk of surgical intervention increases.
Main complications:
- Narrowing of the urethra may occur due to the scarring process;
- disturbance of the innervation of this organ;
- erection dysfunction;
- penis size reduction after surgery;
- infectious and inflammatory processes;
- rejection of the newly formed penis.
The postoperative period lasts one and a half weeks. The man must be in the hospital, and then under outpatient supervision. During the recovery period, physical activity is not allowed, and urination occurs only through a urinary catheter. Sex life with a new or corrected organ is allowed only after 2 months.
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