Phalloplasty
Phalloplasty offers individuals the opportunity to align their physical appearance with their gender identity, promoting improved self-esteem, mental well-being, and overall quality of life.
PHALLOPLASTY: GENDER-AFFIRMING SURGERY
Gender-affirming phalloplasty is a significant step for many people to feel more at ease and self-assured. It can help with body conformity, lessen feelings of gender dysphoria, and improve emotional health. Every person’s transition journey is unique, and this surgery offers another affirming option for those who want it.
Choosing transmasc bottom surgery like phalloplasty is a deeply personal decision. Some people pursue it to improve day-to-day comfort, enhance intimacy, or align more closely with their gender expression. No matter the reason, the choice is valid, and having access to trusted surgical care is key.
Editors note: In our article, we may use terms that are culturally outdated, as many of our patients still rely on them when searching for information. We want to ensure we remain visible to this audience as well.
PATIENT STORIES
Choosing Align Surgical for your gender-affirming care means entrusting your health and identity to a skilled, compassionate team. Hear firsthand from patients who’ve experienced expert care from our renowned doctors.
WHAT IS PHALLOPLASTY
Phalloplasty is a surgical procedure that creates a penis using tissue from another part of the body, often the forearm, thigh, or back. [1] This tissue is shaped and connected to form a penis that looks natural and, depending on your goals, may allow for sensation, urination while standing, and sexual function. [2]
This surgery is a type of gender affirming care, often chosen by transmasculine and nonbinary individuals as part of their medical transition. [1] It helps people feel more comfortable in their bodies and better aligned with their gender identity
Phalloplasty is usually done in multiple stages, and some people also choose urethral lengthening, glansplasty, or penile implants depending on what feels right for them.
The main goals of phalloplasty are
- To create a penis with a natural shape and look (aesthetic)
- To support functions like urinating and possibly sexual activity (functional)
- To affirm a person’s gender and improve well-being (personal gender affirmation)
- To limit surgical complications and need for additional surgery
WHO MIGHT CONSIDER THIS SURGERY
Phalloplasty surgery may be a meaningful option for many people, including
- Transmasculine (transmasc) individuals
- Nonbinary people who want a more traditionally masculine or affirming genital appearance
- Other gender-expansive individuals who are exploring options to feel more at peace with their bodies.
TYPES OF PHALLOPLASTY PROCEDURES
1. Radial Forearm Free Flap (RFFF)
This is one of the most common techniques for gender-affirming phalloplasty. It uses skin, fat, nerves, and blood vessels from the forearm. The tissue is shaped into a penis and connected to nerves and blood vessels in the groin for blood flow and potential sensation.
It offers good outcomes in terms of appearance and function, including the option for standing urination and erogenous sensation. [3]
However, it does leave a noticeable scar on the arm, which some people may find concerning.
2. Anterolateral Thigh Flap (ALT)
This method uses tissue from the thigh, which can provide a larger volume of skin and fat for constructing the penis. ALT phalloplasty is a good option for people who want to avoid a visible forearm scar.
It may result in less sensation than the forearm flap, but it still offers good cosmetic results. [3] It also tends to have fewer visible donor site issues, especially for people with more body fat in the thigh area. Urethral complications such as stricture and fistula may be more common with ALT Phalloplasty.
3. Abdominal-Based Flap
This option may be suitable for patients who are interested in minimizing visible scarring or who may not be good candidates for other techniques, such as RFFF or ALT phalloplasty. [3]
4. Other Donor Site Options
Latissimus dorsi (back muscle): Offers a large amount of tissue but is more complex surgically. This option can be used when the forearm, thigh, or abdomen is not suitable due to scarring, body composition or personal preference.
MICROVASCULAR PHALLOPLASTY
Microvascular phalloplasty is a surgical technique used to construct a neophallus, or new penis, using tissue from the patient’s body, such as the forearm, thigh, or abdomen. This approach is distinguished by:
- The use of microsurgery to attach the harvested tissue.
- The potential for tactile and erogenous sensation.
- High success rates and improved aesthetic outcomes.
Microvascular phalloplasty also offers versatility, allowing for either:
- A single-stage procedure where the surgeon completes all components like urethral lengthening, neophallus creation, and glansplasty at once.
- A multi-stage approach, where the surgeon performs different surgical components separately.
SINGLE SCAR PHALLOPLASTY (SSP)
Using Single Scar Phalloplasty (SSP), it is possible to perform phalloplasty with a single line scar along the thigh, avoiding the typical large areas of scarring. SSP uses a new combination of surgical techniques to achieve scar reduction.
For those looking to urinate from a sitting position, SSP can be done as a shaft only reconstruction, and for patients looking to stand while urinating, urethral reconstruction can be combined with SSP.
We are currently carefully selecting patients for SSP, with the safety and well-being of our patients as our top priority. As we continue trying to innovate in the surgical care of our patients, our hope is that SSP can offer another genital surgery option to the transgender community. Dr. Gurjala is pioneering this technique, further reinforcing Align’s commitment to advancing gender-affirming surgical care
OPTIONAL PROCEDURES OFTEN INCLUDED IN PHALLOPLASTY
Depending on your needs and goals, several additional procedures can be part of your phalloplasty journey:
- Urethral Lengthening: Extends your urethra so you can urinate while standing. This is common in both RFFF and ALT techniques. [3]
- Erectile Implant Placement: A penile implant can be placed after healing to allow penetrative sexual activity. Implants are usually inserted several months after the main surgery to allow tissue healing. [3]
- Glansplasty: This is the shaping of the penile head (glans) to give the penis a natural look. It is often done in the same stage as phalloplasty or in a later revision. [3]
Scrotoplasty with Testicular Implants: Skin from the labia is used to create a scrotum, and testicular implants can be placed for a more complete appearance. [3]
CHOOSING THE RIGHT TECHNIQUE
Your surgeon will help you decide which phalloplasty technique is best for your goals, health, and body type. It’s okay to take your time, ask questions, and look at photos or testimonials to make an informed choice
WHAT TO TALK ABOUT WITH YOUR SURGEON
Not everyone’s path will be the same. It’s important to talk with your surgeon about:
- Whether you want to pee standing up
- What your healing priorities are
- How many stages your surgery may take
- What risks you should prepare for and how to manage them
Align Surgical emphasizes working with each patient to personalize care and explain every step of the process clearly.
TREATING PHALLOPLASTY COMPLICATIONS
Phalloplasty has historically been a very challenging procedure with relatively high complications rates. Addressing these complications can require multiple surgeries, each with their own recovery periods, times away from work, and emotional draw.
As respected and nationally-renowned surgeons for the transgender community, Dr. Gurjala and Dr. Safir are often called upon to assist patients experiencing challenging complications that could arise after undergoing a phalloplasty. Dr. Gurjala has been developing new techniques to provide more definitive solutions to the common phalloplasty complications, so that patients can return to normal life as quickly as possible. Dr. Safir is one of the top urologists in the world with individual fellowship training and experience in both male and female genital reconstruction as part of his subspecialty certification in Female Pelvic Medicine and Reconstructive Surgery (FPM-RS).
It is estimated that between 25 to 75 percent of phalloplasty patients experience complications that require surgical correction. The two most common surgical corrections include:
FISTULA REPAIR
STRICTURE REPAIR
FISTULA REPAIR
FISTULA REPAIR
A common complication after phalloplasty is the development of an opening in the urethra that causes urine leakage. Fistula repair is the corrective treatment to surgically close the opening and restore proper urine flow along the length of the urinary tract.
STRICTURE REPAIR
STRICTURE REPAIR
A percentage of patients who have undergone phalloplasty suffer from a narrowed urethra that makes urination difficult. The stricture may develop within six to twelve months following your procedure. Align Surgical offers a procedure to replace the narrowed portion of urethra with fresh, healthy tissue which maintains proper urinary flow.
RECOVERY AND AFTERCARE
WHAT TO EXPECT DURING THE HEALING PROCESS
Recovery after phalloplasty takes time and happens in stages. Right after surgery, you’ll likely stay in the hospital for several days so your care team can watch for any issues and help you manage pain and swelling
For the first few weeks at home, you’ll need to rest and avoid any heavy lifting, bending, or stretching. You might have drains or catheters in place to help with healing and urination. Your surgeon will give you detailed instructions on how to care for them.
Healing can take several months. Most people return to light activities after about 6–8 weeks, but complete recovery, especially if multiple stages are needed, may take up to a year or more.
COMMON POST-OP TIPS FOR OPTIMAL HEALING
- Follow your surgeon’s aftercare instructions closely. This includes caring for the surgical site, taking medications, and attending follow-up appointments.
- Wear compression garments (if advised) to help with swelling.
- Avoid smoking and alcohol, as they can slow healing.
- Stay hydrated and eat nourishing foods to support your body’s recovery.
- Be patient with your body. Healing takes time, and rest when needed.
Some people also experience changes in how they urinate, and you may have to learn how to stand and pee with the help of a urethral lengthening procedure (if chosen). There may be revisions or touch-up surgeries needed later, which is normal in gender-affirming bottom surgery.
MANAGING EXPECTATIONS FOR FINAL APPEARANCE
It’s important to know that the final appearance after phalloplasty varies from person to person. Factors such as your skin tone, healing process, the technique used, and whether you require additional revisions all affect the final appearance.
While phalloplasty can greatly improve gender congruence and comfort, the results may not match what you imagine at first. That’s okay. Healing takes time, both physically and emotionally. Give yourself grace and space to adjust.
CHOOSING A SURGEON
Choosing a surgeon for phalloplasty is one of the most important decisions you’ll make in your gender-affirming journey. Here’s what to keep in mind:
Experience
Look for a surgeon who specializes in gender-affirming surgeries, particularly phalloplasty. You’ll want someone who has performed many successful surgeries, as experience can lead to better results and fewer complications. A qualified surgeon should be well-versed in the specific needs of transmasc, nonbinary and gender-expansive patients.
Results
Review before and after photos of the surgeon’s previous patients. These images can give you an idea of the results you might expect. Keep in mind that everyone’s body is different, so results may vary. It’s also important to ensure that the photos reflect actual patient outcomes, not just stock images.
Gender Affirming, Safe Care
You deserve a surgeon who is not only skilled but also makes the patient feel safe. This means they understand the emotional and psychological challenges that many transgender and nonbinary individuals face and provide compassionate care that respects your journey. A surgeon who creates a safe, supportive, and respectful environment throughout the entire process.
INCLUSIVE CLINIC VALUES AND PATIENT-CENTERED APPROACH
Look for a clinic that prioritizes inclusive care. This means the staff and surgeons should be understanding, accepting, and respectful of your gender identity. It’s important that the clinic aligns with your values and treats every patient with dignity and respect.
A patient-centered approach involves open communication, clear explanations about your options, and a focus on your well-being at every stage, from consultation to post-surgery care. You should feel like your concerns and questions are heard and addressed.
IMPORTANCE OF BEFORE AND AFTER PHOTOS AND PATIENT TESTIMONIALS
Before making a decision, review before and after photos and patient testimonials. Photos will give you a visual understanding of the surgery’s potential outcome, while testimonials allow you to hear about other people’s experiences. Look for feedback that highlights the surgeon’s skill, how they managed the recovery process, and how patients felt supported throughout the procedure.
A reputable clinic will share authentic patient testimonials and provide opportunities for you to speak with former patients if needed. Don’t hesitate to ask for references or additional photos to ensure the results meet your expectations.
Choosing the right surgeon is a personal decision, and it’s important to feel confident and comfortable with your choice. Take your time to research and ask questions. You’re making a life-changing decision, and your comfort and trust in your surgeon will play a big role in your overall experience.
FINAL THOUGHTS
If you’re considering phalloplasty, know that this decision is a powerful step toward aligning your body with your gender identity. Whether you’re feeling excited, nervous, or uncertain, these emotions are a natural part of your journey. It’s important to honor your feelings and understand that there’s no rush; you get to make this decision on your own terms.
Remember, you are not alone. Gender-affirming surgery can offer profound relief and joy for many individuals, but it’s also okay to take your time, ask questions and explore your options. Take the first step when you feel ready, and trust that you are worthy of the support and care you need.
If you’re ready to take the next step or simply want more information about gender-affirming surgery, we invite you to schedule a consultation. At Align Surgical Associates, we are dedicated to providing compassionate, safe care to support you in your decision-making process. Whether you have questions, concerns, or are just looking for advice, we’re here to help.
Don’t hesitate to reach out for any support or guidance. You don’t have to navigate this path alone; help is available whenever you need it.
BY DR. MICHAEL SAFIR, MD
Dr. Michael Safir, MD is a board-certified reconstructive urologist specializing exclusively in genital gender-affirming surgery. Based in Los Angeles, Dr. Safir brings unique expertise as one of the few urologists in the world with fellowship training in both male and female genitourinary reconstruction. He is subspecialty-certified in Female Pelvic Medicine and Reconstructive Surgery (FPM-RS) and has earned national recognition for his surgical outcomes and compassionate care. Dr. Safir completed his undergraduate and medical education at Northwestern University’s Honors Program in Medical Education and his urology residency at the same institution. He completed dual fellowships at UCSF and UCLA under renowned mentors Dr. Jack McAninch and Dr. Shlomo Raz. His leadership includes past roles as Section Chief of Reconstructive Urology at New York Medical College, President of the Los Angeles Urological Society, and Clinical Instructor at both UCSF and UCLA. He is certified by the American Board of Urology, serves as a Diplomate in FPM-RS, and is an active member of the World Professional Association for Transgender Health (WPATH). Dr. Safir’s dedication to safe, affirming, and individualized surgical care has made him a trusted provider for transgender patients across the United States.
No. 1 Gender Affirming Surgeons in Los Angeles and San Francisco
“My end result is perfection I could scarcely imagine until now, living with this incredible beauty I will be grateful till my last day on earth. Thank you Align Surgical team for changing my life in the most amazing and clarifying event of my life.” – K.D.H.