Phalloplasty is a genital surgery that allows the construction of a penis – neophallus – using tissue from another part of the body. It is a complex procedure with a significant reconstructive component, which is why it requires a specialized and experienced team, along with careful planning—not only for the surgery itself but also for the post-operative follow-up.
As with any gender-affirming surgery, phalloplasty is not a mandatory step nor a necessary decision for all trans men or transmasculine individuals. It is an option that may or may not be part of a trans person’s journey. At IM GENDER, we emphasize a point that often relieves a lot of pressure: identity does not depend on anatomy; every transition is valid, and every decision deserves respect.
What to Expect After Phalloplasty
In general, phalloplasty aims to create a penis that is anatomically proportioned and functionally capable. This surgery can produce a very natural aesthetic result, but the goal is not to “copy” a cisgender penis. Instead, the objective is to achieve a functional, harmonious, and satisfying result for the individual, with realistic expectations.
The most common goals expressed by trans men or transmasculine individuals seeking phalloplasty include:
- Appearance and proportion of the neophallus.
- Standing urination, if urethral lengthening to the tip is planned.
- Sensitivity, which is addressed through surgical techniques but evolves gradually and varies between individuals.
- Sexual intercourse with penetration, which usually requires a subsequent step (prosthesis), if that is the goal.
It is important to note that not everyone seeking phalloplasty has the same objectives. Achieving all potential goals often requires multiple surgical stages to ensure optimal results.
What Does the Phalloplasty Procedure Involve?
Phalloplasty is performed using a flap, which is a segment of skin and subcutaneous tissue shaped to construct the neophallus. At IM GENDER, the most common donor sites are the forearm or thigh, and the choice depends on anatomy, skin type, functional goals, and the overall surgical strategy.
How Phalloplasty is Performed
First, a donor site – such as the forearm or thigh – is selected, and a flap is designed with dimensions and thickness suitable for forming a penis of anatomical proportions. The tissue is shaped and transferred to the genital region. When the flap is free, microsurgery is performed to connect blood vessels and, when necessary, nerves, ensuring tissue perfusion and promoting sensitivity recovery.
If standing urination is desired, a urethroplasty is planned to extend the urethra to the tip of the neophallus. This is one of the most delicate parts of phalloplasty, as it involves a long suture line and healing in an area exposed to moisture and urine flow. For this reason, at IM GENDER, the surgery is often performed in two stages to connect the urethra to the neophallus later, reducing complications such as fistulas or strictures.
External genital reconstruction is also usually performed, which includes creating a scrotal pouch for later placement of testicular implants once swelling has subsided.
Each patient is unique, which is why a personalized surgical plan is defined before phalloplasty.
Before Phalloplasty: Step by Step
Before undergoing phalloplasty, several preparatory surgeries and processes are required. Here’s a step-by-step overview.
Fertility Preservation
Phalloplasty, when part of a process that includes removal of the uterus and ovaries, results in irreversible infertility. If future reproductive desires exist, options such as cryopreservation of oocytes, embryos, or ovarian tissue should be considered before a hysterectomy.
Hysterectomy: Is It Always Necessary?
Not in every case, but in some situations, the team may recommend a laparoscopic hysterectomy before or integrated into the overall surgical plan. The recommendation depends on anatomical and health factors as well as the genital surgery design. The key is to explain clearly what it contributes, what risks it prevents, and how it fits into the patient’s plan.
Practical Preparation: Diet, Blood Work, and Bowel Cleansing
IM GENDER provides a preoperative care guide that emphasizes preparation as crucial as post-operative care. Pre-surgery blood work is performed, along with a specific dietary plan: a low-residue diet in the days prior and bowel cleansing the day before. This is essential, especially if a vaginectomy is performed, due to proximity to the rectum.
Alcohol and tobacco should also be avoided several weeks before and after surgery, as they directly impact healing and increase the risk of complications.
Laser Hair Removal if Using Forearm as Donor Site
If the forearm is used and part of the tissue will form the urethra, laser hair removal of the non-dominant forearm is recommended well in advance (months to a year) to reduce hair in the urethral pathway.
Sensitivity and Sexual Life After Phalloplasty
Sensitivity is a common concern. The clitoris is preserved and strategically repositioned, maintaining nerve endings. Over time, the brain integrates the neophallus as part of the body, and tactile sensitivity develops gradually.
Regarding penetration, not everyone needs a penile prosthesis for a fulfilling sexual life. External prostheses can provide penetration, while an internal penile prosthesis can provide rigidity. The choice depends on individual goals, lifestyle, and surgical plan.
Postoperative Care and Recovery: First Weeks
During hospitalization, bed rest is required for the first days, along with daily nursing care. A urinary catheter is usually kept for about three weeks, although timing may vary depending on recovery and specific urethral reconstruction. In some cases, it may remain for four to five weeks.
Common concerns during the first weeks include minor wound dehiscence at the base of the phallus, changes in urine flow, urine leakage (compatible with fistulas, which often close over time), or urinary symptoms requiring infection checks. To address these, IM GENDER provides a dedicated consultation channel and 24/7 emergency phone support throughout phalloplasty recovery.
If you need more information about phalloplasty, request an initial in-person or online consultation with the IM GENDER team.
