Phalloplasty

Our team has been performing this surgery for over 20 years and, over this time, has improved and developed the technique by significantly reducing the risks and complications and, above all, by producing new genitals much more like biological male genitalia on both a functional and aesthetic level.

Phalloplasty mainly involves removing a flap of skin from a region of the body to create the phallus.. The surgical technique currently recommended by the team at GrS Montréal is phalloplasty by forearm free flap. This technique can achieve more realistic results, both physically and functionally, including the ability to urinate standing up.

Under certain conditions, thigh flap phalloplasty or abdominal phalloplasty could be discussed. However, these surgeries will only be possible in certain exceptional cases and if authorized by your provincial program for coverage of surgeries.  

Radial forearm free flap phalloplasty

Expected and desired results:

• Complete creation of the external male genitalia including a a phallus of a size proportional to your morphology,a glans, and a scrotum;
• Tactile and erogenous sensations with the possibility of sexual pleasure and orgasm
• Construction of a penile urethra, allowing you to urinate standing up;
• Possibility of sexual relations with penetration following insertion of the penile implant.

*Due to multiple factors that are unique to each individual, results may vary from one person to another. Be assured that our team works with each patient individually to achieve the best results possible. To date, it is very rare for a patient to lose all ability to achieve orgasm. Nerve recovery depends on age, lifestyle, and the patient’s overall health.    

The surgical technique:

Generally, there are 3 steps:

1. Phalloplasty – consists of creating the phallus, glans, scrotum and closing the vaginal cavity
2. Construction of the urethra – consists in building the urethra which will allow urination through the phallus in a standing position;
3. Insertion of implants – insertion of testicular and erectile implants that will allow you to have sexual relations with penetration

First stage surgery - Phalloplasty:

1. A skin flap is taken using the entire thickness (skin, nerves, vein, and artery) of the forearm of the non-dominant arm in order to form the phallus (forearm free flap);
2. Skin is taken from the side of the thigh, which is then grafted to the donor forearm. *Once the thigh wound has healed, it is possible that the dermis of the new skin will be slightly discoloured;
3. Construction of the glans;
4. Closure of the vaginal cavity;
5. Creation of the scrotum using the skin of the labia majora;
6. Burial of the clitoris at the base of the phallus;
7. Lengthening of the biological urethra to the base of the new penile urethra, at the level of the scrotum (peno-scrotal urethra);
8. Positioning of the phallus, connection of the vascular and nervous networks: a clitoral nerve and a genito-femoral nerve is connected to the nerves of the forearm flap (phallus);
9. Attachment of the phallus.

Required before surgery: 

• Hysterectomy including removal of the cervix must be performed at least 6 months before the first stage of the phalloplasty surgery. 
• A mandatory in-person consultation is required at our office to assess the flap removal site before beginning permanent hair removal.

 *Some conditions may require the use of the dominant arm or a site other than the forearm, so the surgeon must assess you in person.

• Permanent hair removal in the area of the arm to be used for construction of the phallus is required before surgery. Treatments can be made by laser or electrolysis and must be completed before surgery. No regrowth of hair should be observed on arm before surgery for at least 3 months. 
• Smokers are not candidates for phalloplasty. If you smoke, you must stop using tobacco and products derived from tobacco at least 6 months before and after surgery.

Postoperative care:

During your convalescence, you will be provided with the document Information and Postoperative Care – Phalloplasty. This document contains your surgeon’s instructions and will serve as a guide.

Phalloplasty Information Booklet Part A

Phalloplasty Information Booklet Part B

Phalloplasty Information Booklet Part C

 

The surgical procedure, your stay and convalescence

Average length of the surgery	Admission to the CMC	Anesthesia	Hospitalization	Convalescence at Asclépiade	Convalescence at home	Return to physical activities and sports
6.5 hours	The day of the surgery	General	3 nights postoperatively	7 nights postoperatively	6 to 8 weeks	3 months
Medical follow-ups and appointments: Asclépiade provides personalized postoperative follow-ups to all patients. You will be getting a follow-up appointment with your surgeon one month after your surgery. If you cannot come to your appointment, your attending physician can follow-up with our surgeons by contacting the Asclépiade.