Phalloplasty is a gender-affirming, masculinizing, lower surgery to create a penis, scrotal sac, and testes.
What is the procedure for a phalloplasty?
Surgical techniques vary from surgeon to surgeon. The Free-Forearm Flap is the procedure used at GRS Montreal:
The surgeon removes skin, nerves, veins and arteries from your forearm. A vein graft from your leg may also be required.
A small part of the forearm tissue is used to extend your urethra.
A larger part of the forearm tissue is wrapped around the urethra to create the penis shaft and glans.
The labia*labia* (with an asterisk) is used to acknowledge the many different words that are used for this body part. are repositioned and reshaped to make a scrotum.
The lining of the vagina*vagina* (with an asterisk) is used to acknowledge the many different words that are used for this body part. is removed.
Skin from the thigh is grafted to the forearm.
9-12 months later, testicular implants are inserted in the scrotum, if desired.
The glans is tattooed.
If desired, an implant to get an erection on demand (called Mentor Alpha II) is inserted in the penis.
How long will my hospital stay be?
You’ll be admitted to the recovery residence in Montreal two days before your surgery. Once your surgery takes place, you’ll probably spend four nights in hospital. Then you’ll go back to the recovery residence for ten days.
What will my post-operative care look like?
Please visit the GRS Montreal website for more information.
What medications will I be prescribed after surgery?
You will likely receive painkillers and antibiotics to prevent infection. Your surgeon will provide you with a list of medications to avoid around the time of your surgery.
What dressings will I need to wear?
The forearm that was used as a donor site for a skin-graft will be wrapped under air- and water-tight dressings for 5 days. The part of your thigh used for a skin graft will be dressed with a sheet of gauze. The gauze will be gradually trimmed away as it lifts up from its edges over the following 1 to 2 weeks.
What should I expect during the healing process?
Some bleeding during the first 48 hours.
Swelling of the penis, scrotum, and pubic region and other surgical sites for the first month. Can take 4 months to completely disappear.
Bruising that can extend from your navel to your thighs. Takes 3-4 weeks to settle down.
Itching and occasional small shooting electrical sensations as nerve endings heal.
Difficulty urinating while standing for the first few weeks.
Numbness in the penis and scrotum that will resolve in the first 18 months.
Stiffness in your elbow, wrist and hand on the arm where a skin graft was taken.
Pink or red scars on your forearm, thigh and penis that will pale over time. Takes 12-18 months to heal. The scar on your forearm will be permanent.
What check-ups will be needed after my hospital stay?
The number of check-ups needed varies from person to person. If possible, see your primary care provider about a week after you return from Montreal and then every 2-4 weeks for the first few months. When you visit your surgeon or primary care provider, they should check your surgical sites to make sure there are no infections or wound healing problems. They will ask questions about pain, bleeding, urination, bowel movements, fever, and how you are feeling physically and emotionally.
How long will it take for me to get back to my usual activities?
Recovery time varies from person to person, so always follow the advice of your surgeon. You’ll be able to return to many of your normal activities within 6-8 weeks. Some activities, such as driving, heavy lifting, exercise sex, and soaking in hot tubs, may be restricted in the post-operative period. Your surgeon will give you advice about when it is okay to resume these activities. Complete recovery can take up to one year.
What complications are associated with phalloplasty?
All surgical procedures involve some risks, including negative reactions to anesthesia, blood loss, blood clots and artery blockages. These complications can, in extreme cases, result in death. It’s important to discuss these risks in detail with your surgeon. Your surgical care team will take a wide variety of steps to prevent these problems, detect them if they arise, and respond to them appropriately. They will also inform you about what you can do to minimize your risks.
The list below includes some of the complications associated with phalloplasty in particular. It does not replace a thorough consultation with your surgeon.
Tissue transfer complications
These are problems related to the transfer of skin from your forearm to your groin. In less than 1% of cases, the transfer is unsuccessful. In about 3% of cases there is some degree of skin slough or partial loss of skin.
Numbness in hand or wrist of donor arm
Difficulty using your donor arm usually resolves in a few weeks. Numbness in this site can be permanent, but this is rare. About 5% of patients need prolonged physiotherapy to recover.
An implant can be surgically inserted in your penis to allow you to get an erection. Complication rates may be quite high. Complications associated with implants include poor positioning, technical failure, and infection. The implant can be either be repaired or surgically removed and replaced. Complications associated with testicular implants also include poor positioning and infection.
This is when blood collects in the surgical site, causing pain, swelling and redness. May require removal through surgery.
An abscess is a collection of pus. It’s caused by a bacterial infection. It can be treated with antibiotics or drained by the surgeon.
This is when clear fluid accumulates in the surgical site. Small seromas may need to be aspirated, or sucked out, once or more by the surgeon.
These are very common, though they often resolve with time. Examples include fistulas (flow of urine to areas other than urethra opening), stenosis (narrowing of the urethra, causing difficulty urinating), strictures (blockage of the urethra, causing difficulty urinating), and hairy urethras. If these problems don’t resolve on their own, they may require additional surgery.
A large scar on your forearm is to be expected from the free forearm flap phalloplasty technique. Severe scarring may require surgical revision. You can take steps to prevent severe scarring by following your surgeon’s advice about sun avoidance, massage exercises and ointments.
Dissatisfaction with the size and/or shape
Some people may be dissatisfied with the size and/or shape of the penis*. (Check with your surgeon to see if a revision is possible.)
Decreased sensation and ability to achieve orgasm
Studies suggest that the vast majority of people who undergo phalloplasty experience an improvement in their sex life and increased sexual excitement, however research is scarce and the role sensation plays is unclear.
What expenses are not covered by MSP?
Please see our Surgery Funding for more information.