Free microsurgical flap SRS phalloplasty

These techniques are involves using a free graft of tissue, from inner side of forearm (Free Radial Flap – FRF — phallourethroplasty), sometimes from back side of chest (Free Thoracodorsal Flap or Musculocutaneous Latissimus Dorsi flap – FTDF or MLD Flap – phalloplasty) or from groin region (Pedicled Groin Flap – PGF — phalloplasty) or from outer surface of thigh (Anterolateral Thigh Flap – ALT-phalloplasty). Any mentioned technics may be performed in any separate case (choice depends on the personal features of the patient). This tissue is removed from its original place, rolled up, with a part of it forming new urethra, and grafted to its new place between the thighs (perineum). Microsurgery technique is used. The urethra up this point is formed from the inner labia (labia minora) and free graft of vaginal mucosa. The labia majora’s are united to form a scrotum, where testicular implants can be inserted in a future. In the following time after main stage of phallourethroplasty can be performing the erectile device implantation. 

Sensation is retained through the clitoris which is at the base of the neophallus, also, often a large nerve in the graft is connected to nerves either from clitoris or other nearby nerves. Also, nerves from the graft and the tissue it has been attached to usually connect after a while, thereby allowing additional sensation. This is by far the most common surgical technique for phalloplasty today, and also the one which produces the best results in both functioning and aesthetics.

FAQ about SRS phalloplasty

My experience in SRS phalloplasty is 55 cases during last 15 years. In my hands, the most common techniques are FRF and ALTF. When
neourethroplasty is performed — more than 80% of my patients are faced with neourethra complications (fistulas and strictures), usually 1-2 additional surgeries required for correction of neourethra. If you are smoker the one of the seriously complication is neophallus partial or total necrosis – reoperation is only one way to correction.

It is one main stage for FRF phallourethroplasty. Additional are possible if complication occur (urethral fistula is more often).

Usually two stages for pedicled groin flap (PGF) phalloplasty (6 months between the stages) + 1 additional for neourethoplasty (after 6 months minimum) – 3 stages total. But sometimes it possible to perform all in one main stage, depend on BMI (body mass index) of the patient and blood supply of the groin region.

Concluding all mentioned before, groin flap phalloplasty can perform in 1 stage or in 2-3 stages too. It is depend on blood supply in donor groin region. We can make sure in that only in time of the surgery.

For free thoracodorsal flap (FTDF) — one for phalloplasty (with scrotoplasty and perineal urethroplasty) and second (after 6 months as minimum) for neourethroplasty (by free radial flap) and glans formation.

For free or pedicled anterolateral thigh flap (ALTF) — one for phalloplasty (with scrotoplasty and perineal urethroplasty, glans formation) and second (after 6 months at least) for neourethroplasty (free radial flap).

Only with the use of FRF can one hope for a complete restoration of all types of sensitivity of the skin of the neofallus in 6-12 months after the operation. With other methods of phalloplasty, part of the erogenous sensitivity is restored within 1 year after the operation and longer.

The interested patient should be aware that groin flap phalloplasty (PGF) is not a promising method for the complete restoration of tactile and sexual sensations.

Stages. 1-st  — groin skin and subcutaneous tissue tube with another tube inside (for neourethra) formation on wide feeding base, Urethra’s pars fixa formation (perineal urethroplasty), scrotoplasty. If BMI more than 18 and skin pinch in groin region more than 1.5 cm the separate stage for neourethra formation need in 6 months after main stage.

2nd — After  3 months minimum (more often — 6 months) feeding base resection and neophallus formation with, if it possible, connecting neourethra and pars fixa of urethra, vaginectomy, glans formation, testicular prostheses implantation. 

3-rd – in 6 months later, if the BMI more than 18 and skin pinch in groin region more than 1.5 cm, performing neourethra formation and, if it did not performed on 2-nd stage, connecting neourethra and pars fixa of urethra (perineal part), vaginectomy, glans formation, testicular prostheses implantation. 

Thus total time for this kind of phallourethroplasty can takes more than 18 months. Also you have to know that groin flap phalloplasty is the method with lower perspective for full tactile and sexual sensations restoration. 

Endophalloprosthesis procedure is possible not earlier than 12 months later after the last stage is be completed.

No, only clitoris implantation into the base of the neophallus (PGF). It can get the erogen sensation for neophallus.

The scrotoplasty performing with phalloplasty in same stage, but testicular implants puttin’ in later. It is never performing Scrotoplasty and testicular implants in same stage. For these operations need two separate stages as minimum, with 3 months or longer time distance between.

Usually for testicular implantation I’ve use the EUROSILICONE (France) or POLYTECH (Germany) silicone implants.

For endophalloprosthesis AMS by Boston Scientific (USA):

As well as Zephyr implants (Switzerland):

It is a separate surgery, possible not early than 1 year after successfull phalloplasty. The 12 month period allows tissues of neophallus to heal and restore enough, thereby reducing the risk of neophallus damage by implant.  

Sometimes it may be performed w/testicular implantation in same stage.

3-4 weeks is average term of staying for patients after free radial flap (FRF) or anterolateral thigh flap (ALTF) phalloplasty.

All tests and any other preop examination are provided at the clinic.

Doctor’s Letter about your current status and all that happened with your health in the past.

At least for 3 weeks no driving and no sitting long time at all (more than 15-20 min continuously) after the surgery.

The prices are vary and depends on types of the flaps.

For more information about costs, more photos and any other further information, please contact us.

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