Criteria for patients who qualify for phalloplasty are as follows:
- Patients must be at least 18 years old. For those under 20 years of age, authorization from parents or legal representatives is required.
- The patient must have taken the male hormone continuously for at least 1 year.
- The patient must have led life as a man for at least 1 year.
- The patient has undergone a mental test and has been certified by a psychiatrist in normal mental state.
- The patient must be physically fit.
- The patient must have performed mastectomy and hysterectomy & total oophorectomy at least 6 months before.
Phalloplasty - ALT, the latest phalloplasty technique
Anterolateral thigh flap phalloplasty, ALT (Anterolateral Thigh) is the most current technique. The procedure rearranges the skin, fats under the skin, blood vessels and nerves to make the new penis.
- The technique of the procedure is performed with a pedicle flap of the front and side of the thigh, the risks and complications are less than in the conventional technique of free flap surgery.
- The new urethra is constructed from a small radial free flap of the forearm that is more reliable than the long conventional flap and leave a less visible scar in a straight line on the forearm. The new urethra is performed with skin that has less risk of long-term urethral constriction. The nerves of the thigh will connect to the nerves of the clitoris. The thigh wound is covered with a thin skin graft.
- A new penis with urethra, scrotum and nerve connection is performed in one step. The prostheses can be inserted for erection 6-12 months later when there is complete recovery of nerves. However, many patients do not need testicular implantation.
- Donor area scar on the thigh can be easily hidden under the pants.
- Suitable size of new penis.
- Less recovery time.
- Surgery in a single time.
- Not suitable for obese or high fat thighs.
Anterolateral thigh flap technique
- Mastectomy, hysterectomy and total oophorectomy, vaginectomy (vaginal closure), and urethral enlargement, laser to remove hairs in surgery areas (thigh for new penis and forearm for new urethra).
- Phalloplasty operation.
- Penis implantation.
Risks and complications of phalloplasty
The main possible risks are inflammation, bruising, bleeding, infection, necrosis, scarring and numbness or change in sensitivity. Following the advice of the surgeon will reduce the risks and complications.
The alternative procedure for phalloplasty:
Free forearm radial flap technique
It can be performed in the case of the long forearm and thin skin. The procedure can be performed in 1 step as the ALT technique. However, the radial free forearm flap technique is not suitable for the patient who has thin and small forearms. Additionally, patients have to accept the large scar on the forearms.
Free fibula flap technique
The free fibula flap procedure is suitable for those who need self-stiffness with the bone, which means there is no need for penile implantation. Limitations for this technique involve limitation of the penis length. Prelamination of skin graft urethra is needed 6-8 months before the operation and longer recovery time (3-6 months). Additionally, the urethra connection needs to be performed in the separate operation.