Aesthetic Refinements after Radial Free Flap Phalloplasty: Optimizing the Donor Site and the Phallus

Abstract

Background:Phalloplasty with radial forearm flap is the gold standard for female-to-male sex reassignment surgery. However, it leaves a stigmatizing forearm scar, and as the new phallus is created with the forearm’s skin and fat, it does not look like that of a biological man. The aesthetic appearance of the donor site and the neophallus can be optimized after phalloplasty. In this study, we review refinement techniques (RTs) performed after radial forearm flap phalloplasty.Methods:We present a historical cohort of patients who underwent the following RTs: forearm fat grafting and localized laser in the forearm’s scars, and micropigmentation of the neophallus. Patient’s aesthetic satisfaction was evaluated using the Patient and Observer Scar Assessment Scale for the forearm’s refinements and the Male Genital Self-Image Scale for the neophallus.Results:Between January 2014 and January 2016, 8 patients underwent forearm fat grafting with localized laser, and 7 patients micropigmentation of the neophallus after radial flap phalloplasties. All Patient and Observer Scar Assessment Scale parameters showed a statistically significant reduction between preoperative and postoperative values. Male Genital Self-Image Scale survey showed that all patients felt positively about their genitals after micropigmentation. Patients who underwent refinement procedures were highly satisfied with the aesthetic outcome and felt more confident. They also claim that they would choose to have the refinement procedure done again.Conclusions:The proposed RTs are minimally invasive interventions to complement and enhance female-to-male sex reassignment surgery with very few complications and excellent aesthetic results of both the forearm scars and the constructed phallus.

Piloting a Genital Affirmation Surgical Priorities Scale for Trans Masculine Patients

“…9,21 This led to multiple visits where the surgical team and patient worked together to determine whether available surgical techniques would be able to give him an outcome he could be satisfied with. For many other patients, conversations focused more on their concerns about postsurgical scarring, 22–25 and how to balance their functional goals with their esthetic preferences, in terms of both technique (metoidioplasty/phalloplasty) and flap (radial forearm/anteriolateral thigh) choice. Having a quantitative assessment of how individuals ranked specific functional issues, as well as a qualitative assessment of other concerns, allowed the team to help patients better conceptualize the risks and benefits of their various options.…”

Narrative review of penile prosthetic implant technology and surgical results, including transgender patients

“…Radial forearm flap phalloplasty with a simultaneous urethral reconstruction using the "tube within tube" technique is considered the current standard procedure female to male reassignment surgery. Other anatomic locations which can be used for tissue donation during phalloplasty include the anterolateral thigh, abdomen, superficial circumflex iliac artery perforator flap, and thoracodorsal artery perforator flap (87,88).…”

Ci̇nsi̇yet Deği̇şti̇rme Cerrahi̇si̇

“…Duyu gelmeden önce, tatuaj veya mikropigmetasyon gibi ağrılı uygulamalar mümkünse ameliyattan sonra 2-3. aylarda yapılır. Ereksiyon sağlamak amacıyla penil protezin yerleştirilmesi protektif duyunun sağlanmasından sonra, genellikle 12 aydan sonra yapılır (13)(14)(15).…”

“…Üretra stenozu veya fistülü gibi üretral komplikasyonlar ve flebin total veya parsiyel nekrozu gibi flep komplikasyonları da görülebilir (17). Donör alan ve neofallusun görünümün iyileştirilmesi için minimal invaziv teknikler arasında yağ grefti uygulaması, lazer uygulamaları, mikropigmentasyon bulunur (14).…”