An Update on Genital Reconstruction Options for the Female-to-Male Transgender Patient: A Review of the Literature

Abstract

Although many transgender individuals are able to realize their gender identity without surgical intervention, a significant and increasing portion of the trans population is seeking gender-confirming surgery (alternatively, gender reassignment surgery, sexual reassignment surgery, or gender-affirming surgery). This review presents a robust overview of genital reconstruction in the female-to-male transgender patient-an operation that, historically, was seldom performed and has remained less surgically feasible than its counterpart (male-to-female genital reconstruction). However, as the visibility and public awareness of the trans community continues to increase, the demand for plastic surgeons equipped to perform these reconstructions is rising. The "ideal" neophallus is aesthetic, maintains tactile and erogenous sensibility, permits sexual function and standing urination, and possesses minimal donor-site and operative morbidity. This article reviews current techniques for surgical construction, including metoidioplasty and phalloplasty, with both pedicled and free flaps. Emphasis is placed on the variety of techniques available for constructing a functional neophallus and neourethra. Preparative procedures (such as vaginectomy, hysterectomy, and oophorectomy) and adjunctive reconstructive procedures (including scrotoplasty and genital prosthesis insertion) are also discussed.

A Capable Surgeon and a Willing Electrologist: Challenges to the Expansion of Transgender Surgical Care in the United States

“…In phalloplasty, a free skin graft typically from the forearm or thigh is used to form a phallus that is transplanted to just above the clitoris in situ. The urethra can be extended through the neophallus, and erectile prosthetics can be placed to allow penile erection (see Frey et al 2017).…”

“…The urethra can be extended through the neophallus, and erectile prosthetics can be placed to allow penile erection (see Frey et al. ).…”

What Is the Ideal Neophallus? Response to Frey et al. (2017): An Update on Genital Reconstruction Options for the Female-to-Male Transgender Patient: A Review of the Literature

“…With great interest we have read the literature reviews on genital reconstructive techniques applied to female-to-male transgender individuals by Frey et al 1 , 2 Over time, many different surgical techniques have been developed for male genital reconstruction and a comprehensive overview of these techniques is currently lacking. Hence, we applaud the authors for providing an overview of literature on this topic.…”

“…Nevertheless, we would like to put these outcomes into a different perspective. Frey et al 1 , 2 state that the notion of an “ideal” bottom surgery outcome has not been articulated from the perspective of patients. By lack of an up-to-date standard, they revert to a definition of the “ideal neophallus” as described by Hage and De Graaf 3 in 1993.…”

Median Nerve Neuropathy following Radial Forearm Free Flap Phalloplasty: A Case Report

“…These procedures are performed with a wide array of complications such as flap loss, urethral strictures and fistula, and donor site morbidity. 1 …”