Can phalloplasty be performed in a single surgery, or are multiple stages necessary?

Phalloplasty can be performed in a single surgery, but this is not the most common approach. Most surgeons prefer to perform phalloplasty in two stages, with the second stage taking place several months after the first. This allows the tissues to heal properly and reduces the risk of complications.

The first stage of phalloplasty involves creating the phallus. This can be done using a variety of techniques, but the most common is to use a flap of tissue from the arm, thigh, or abdomen. The flap is then shaped and placed in the desired location.

The second stage of phalloplasty involves creating the urethra and scrotum. The urethra is created by connecting the flap to the bladder. The scrotum is created by using skin from the inner thigh or labia.

In some cases, a third stage of surgery may be necessary to implant erectile tissue or testicular prostheses.

The decision of whether to have a single-stage or two-stage phalloplasty is made on a case-by-case basis. The patient’s individual circumstances, such as their anatomy and health, will be taken into account.

Here are some of the advantages and disadvantages of single-stage and two-stage phalloplasty:

Single-stage phalloplasty

• Advantages:
  • Shorter overall recovery time
  • Lower risk of complications
• Disadvantages:
  • More complex surgery
  • Higher risk of dissatisfaction with the results

Two-stage phalloplasty

• Advantages:
  • Lower risk of complications
  • More time to heal and recover
  • More time to adjust to the changes
• Disadvantages:
  • Longer overall recovery time
  • More expensive

Phalloplasty is typically performed in multiple stages, and it is rare for the entire procedure to be completed in a single surgery. The decision to perform phalloplasty in multiple stages is based on several factors, including the complexity of the procedure, patient safety, and achieving the best possible aesthetic and functional outcomes. Here is a general overview of the stages involved in phalloplasty:

1. Stage 1: The initial stage involves the creation of the neophallus using a chosen flap technique (e.g., radial forearm, ALT, abdominal flap). This stage may also include the construction of the urethra (urethroplasty). Creating the neophallus is a complex procedure that requires a significant amount of surgical time.
2. Stage 2: Typically performed several months after the initial surgery, Stage 2 involves additional refinements to the neophallus. This can include further shaping and contouring of the phallus, scrotoplasty (creation of a scrotum), and the insertion of testicular implants.
3. Stage 3 (Optional): Some individuals choose to undergo additional surgeries, such as penile implant surgery, to enable the neophallus to achieve erections. This stage is optional and depends on the patient’s preferences and goals.

The use of multiple stages allows for better healing, reduced risk of complications, and improved precision in shaping and refining the neophallus. It also provides the opportunity for the surgical team to monitor progress and address any issues that may arise during each stage.

The timeline for completing all stages of phalloplasty can vary from patient to patient and depends on factors such as individual healing rates, the need for additional surgeries, and the chosen surgical techniques. Patients should work closely with their surgical team to develop a personalized treatment plan and timeline based on their specific needs and goals.