Free microsurgical flap SRS phalloplasty

These techniques are involves using a free graft of tissue, from inner side of forearm (Free Radial Flap – FRF – phalloplasty), 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). 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 forming 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

 

  1. What is your personal experience in FRF phalloplasty?

– My experience in FRF phalloplasty is 45 cases during last 10 years, more than 80% of my patients 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.

  1. Do you do everything for the phalloplasty in one stage or are they separated into stages?

– 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.

  1. What about erogen sensation of the neophallus?

– Only FRF using can get any hopes for full restoration all kinds of sensation of the neophalluses skin during 6-12 months after surgery. In cases of other ways for phalloplasties some erogen sensation had restore more or less during 1-year approx. after surgery.

– Also you’ve to know that groin flap phalloplasty (PGF) is the method with low perspective for full tactile and sexual sensations restore.

  1. What are stages of PGF phalloplasty if it takes more than 1 stage?

– 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 early than 12 months later after last stage is will be complete.

  1. Do you do the nerve hook up for the  groin flap phalloplasty?

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

  1. Scrotoplasty, have you performed it in separate stage or in the same surgery with phalloplasty? What about testicular implantation?

– 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;

  1. What kind of testicular implants you have used?

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

  1. What type of erectile devices you offer?

– For endophalloprosthesis procedure I’ve use the  AMS 700 Series (3-piece Inflatable), AMS Ambricor (2-piece inflatable) or AMS Spectrum

Penile Implant (USA): https://americanmedicalsystems.com/en/professionals.html#Products

It is 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.

But sometime it could be performing w/testicular implantation in same stage;

  1. Are you also offer thigh phalloplasty? ALT technique?

– No, never use it.

  1. How long patient stay at the hospital after surgery?

– 5-7 days 

  1. How long is time of follow up period after surgery?

– 3-4 weeks is average term of staying for patients after free radial flap (FRF) phalloplasty in Minsk.

  1. Do patient need preop labs or an ECG before leave home for surgery?

– All tests and any other preop examination will provide in clinic.

  1. Will patient need to bring any medical supplies?

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

  1. How long do you suggest waiting before driving after surgery?

– As minimum for 3 weeks no driving and no sitting long time at all (more than 15-20 min continuously) after surgery moment.

  1. What is the phalloplasty cost?

– 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.

Phalloplasty Photos

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