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Page 2 of 13 Bencic et al. Plast Aesthet Res. 2025;12:30 https://dx.doi.org/10.20517/2347-9264.2025.38

neophalloplasty and prosthesis implantation was 44 months (range 6-120 months). No intraoperative
complications occurred. The most significant complication observed was fracture of the penile implant (n = 2,
10%). All patients who engaged in penetrative sexual intercourse reported satisfactory penetration, with a mean
IIEF score of 21.1.

Conclusion: These novel penile prostheses for transgender men demonstrate favorable surgical outcomes after
latissimus dorsi neophalloplasty, with a high rate of patient satisfaction.

Keywords: Gender dysphoria, musculocutaneous latissimus dorsi, transmen, neophalloplasty, penile prostheses

INTRODUCTION
There are various surgical techniques for neophalloplasty in transgender men, each with its own advantages
and disadvantages. A primary goal of neophalloplasty is to enable penetrative sexual intercourse. Since the
neophallus lacks native erectile tissue, implantation of a penile prosthesis is necessary to obtain erectile
rigidity. At our center, the musculocutaneous latissimus dorsi (MLD) free flap technique is the method of
choice as it provides a neophallus with excellent volume and length, enabling safe penile prosthesis
[1-3]
implantation. Its main drawback, however, is the lack of sensation in the neophallus .

Neophalloplasty is a multi-stage procedure; prosthesis placement is usually the last step in patients who
require urethroplasty. Insertion of the penile implants is performed at least six months after the initial
neophalloplasty to ensure adequate tissue healing and maturation before proceeding with further surgical
intervention . Although multiple techniques exist for prosthesis placement, current literature has not
[2]
demonstrated the superiority of any one approach over others . Device selection is often based on a
[4]
combination of patient-specific factors, surgeon preference, and device availability. In neophalloplasty,
erectile devices are associated with high complication rates that may directly compromise the neophallus .
[5]
Common complications include infection, migration, and protrusion, often resulting in prosthesis rejection
and removal. One of the reasons for frequent complications is the lack of supportive tissue in the neophallus
that would normally cover the implant, as is the case with cavernosal bodies in cismen. Until recently, only
penile prostheses designed for cismen were available for transgender men, making high complication rates
inevitable.

Despite numerous described techniques, no universal solution exists to achieve ideal penile rigidity in
[2-5]
transgender men . Even with significant surgical advances and improved knowledge, complications
remain frequent. Therefore, the search for better solutions continues. Recently, penile implants specifically
designed for transmen have been developed .
[6]
This study aimed to assess the surgical outcomes of novel malleable and inflatable penile prostheses
specifically designed for transgender men, following MLD neophalloplasty.

METHODS
This retrospective, observational, descriptive study included all patients who underwent insertion of the
specifically designed penile prostheses after primary MLD neophalloplasty at our center between January
2022 and January 2025, yielding a total of 20 patients. Patients who underwent other types of
neophalloplasty or had a different type of prosthesis inserted were excluded. The mean age was 34.3 years
(range 23-58). Data were collected from medical records and outpatient examinations, including patient
demographics, age at surgery, type of surgical correction, complication rates, and sexual function. The
dorsal neophallic approach was used in all cases.