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Bencic et al. Plast Aesthet Res. 2025;12:30 https://dx.doi.org/10.20517/2347-9264.2025.38 Page 3 of 13

The study was approved by the institutional review board, and informed consent was obtained from all
patients.

Sexual function was assessed using the International Index of Erectile Function (IIEF) questionnaire, which
evaluates five domains: erectile function, orgasmic function, sexual desire, intercourse satisfaction, and
[7]
overall satisfaction .

Descriptive statistical analyses were performed using IBM® SPSS® Statistics 20.

Erectile devices
While a variety of penile implants are available, devices specifically designed for transgender men are
limited. The differences between conventional penile implants and those tailored for transgender patients
are summarized in Table 1 [8-13] .

Malleable penile implant (ZSI 100 FTM)
The ZSI 100 FTM is a one-piece malleable penile implant consisting of an adjustable cylinder, 22 mm in
diameter, which can be shortened from 200 to 130 mm by sequentially trimming 5 mm from the distal end
(ZSI 100 FTM). The distal tip features an ogive-shaped removable glans stopper. At the base of the cylinder,
a silicone-coated, stainless-steel plate allows the prosthesis to be anchored to the pubic bone [Figure 1] .
[10]
Another variant, the ZSI 100 D13 FTM, has a 13 mm diameter and can be adjusted up to 220 mm in
length .
[10]
Inflatable penile implant (ZSI 475 FTM)
The ZSI 475 FTM is a 3-piece inflatable penile implant consisting of a cylinder with a realistic glans shape, a
fixation plate at the base, a testicle-shaped pump, and a reservoir. In this study, the penile prosthesis
comprises a single cylinder engineered to provide both stability and optimal cosmetic outcomes in both
inflated and deflated states . The device is available in four lengths - 120, 150, 180, and 210 mm - and has
[11]
diameters ranging from 20 to 22 mm. Size selection was individualized based on patient anatomy and
surgical planning to ensure proper fit and function. The fixation plate, made of silicone-coated stainless
steel, allows the prosthesis to be anchored to the pubic bone [11,12] .

Surgical candidacy
The implantation of a penile prosthesis is the final stage in neophallus reconstruction, providing neophallic
rigidity. This procedure should be performed at least six months after the first stage to allow complete tissue
healing.

A limitation of MLD free flap neophalloplasty is the limited tactile sensation of the neophallus, despite
coaptation of the thoracodorsal nerve (primarily motor) to the ilioinguinal nerve (primarily sensory, with
some motor fibers), which is a standard step in the procedure. Sensation is restricted to the proximal
segment of the neophallus because the clitoris is incorporated at the base, and the urethra is formed via
[1]
tubularization of the labia minora . Hence, in this cohort, tactile sensation should not be used to guide the
timing of surgery. The choice of penile prosthesis (ZSI vs. other devices) is influenced by several factors,
including patient preference, surgeon experience, and anatomical considerations. Our center generally
prefers ZSI devices, as they are specifically designed for transgender men and are relatively easier to implant.
However, in cases of specific anatomical challenges or if a patient has a strong preference for a non-ZSI
device, alternative options are considered.