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Bencic et al. Plast Aesthet Res. 2025;12:30 https://dx.doi.org/10.20517/2347-9264.2025.38 Page 7 of 13

Patient satisfaction
Currently, there is no validated, patient-reported outcome measure specifically for transmen, so surgical
outcomes must be interpreted with caution. However, sexual function following prosthesis implantation
was evaluated using the validated IIEF questionnaire .
[13]

RESULTS
The mean follow-up was 21 months (range 4-36) [Table 2]. Malleable ZSI 100 FTM and inflatable ZSI 475
FTM penile prostheses were implanted in 15 (75%) and 5 (25%) patients, respectively. In one case, a ZSI 475
FTM was implanted following the explanation of a prior inflatable prosthesis designed for cismen. The
standard ZSI 100 FTM was placed in 12 patients, while the ZSI 100 D13 variant was used in 3 patients.
Among the ZSI 475 FTM implants, 150 mm prostheses were used in 3 patients, and 180 mm prostheses in 2
patients. No modifications to the prosthesis glans cap were required for any of the patients.

The median time from neophalloplasty to prosthesis implantation was 44 months (range 6-120 months). No
intraoperative complications or issues with glans dilatation occurred. In this type of phalloplasty, the
vascular bundle passes to the right of the pubic symphysis toward the groin; therefore, the pump is placed in
the contralateral hemiscrotum to avoid potential vascular injury.

There were 6 cases (30%) with postoperative complications in total [Table 3]. Three cases (15%) of wound
dehiscence were successfully treated conservatively. Three additional cases (15%) required revision surgery:
two due to implant fracture and one due to implant detachment. Implant fractures occurred 6 and 9 months
after implantation [Figure 4]. In this follow-up period, no complications such as rejection, protrusion,
erosion, malfunction, or infection were encountered.

In those two cases with penile implant fracture, we had initially inserted ZSI 100 D13. Patients requiring
revision received new penile implants, all of which were replaced with the ZSI 100 FTM device. One patient
in this group requested removal of the penile implant, expressing a preference to avoid additional surgery in
case of future complications. In one patient (5%), prosthesis detachment occurred 16 months after the
primary implantation, requiring an additional surgical procedure for refixation. In this study group, three
cases (15%) experienced mild complications (Grade I according to the Clavien-Dindo classification),
including partial wound dehiscence, which was managed conservatively. In one case, there were some
difficulties with pump manipulation, which were resolved through reinforced patient training after
confirming that there was no mechanical failure of the device. No complications related to the MLD flap or
any other further complications developed.

Intercourse with complete penetration was feasible in all cases. All patients completed the IIEF
questionnaires (100%) and reported satisfactory penetration, with a mean IIEF of 21.1. Average scores were
21.3 (range 19-26) in the erectile function domain and 8.7 (range 7-10) in the overall satisfaction domain.
Three patients (15%) scored below 21 in the erectile function domain, indicating erectile dysfunction. At the
end of the follow-up, 19 patients (95%) still had prostheses, with an overall revision rate of 15% [Figure 5A
and B].

DISCUSSION
Adequate erectile function is an important aspect of many men´s quality of life [14-16] . Consequently,
[16]
achieving penetrative sexual function is a key surgical goal for transmen undergoing neophalloplasty . An
erectile device is usually necessary to attain this goal; however, it is associated with a high complication
rate [16,17] . Transgender men and surgeons dealing with these shared goals have to grapple with complications
that jeopardize the patient’s quality of life.