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Carter et al. Plast Aesthet Res 2020;7:33 Plastic and
DOI: 10.20517/2347-9264.2020.81 Aesthetic Research

Review Open Access

Established and experimental techniques to
improve phalloplasty outcomes/optimization of a

hypercomplex surgery

Erin E. Carter , Curtis N. Crane , Richard A. Santucci 2
2
1
1 Department of Urology, Boston University School of Medicine, Boston, MA 02119, USA.
2 The Crane Center for Transgender Surgery, Austin, TX 78746, USA.

Correspondence to: Dr. Richard A. Santucci, Senior Surgeon, The Crane Center for Transgender Surgery, 5656 Bee Cave Rd Suite
J201, Austin, TX 78746, USA. E-mail: richard@cranects.com

How to cite this article: Carter EE, Crane CN, Santucci RA. Established and experimental techniques to improve phalloplasty
outcomes/optimization of a hypercomplex surgery. Plast Aesthet Res 2020;7:33. http://dx.doi.org/10.20517/2347-9264.2020.81
Received: 15 Apr 2020 First Decision: 18 May 2020 Revised: 27 May 2020 Accepted: 19 Jun 2020 Published: 30 Jun 2020

Science Editors: Marlon E. Buncamper, Stan J. Monstrey Copy Editor: Cai-Hong Wang Production Editor: Tian Zhang

Abstract
An increasing number of transgender and gender non-conforming patients are seeking genital gender affirming
surgeries in order to better align their physical characteristics with their innate gender identity and treat gender
dysphoria. Phalloplasty is the most complex of these surgeries, and this complexity creates a wide range of
potential complications. Some of the most common complications and therefore, targets for improvement in
outcomes, concern neourethral fistula/stricture, efficacy of reinnervation of the phalloplasty flap, postoperative
flap monitoring, and donor site morbidity. In the setting of no established “gold standard”, this review seeks to
describe the components and staging of phalloplasty, with an emphasis on established and experimental solutions
to the most common and vexing problems.

Keywords: Phalloplasty, transgender, female to male, transmasculine, surgical complications, radial forearm flap,
anterolateral thigh flap, genital gender confirmation

INTRODUCTION
Gender dysphoria is the distress resulting from a marked incongruence between a patient’s natal sex and
their innate gender identity. Treatment of gender dysphoria in transgender (TG), non-binary, and gender
non-conforming patients (TGNC) may include both medical and surgical interventions using shared
decision making to customize treatment plans according to individual patient goals. A significant and
growing population are seeking out genital gender-affirming surgery (gGAS) and an increasing number of
[1,2]
surgical centers are available to meet that need . For such patients, these procedures improve quality of life,
© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
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