Phalloplasty in Female-to-Male Gender Confirmation Surgery
Our criteria of those who quality for phalloplasty are as follows:
1. The patient will need to have be at least 20 years of age. If age is less than 20, it is necessary that the legal parents or guardian authorize their permission to the surgery.
2. The patient will need to have continuously taken male hormone for a minumum of one year.
3. The patient will need to have lived a life as a man for at least 1 year.
4. The patient will need to have undergone a mental test and been certified with a psychiatrist as in normal mental state.
5. The patient should be in physically fit condition.
6. The patient will need to have undergone mastectomy and total hysterectomy-oophorectomy for at least 6 months.
Kamol hospital offers 4 options for phalloplasty
- Anterolateral thigh pedicle flap (ALT)
Skin with its pedicle containing nerves and vessels from the upper and outer part of non-dominant thigh is used to reconstruct the new penis.
- Radial forearm free flap (RFF)
The skin at the front side of forearm is used to reconstruct the new penis under microsurgery technique.
- Fibula Free Flap (FFF)
The skin, nerves and some parts of the fibula bone are used as the neo phallus (penis) under microsurgery technique.
- Musculocutaneous Latissimus Dorsi (MLD) flap
The skin island containing nerves and vessels is moved to the genital area to reconstruct the neo penis under microsurgery technique.
Anterolateral thigh pedicle flap technique:
We provide two techniques, as follows;
- One flap technique
The surgical technique involves a two-step operation; the first faltering step includes oophorectomy-hysterectomy (O&H), vaginectomy, urethral lengthening and urethral tube preparation (urethral prefabrication). The neophallus (penis) is reconstructed with the pedicle flap with sensory nerves and urethral anastomosis (connection) is in the 2nd step. The duration between first and next step is approximately 6 – 12 months. - Double flaps technique or Two flap technique
Patients also need O&H, vaginectomy and urethral lengthening 3-6 months ahead of the step of neo penis reconstruction. The redial forearm free flap is used for the neo urethra under microsurgery technique while nerves and urethral re-connection are performed. The ALT flap is wrapped round the radial forearm urethra at one-stage operation.
(ALT-Pedicle Flap)
Radial forearm free flap technique
We provide two techniques, as follows;
- Two-stage technique
The two-stage radial forearm free flap technique involves urethral prefabrication prior to the main step (phalloplasty) for 6 months. This is suitable for those who have small size of forearm.
( Radial Forearm Free Flap)
- One-stage technique
The one-stage radial forearm free flap involves reconstruction of the neo penis and neo urethra in one stage under microsurgery technique.
( Radial Forearm Free Flap)
Fibula free flap technique
The skin, a piece fibula bone, and nerves are used for the neo penis in one stage under microsurgery technique. The neo urethra is being pre-laminated in situ for 6 months prior to the main step of neo penis reconstruction.
(Fibula Free Flap)
Musculocutaneous Latissimus Dorsi (MLD) free flap
The skin paddle contained nerves and vessels is moved from the area behind the arm to the genital area under the microsurgery technique to reconstruct the neo in the first stage. The neo urethra is constructed the second stage.
( MLP)
Urethral reconstruction of phalloplasty
Kamol hospital currently offers 3 options for neo urethral reconstructions, as follows;
- Skin graft from the groins
- Buccal mucosa
- Intestinal musculo-mucosa
Comparison of different phalloplasty techniques
| Flap technique | Size of neo penis | Donor scar | Sensation | Self-stiffness |
| ALT | Medium-to-Large | Thigh | Yes | No |
| MLD | Medium-to-Large | Side of Torso | Yes | Yes |
| Radial forearm | Small -to-medium | Forearm | Yes | No |
| Fibula | Small | Leg | Yes | Yes |
Kamol Hospital – Cosmetic & Plastic Surgery 1223 Ladpraw 94 Intraporn Rd. Wangthonglang Bangkok 10310, Thailand