Phalloplasty

Phalloplasty is the surgical creation of a penis. In this procedure, surgeons harvest one or more "flaps" of skin and other tissues from a donor site on your body (usually your forearm) and use it to form a penis and urethra.

The clinicians in the Center for Gender Surgery at Boston Children's Hospital offer phalloplasty as a gender affirmation procedure to eligible patients age 18 and over who have been living in their identified gender full time for at least 12 months. Our skilled team includes specialists in plastic surgery, urology, gender management, and social work who work together to provide a full suite of options for transgender teens and young adults.

Gender affirmation surgeries are a group of surgical procedures that some transgender and gender diverse people use to help affirm their gender identity. Phalloplasty is a type of "bottom surgery" (surgery on the genitals) available to transgender men, or those who identify as transmasculine. It involves the surgical creation of a penis from skin and other tissue harvested from another part of your body.

Who is eligible for phalloplasty?

Surgery is never the first step in a gender transition. It is something that happens after you have already explored social and medical transition options. People who choose to undergo phalloplasty usually do so after taking other steps in the gender affirmation process, such as taking supplemental hormones and undergoing chest surgery. To qualify for phalloplasty at Boston Children's Hospital, you must be at least 18 years old and meet certain criteria.

What happens before and during phalloplasty?

Phalloplasty involves the harvesting of one or more "flaps" of skin and other tissues from your forearm, although several other options may be available, such as the thigh. Prior to surgery, you will need to undergo permanent laser hair removal or electrolysis on your arm or other donor site. It is also crucial that you stop smoking of any kind at least three months prior to your operation. In order to be ready for phalloplasty, patients also need to undergo uterus removal (hysterectomy), which needs to be completed at least three months before the phalloplasty. During phalloplasty, the surgeon removes the flaps and then uses them to create a penis and urethra. Your donor site will be covered with a skin graft from your thigh, which will heal on its own. At Boston Children's, this procedure usually takes place during a single, long surgery, which can last between eight and 12 hours. The vagina may also be removed at this time.

What happens after phalloplasty?

Phalloplasty is a complex surgical procedure that requires a significant recovery time and ongoing self-care. You should expect to spend about a week in hospital following your surgery and to return for follow-up appointments after you are discharged. Because the healing process can take time, you shouldn't engage in strenuous physical activity or heavy lifting in the first six weeks after phalloplasty. You will also likely need to urinate through a catheter for the first three to four weeks after surgery. Your clinical team will give you detailed instructions on how to care for the catheter, as well as the surgical wounds on your donor site and graft site, and how to check for signs of infection, such as redness and swelling.

You will likely be able to walk around and engage in light activity within a week after surgery, and healed enough to go back to all activities at around six weeks. This surgery has a very long healing process that can take 12 to 18 months.