What you need to know about penis reconstruction surgery (Phalloplasty)

Sometimes, due to a congenital problem or a serious injury caused by an accident, a person can experience a lot of anxiety and stress about their genitals. Phalloplasty is a very complex surgery that is performed to recreate or reconstruct a penis in such cases. Since this is a big decision, it is very important to be fully informed about it. So, let's talk about this in detail, in a simple way that you can understand.

What exactly is phalloplasty?

Simply put, phalloplasty is the surgical creation of a new penis (neophallus) or reconstruction of a damaged penis. This is often done as a treatment for a congenital defect, severe injury to the penis, or a medical condition.

There are several main goals of this surgery:

• Creating a natural-looking penis.
• Providing the ability to urinate while standing.
• Providing sensation for touch and sexual pleasure.
• Providing the ability to rejuvenate the penis with the help of a special device (penile implant).
• Creating a penis that is capable of sexual intercourse.

In what cases is this surgery necessary?

Phalloplasty surgery is usually recommended for two main reasons: congenital conditions and severe damage to the penis. Let's take a closer look at these.

How should I prepare before surgery?

Since this is a very complex surgery, it is essential to prepare yourself well beforehand. These things are important to achieve the best results.

• A complete medical examination: Your doctor will examine your overall health and discuss your complete medical history.
• Thorough education: Doctors will fully educate you about the pros, cons, risks, and post-operative care of this surgery.
• Mental health evaluation: This is a very important step. A qualified mental health counselor (therapist, psychiatrist) will talk with you to make sure you are mentally ready for this surgery. They will talk about why you want to have this surgery, what your expectations are, and how it will affect your life. Usually, this requires letters of recommendation from two mental health professionals.
• Hair removal: Hair must be permanently removed from the area where the new penis is to be implanted (for example, the forearm, arm, or thigh). This can be done using methods such as electrolysis or laser hair removal .
• Health habits: Quitting smoking if you smoke and maintaining a body mass index (BMI) below 32 can help reduce complications of surgery.

How is the surgery done?

Before the surgery begins, an anesthesiologist will give you general anesthesia to put you completely to sleep. So you won't feel any pain during the surgery.

Then, surgeons take a flap of skin, fat, nerves, and blood vessels from your forearm (radial forearm free flap) or thigh (anterolateral thigh free flap) . This flap contains everything in a penis except for the erectile tissue.

Next, the tissue is rolled into a tube, shaped like a penis, and attached to your groin. This surgery can take 8-10 hours or more.

Sometimes, several additional surgeries can be performed at the same time as this surgery, or they can be broken down into several stages, allowing time for healing. Such additional surgeries include:

• Urethroplasty (lengthening of the urethra) to allow you to urinate while standing.
• Creating a glans (glansplasty) for the penis.
• Penile implant.
• Creating a scrotum for the testicles (scrotoplasty) .

What are the benefits of this surgery?

The main benefit is relief from physical and mental challenges. Having a sexually active, natural-looking penis can make a big difference in your life.

Also, the benefits vary depending on the type of tissue chosen:

• Tissue taken from the forearm: Provides very good results in appearance and better sensation.
• Thigh graft: There is more choice in the length of the penis. Also, the scar from the graft can be easily covered with pants or shorts.

Possible problems and risks after surgery

Since phalloplasty is a complex surgery, there is a risk of complications. Having the surgery performed by an experienced surgeon can reduce this risk. If a problem does occur, early detection can minimize long-term effects.

Recovery time and things to be aware of

After the surgery, you will need to rest well. You will need to stay in the hospital for at least a week. During this time, doctors will regularly check the blood supply to the newly created penis.

• Rest: It will take at least 6 weeks to resume normal activities. Activities such as exercise and housework should be limited during this time.
• Urination: Initially, urine is passed through a catheter.
• Wound care: Surgical wounds should be kept clean and dry. Dressings should be changed as directed by the doctor.
• Medications: You should use the medications your doctor prescribes exactly to treat pain, prevent infections, and prevent constipation.

It usually takes about 2-3 months to return to work or school. However, if you have a physically demanding job, you may need to rest for longer, perhaps 3-4 months.

When to see a doctor immediately

After surgery, you should see your doctor at regular intervals to monitor your recovery. Also, if you experience any of the following symptoms , seek medical advice immediately or go to the hospital's Emergency Treatment Unit (ETU).

• Signs of infection (fever, chills, headache, wound discoloration, swelling, or pus drainage).
• Persistent vomiting and inability to retain fluids.
• Excessive bleeding or the dressing being completely soaked with blood.
• Difficulty or severe pain during urination.
• Pain that does not subside despite taking medication and lasts longer than expected.
• Discoloration or other abnormalities in the newly formed penis.