Some surgeries are a little awkward to talk about openly. Phalloplasty can be one such topic. But this is a surgery that can be very important in a person's life, especially for someone who is going through a journey with their gender identity, or someone who has suffered from an accident or illness. So today, let's talk about it without fear, openly, and in simple language that you can understand.
Simply put, what is Phalloplasty?
Phalloplasty is the surgical creation or reconstruction of a penis. This is a very complex procedure . It can take up to two years to complete. However, the success rate of this surgery is very high. Many people who undergo phalloplasty are very happy with the results.
There are two main situations in which this surgery may be necessary:
1. Gender Transition: This surgery helps a transgender man, who lives with an identity that is different from his birth gender, adjust his body to match his perceived identity. This is sometimes called "bottom surgery," but it can also include other gender surgeries.
2. Reconstruction: This surgery is used to reconstruct a penis in a man who has lost or damaged his penis due to a serious accident, a medical condition such as cancer, or a birth defect.
What are the types of phalloplasty surgery?
To create a penis, skin and tissue (skin graft) must be taken from another part of the body and transplanted into the groin area. There are three main methods for obtaining this tissue. The most suitable method will depend on your body type, your expectations, and your doctor's recommendations.
| Graft Type | Tissue collection site | Description |
|---|---|---|
| Radial Forearm Free Flap (RFF) | Forearm | A popular method that is often used. It can restore good nerve sensation and blood supply. However, it leaves a noticeable scar on the hand. |
| Anterolateral Thigh Flap (ALT) | Thigh | Some people like this method because the scar can be hidden by clothing. However, sometimes the penis created can be quite large. |
| Musculocutaneous Latissimus Dorsi (MLD) Flap | Side of the back | This method also allows for a large amount of tissue to be removed and the scar is easily hidden. |
The most important thing is to have a very open and lengthy discussion with your doctor before deciding which of these methods is best for you.
This is the stage of the surgical process.
Phalloplasty is not a one-time surgery. It is mainly done in three stages. Once one stage is completed, the body is given time to heal before moving on to the next stage.
Stage One: Creating the Penis
This is the first and largest surgery. As mentioned earlier, the penis is shaped using tissue taken from another part of the body. A catheter is inserted into the new penis to drain urine. After this stage, the body takes several months to heal.
Second stage: Urethral Lengthening & Scrotoplasty
This stage is performed about 5-6 months after the first surgery. Here are a few key things that happen:
- The urethra, which comes from your bladder, is connected to the tube in your newly created penis. You will then be able to urinate through your new penis.
- If you are a transgender man, you may want to consider having a vaginectomy at this point. However, this is not mandatory and is a completely personal decision. You should discuss this with your doctor.
- To increase sexual sensitivity, the clitoris can be placed under the skin of the new penis.
- Then, the skin of the external genitalia is used to create the scrotum. This is called ``Scrotoplasty``.
Stage Three: Penile and Testicular Implants
This final stage is reached about a year after the second stage.
- Here, a special device (Penile Implant) is implanted into the created penis to give it the ability to have an erection.
- Also, testicular implants are inserted into the created testicles to give them a full appearance.
Important: Complications can sometimes occur after phalloplasty surgery. For example, problems with the urethra or the implanted devices. If this happens, further surgery may be needed to correct them.
How much does phalloplasty surgery cost?
This is the biggest problem that many people have. To be honest, Phalloplasty is a very expensive series of surgeries. This is due to the complexity of it, the expertise required, and the time it takes.
The costs vary from country to country and from hospital to hospital. In foreign countries, this can cost as much as $25,000 to $150,000 (75 lakhs to 45 crores or more in Sri Lankan currency). These costs can vary within Sri Lanka. Therefore , to know the exact cost, you should definitely ask the doctor or hospital where you are planning to undergo this surgery.
This total cost usually includes the following:
- Surgeon's fee
- Hospital or operating room fees
- Anesthesiology fees
- Medications needed after surgery
- Post-surgery garments
- Things like necessary lab tests and X-rays
Additionally, if your doctor is in another city, there may be additional travel and accommodation costs, so it's important to get a clear picture of the cost of the entire process from the start.
Will this cost be covered by insurance?
Phalloplasty is considered "reconstructive surgery" in many countries because it is performed to confirm gender identity or to reconstruct a penis that has been lost due to an accident or disease. Therefore, some insurance companies cover all or part of the cost of this surgery.
However, the situation in Sri Lanka may be different. You should definitely discuss with your insurance company and doctor whether and to what extent your insurance policy covers such surgeries. Do not assume anything.
Take-Home Message
- Phalloplasty is a complex, multi-stage surgical procedure that creates or reconstructs a penis.
- The cost of this is very high, so it is important to plan well from the beginning regarding the financial aspect.
- It is essential to have a very open and detailed discussion with your doctor before surgery to gain a clear understanding of the surgical procedure, stages, costs, and insurance coverage.
- The journey can be long and challenging, but many say the results they receive and the positive changes in their lives make it all worth it.


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