Phalloplasty: Indications, Procedure & Recovery

Phalloplasty is a surgical procedure used to create, reconstruct, or enlarge the penis. It may be performed to increase penile length or girth and improve function or appearance.

The procedure may be indicated for people with micropenis, congenital genital differences, penile injuries, or other conditions that require penile reconstruction. It may also be performed as part of gender-affirming surgery to create male genitalia.

Phalloplasty is performed in a hospital by a urologist or plastic surgeon with specialized training in reconstructive surgery. Recovery varies depending on the type of procedure and typically includes rest, pain medication as needed, and avoiding sexual activity for a period of time.

Main indications

Phalloplasty may be recommended for:

• Micropenis

• Increasing the length and/or girth of the penis

• Correcting penile curvature caused by Peyronie’s disease

• Penile fracture

• Complications from circumcision

• Burns affecting the penis

• Aphallia, which is the absence of the penis at birth

• Congenital urethral abnormalities, such as epispadias or hypospadias

• Differences of sex development

• Penile reconstruction after tumor removal

Phalloplasty may also be performed to create male genitalia as part of gender-affirming surgery.

Preparing for surgery

Important steps when preparing for phalloplasty include:

• Asking the surgeon any questions about the procedure and recovery

• Discussing the expected results and personal goals with the surgeon

• Telling the healthcare team about all medications, vitamins, and dietary supplements taken regularly, because some may affect surgery or recovery

• Informing the healthcare team about any allergies and physical or mental health conditions

• Stopping smoking and using nicotine products for the period recommended by the surgeon

• Managing weight or other health conditions as recommended to reduce the risk of complications

• Completing any required preoperative or mental health assessment and making sure the procedure, risks, and potential effects are clearly understood

• Avoiding alcohol as directed by the surgical team

• Following the surgical team’s instructions about eating and drinking before surgery

Before surgery, the surgeon may order blood tests, a preoperative medical evaluation, and other tests needed to assess overall health and plan the procedure.

According to the World Professional Association for Transgender Health, assessment before gender-affirming surgery should confirm the person’s capacity to provide informed consent and identify any health conditions that could affect surgical outcomes. Imaging tests, such as X-rays or CT scans, may be ordered when clinically necessary.

For gender-affirming phalloplasty, a hysterectomy may be required if the procedure includes removal and closure of the vaginal canal. Removal of the ovaries is not always required, and the need for these procedures and their timing depend on the planned surgery, the surgeon’s protocol, and the patient’s preferences.

How it is performed

Phalloplasty is performed in a hospital under general anesthesia by a surgical team that may include plastic surgeons and urologists with specialized reconstructive training. Skin, fat, blood vessels, and nerves may be taken from another area of the body, most commonly the forearm or thigh, to create or reconstruct the penis.

Depending on the patient’s goals, additional procedures may be performed to lengthen the urethra or create a scrotum. These procedures may be completed during the initial operation or in later stages.

The length of surgery varies depending on the technique and the procedures performed. Complex penile creation or reconstruction may take several hours and often requires more than one surgery.

Recovery time

Recovery after phalloplasty for penile enlargement is usually shorter. Many people are discharged from the hospital the day after surgery, and the timing of their return to work depends on the type of procedure and the surgeon's recommendations.

Sexual activity should generally be avoided for about 30 days, or as directed by the surgeon.

Recovery after gender-affirming phalloplasty or penile creation or reconstruction is usually longer. The patient may remain in the hospital for up to one week, depending on their overall health and whether complications occur.

After discharge, strenuous physical activity should generally be avoided for at least 6 weeks. Complete recovery and healing may take approximately 12 to 18 months.

Possible complications

Possible complications of phalloplasty include:

• Infection

• Partial or complete loss of the reconstructed tissue if blood flow is inadequate

• Wound-healing problems

• Urethral fistula, which is an abnormal opening that allows urine to leak

• Urethral stricture, which is narrowing of the urethra caused by scar tissue

• Difficulty urinating or urinary blockage

• Changes in sensation

• Complications involving a penile implant, when one is used

For certain penile enlargement procedures, scar tissue may cause the penis to retract or appear shorter because of scar contracture.

Some people may be dissatisfied with the appearance, function, sensation, or overall results of the surgery, particularly if complications occur or the results do not meet their expectations.