Summary: Although many transgender individuals are able to realize their gender identity without surgical intervention, a significant and increasing portion of the trans population is seeking gender-confirming surgery (alternatively, gender reassignment surgery, sexual reassignment surgery, or gender-affirming surgery). This review presents a robust overview of genital reconstruction in the female-to-male transgender patient—an operation that, historically, was seldom performed and has remained less surgically feasible than its counterpart (male-to-female genital reconstruction). However, as the visibility and public awareness of the trans community continues to increase, the demand for plastic surgeons equipped to perform these reconstructions is rising. The “ideal” neophallus is aesthetic, maintains tactile and erogenous sensibility, permits sexual function and standing urination, and possesses minimal donor-site and operative morbidity. This article reviews current techniques for surgical construction, including metoidioplasty and phalloplasty, with both pedicled and free flaps. Emphasis is placed on the variety of techniques available for constructing a functional neophallus and neourethra. Preparative procedures (such as vaginectomy, hysterectomy, and oophorectomy) and adjunctive reconstructive procedures (including scrotoplasty and genital prosthesis insertion) are also discussed.
New York, N.Y.
From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center.
Received for publication May 26, 2016; accepted July 27, 2016.
Disclosure: The authors have no financial interest to declare in relation to the content of this article.
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Alexes Hazen, M.D., Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, 550 1st Avenue, New York, N.Y. 10016, firstname.lastname@example.org