By Richard A. Santucci MD, FACS, HON FC Urol(SA) Senior Surgeon, Crane Center for Transgender Surgery (

When considering a phalloplasty for masculinizing genital confirmation surgery, you have some big decisions to make. One of the biggest is whether the new phallus will be built from tissue from your arm or leg.  (It can also be built from the “back” latissimus dorsi muscle, but at Crane Center we avoid this surgery when we can, as it has several disadvantages over RFF (arm) or ALT (leg) donor sites). 

A quick primer on RFF (arm) vs ALT (leg) donor sites:

 The “Radial Forearm Flap” (RFF) is located in the arm. The incision generally starts right at your wrist and goes up about 5 inches.  It is 8.5 X 5 inches in size total. The space left when this flap is used to make a phallus is then covered with a skin graft.

The “Anterio Lateral Thigh” (ALT) flap is located in the leg. The incision starts about two inches above the kneecap and is 8.5 X 6 inches in total size. The wound is then covered with a skin graft just like the arm (RFF).