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Top 5 Things to Prepare for Phalloplasty

By Richard A. Santucci MD, FACS, HON FC Urol(SA)

Senior Surgeon, Crane Center for Transgender Surgery (

Phalloplasty is a big operation! It requires careful planning in order for you to do well.

Here are 5 things to keep in mind when you are planning/preparing to have a phalloplasty:

1. Decide what surgery you want.

It’s important to do your research to figure out which operation is best for you: Arm

(RFF) or leg (ALT) phalloplasty.  Your surgeon can help you decide if you are not sure!

2. Decide how long is the dong?

Deciding how long the phallus will be is an important early step. If you choose RFF (arm) phalloplasty, the skin and the all-important artery that feeds the tissue is only so long .  So, these phalluses tend to be a maximum 5.5 inches long (that’s the average length of a phallus in North America). If you choose an ALT (leg) phalloplasty, there’s more skin and a longer artery, so a longer phallus can be constructed, up to 8.5 inches.

3. Decide what other surgeries you want:  Vaginectomy? Urethral lengthening? Scrotoplasty?  

While it’s common to do all three at the time of phalloplasty, it’s not required. A good surgeon will build what you want. For instance, it is completely up to you whether you want to do a vaginectomy at the time of phalloplasty. This surgery removes the vagina completely and leaves a flat “male type” perineum afterwards, but some patients decide to leave the vagina in place below the phallus. Your surgeon can also make a scrotum out of the labia majora (the “outer lips” of the vagina), but again, this is optional and determined by patient preference. Finally, your surgeon can create a new urethra (peeing tube) so that you can pee standing up. While this is desired by many patients, it’s not mandatory. If urethral lengthening is not desired, then this simplifies the surgery a lot, and you may have less risk for complications. The result still leaves a flat “male type” perineum afterwards, but with a small “pee hole” between the scrotum and anus.

4. Start your hair removal  

It’s suggested that you have some type of long-lasting hair removal on the donor site. It can be laser or electrolysis. It’s most important portion to remove hair from portion of skin that will be used to make the urethra, to avoid hair from regrowing in the urethra tube after the surgery.  Your surgeon can help you identify just where that is, so you can concentrate hair removal there. Most hair removal professionals recommend several cycles of hair removal over a period of six or more months for maximum effect so start early!

5. Get a hysterectomy (removal of the uterus) if you plan to have a vaginectomy. 

If you plan to have a vaginal removal (vaginectomy), it’s important that you have your uterus removed at least 3 months before any planned phalloplasty. This give you time to recover completely before you have your next surgical step. Also, it’s rare but sometimes the “vaginal cuff” portion of the hysterectomy doesn’t heal properly after surgery and it’s important to know this and fix it well before your phalloplasty operation.

Dr. Richard Santucci spent the last 18 years as one of the nation’s premier academic reconstructive urologist and now devotes his surgical talents full-time to transgender surgery at the Crane Center in Austin, Texas. Dr. Santucci offers Metoidioplasty, Phalloplasty, Orchiectomy, Vaginoplasty and Vulvoplasty.

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