Total phallic construction techniques in transgender men: an updated narrative review

Area of Science:

• Urology
• Plastic Surgery
• Gender-Affirming Care

Background:

• The World Professional Association for Transgender Health (WPATH) established standards for genital gender-affirming surgery (GGAS) in 2012.
• GGAS for transgender males focuses on creating a neophallus with aesthetic appeal, functional micturition, penetrative capability, and erogenous sensation.

Purpose of the Study:

• To provide a contemporary overview of surgical procedures for total phallic construction (TPC) in transgender males.
• To focus on key surgical steps, outcomes, and complications associated with TPC.

Main Methods:

• This narrative review synthesizes current literature on TPC techniques.
• Focuses on advancements, including microsurgical procedures and various flap types (pedicled and free-flaps).

Main Results:

• TPC remains a complex surgical challenge with no universally ideal technique demonstrated.
• Complications include ischemic events, flap loss, donor site morbidity, and urethral issues like fistulae and strictures.

Conclusions:

• Despite advancements in microsurgery and flap techniques, TPC for transgender males is complex and associated with significant complications.
• Further research is needed to identify optimal, safe, and reproducible TPC procedures with improved functional and aesthetic outcomes.