Advanced Phalloplasty: Management of Complications and Techniques for Revision

Phalloplasty is one of the most technically challenging reconstructive microsurgery procedures performed by plastic surgeons today. Potential complications include complete or partial flap necrosis, hematoma, hypertrophic scarring, donor site issues, and urethral stricture and fistula. Less commonly recognized issues include lymphedema, phalloplasty malposition and others. Despite the relatively high incidence of these complications, patient satisfaction is high. Based on cases and data from an academic center (Harvard/MGB) that receives a high volume of phalloplasty revision referrals, this article proposes strategies for prevention, diagnosis and successful operative management of complications after phalloplasty.