What is Phalloplasty?
At L Plastic Surgery, our board-certified plastic and reconstructive surgeon, Dr. Charles K. Lee, performs phalloplasty or reconstructive surgery for a penis. Dr. Lee is skilled in surgically creating a penis for trauma victims, cancer patients, and transitioning female-to-male patients with designer flaps and phalloplasty. Many people also know this as FTM bottom surgery. This type of designer flap surgery is made possible from a section of tissue (skin, fat, nerve, and muscle) connected to their own blood supply, and relocated to make a penis. The donor tissues can be designed and fashioned into various shapes and sizes. The techniques that Dr. Lee prefers for this surgery are the radial forearm free (RFF) flap and the anterolateral thigh (ALT) flaps for phalloplasty.
Dr. Lee trained with world renowned plastic surgeons, Drs. Robert Walton & Lawrence Gottlieb at the University of Chicago, and Harry Buncke, in San Francisco, where he was first introduced to advanced microsurgical techniques and designer flap surgeries in 2001. More recently, Dr. Lee was asked to join the world-renowned team of Drs. Curtis Crane and Michael Safir, at the Crane Center in San Francisco, CA, where he works with fellow expert microsurgeons (Drs. David Chang, Gabriel Kind, and Brian Parrett). If you would like to discuss this surgery with Dr. Lee, please make an appointment at L Plastic Surgery in San Francisco, CA for a consultation.
"When you want work done to your body or face, you want to make sure you go to the right doctor. It took me years to finally choose one and I'm so glad I chose Dr. Lee. He is an amazing surgeon and I would definitely recommend him to anyone that wants any procedures done. It's been 5 weeks since I got breast augmentation and they're healing very well. The scars are very light and will get even lighter after time. He will give you his honest opinion about your suggestions and will make you look very natural. Most doctors just want your money and do whatever you want, but Dr. Lee cares about his reputation and that's why he gets so many referrals. I have a ton of friends who are going to him after seeing my breasts. I absolutely love them :)"- S.R. / Yelp / Jan 25, 2020
"Highly Recommend! - I wanted to get double eyelid surgery since I was young but never knew what the process was like or which surgeon to pick. None of my friends had the procedure done so I had to base my decision on online reviews. After spending months researching, I picked Dr. Lee because he had the best reviews and seemed the most competent during the consultation, and I’m so glad I did! The entire process went very smoothly, from the consultation, surgery itself, and follow ups. During the consultation, Dr. Lee took the time to understand exactly what I wanted my eyelids to look like. He and his staff clearly explained what I would expect during and after surgery, as well as how to take care of my eyelids. He also met with me at various stages post-surgery to make sure my eyelids were healing properly. As a result, I experienced minimal discomfort during recovery and am very happy with my results— my eyelids look very natural, just how I wanted them to be! Dr. Lee and his staff are professional, competent, and reassuring, and I wouldn’t hesitate to recommend him!"- S. / RealSelf / May 22, 2020
"Been shopping around for quite a while to look into getting an old tattoo removed. Spoke with a few places and decided to go with L Plastic Surgery as they are honest and realistic about how they treat these tattoos along with the cost behind it. After my consultation, which was free. I made an appointment to get the process started. The pain was not as bad as most people tend to describe it for myself at least. Definitely would recommend anyone looking into getting a tattoo removed to come here. Will be going to my second session this week."- H.T. / Yelp / May 12, 2020
"Amazing bedside manor and staff was just as kind. I was very nervous and Dr. Lee was so comforting. He heard my concerns since this was a revision and was very communicative. When I woke up from surgery he was right there and extremely empathetic. Lastly, I love my breast implant/lift. I would go to no one else. Did I mention he was referred to me. Thank you Dr. Lee and staff!!!"- A.H. / Yelp / Apr 22, 2020
"Experienced and professional - I am so pleased with my results! - I am so pleased with my results! I had Botox in my brow/crows feet area which turned out amazing, no bruising. I had a lift and implants placed 5 months ago and they look amazing! Highly recommend."- N. / RealSelf / Apr 20, 2020
Who qualifies for the surgery?
Phalloplasty may be needed to reconstruct a penis after a penile trauma, cancer removal surgery, and or female-to-male (FTM) gender reaffirmation surgery. To find out if you qualify for phalloplasty, we require our patients (age 18 or older) to have a consultation with Dr. Lee to discuss eligibility. He will discuss the risks and benefits of this surgery. If you are a patient who is transitioning from female-to-male and would like to this surgery. You may also discuss laser hair removal options, and other plastic surgeries to recontour your facial or body contours. We have a compassionate team of medical professionals that will help coordinate your care.
Dr. Lee's Surgical Technique
Every phalloplasty is a customized procedure designed for the patient's needs. This surgery is performed in a hospital under anesthesia and will require an inpatient stay for a few days post-procedure. Dr. Lee prefers to take the donor tissue from the forearm or thigh to reconstruct a penis, which may create a penis that is 5 – 8 inches in length. This type of reconstructive surgery can take eight hours or longer to perform. A RFF flap from the forearm is detached from the body, which means that the blood vessels and nerves have to be reattached. The ALT flap from the thigh or abdomen can eliminate the step for reconnection as the blood vessels and nerves are repositioned to make the penis without detachment. A penile implant or inflatable device may also be inserted into the flap to make the penis capable of erections.
Using his microsurgical skills, Dr. Lee will relocate the autologous tissue, and he will make sure that the nerves and blood vessels are intact. He will create a tube-within-a-tube technique to make the urethra, outer shaft, and glans. All of the details of this surgery will be discussed with you in full detail. All incisions will be made as inconspicuously as possible at the donor site and for the newly formed penis. Once the flap has been made, you will be taken to a recovery area where our post-op nursing team will carefully monitor your vital signs and blood flow to the new flap.
Recovery From Phalloplasty
Dr. Lee and his medical team will go over post-surgical instructions and make sure you have a follow-up appointment scheduled
You’ll have to remain in the hospital for 5 days after your procedure so you’ll be fully cared for and monitored as you heal.
For the week and a half after you return home, expect close supervision from your medical team to watch for any complications. If you had your urethra extended, you may need to wear a catheter for up to three weeks while you heal.
Good post-op care is critical following phalloplasty. You’ll have to wear supportive underwear, keep the neo-penis dry and elevated, and watch for any changes in color (such as the skin turning red or purple).
If you chose to get a donor graft from your forearm, you may need physical therapy to restore full function to your hand in the weeks following surgery.
Frequently Asked Questions
Are there other surgeries I can have as well as phalloplasty?
Dr. Lee will take the time to get to know you in your consultation and can make recommendations for your care after he meets you. Many patients do have more than one type of surgery no matter if it is for reconstructive after an accident, a removal because of cancer, or as a gender reaffirming surgery. At L Plastic Surgery, we want you to be a part of your treatment decisions and we will try to make recommendations that are your best interest for your health and safety.
Will I be able to have sex after phalloplasty?
Given that you have the type of phalloplasty that involves giving you the capability to have an erection (such as a penile implant or inflatable device), then you should be able to have penetrative sex. If you have a metoidplasty (a penis created with the clitoris), you would not have erections. With phalloplasty, you would be able to sense touch and temperature.
What can be done to optimize the donor site?
Dr. Lee performs the Integra + Skin Graft as a single stage procedure at the time of the phalloplasty. He has been perfecting this technique for over 10 years and has performed hundreds of improved donor site grafts to the radial forearm and ALT donor sites. In addition, Dr. Lee performs secondary procedures such as fat grafting and lasers to the donor sites for improved appearance and function. Please ask him about these techniques which will improve the function and aesthetics of the donor site.
Will I have extensive scarring?
Scars occur from a herediary factor (genetics and predisposition with darker skin), and surgical technique (tension at the suture line) .Dr. Lee will do everything he can to prevent excessive scarring but scars come with the complexity of the operation.
Discuss Your Designer Flap
If you are considering phalloplasty, we would like to offer you a consultation with our board-certified plastic and reconstructive surgeon, Dr. Lee. He is well-versed in the microsurgical technical skills that are needed for this surgery. If you would like to meet with him to discuss your surgical goals, please call our office in San Francisco, CA to schedule an appointment. If you have other doctors that Dr, Lee will need to work with in tandem for your treatment, he would be happy to assist with wrap-around services and care. Call today.