Phalloplasty in San Francisco, CA

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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.

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.

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