Gender-affirming surgery is easier and safer than in the past. While some of this has to do with less stigma around the procedure, other factors include the ability to find specialists who are qualified to perform this game-changing technique known as a phalloplasty.
Genitourinary surgery takes an experienced, compassionate, and, sometimes, creative hand. Finding a surgeon who is very familiar with phalloplasty and with other types of genital surgery is paramount to your success.
But, so is knowing the truth about phalloplasty. Rumors and misconceptions abound in this still mysterious area of plastic surgery.
When seeking phalloplasty, you’ll want to know what’s true and what isn’t about this amazing and intricate surgery.
Here are some of the most common misconceptions about phalloplasty and the real truth behind each.
Myth #1: There Is Only One Type of “Bottom Surgery”
People who have vaguely heard of phalloplasty, or those who are in the very beginning stages of seeking this technique, may have heard that female-to-male “bottom surgery” involves taking skin from “somewhere” and replacing it where it needs to be to form a phallus.
However, there are two major types of bottom surgery, and they’re very different.
Phalloplasty
Phalloplasty — the subject of our article — is the creation of a neophallus (new penis) using skin grafts from a different part of the body.
Typically, either skin from the forearm or abdomen is used. The skin is trimmed and shaped to resemble a natural penis, then fitted into the area. Later surgeries involve a neourethra and possibly an implant.
Metoidioplasty
Metoidioplasty is different. With this procedure, the clitoris is first hormonally enlarged. When the clitoris is ready, the ligaments are detached to allow it to hang lower, giving it a bit more length.
The result is a reasonably realistic-looking phallus, but smaller-than-average penis, at about five to seven centimeters (a little under three inches) in length.
Myth #2: Phalloplasty Costs Much More in Some Areas of the Country
Phalloplasty is not a cheap surgery. Luckily, many urogenital plastic surgery specialists offer payment plans for phalloplasty.
Some areas of the country may be more expensive than others overall, but the cost of genitourinary reconstruction in Los Angeles may or may not be considerably more than the same procedure in, say, New York or Atlanta. It’s not just different locales but different doctors and your own personal needs that determine what your phalloplasty will cost.
Make sure to ask your plastic surgeon to be clear about what your total costs will be, including the surgery itself, anesthesia fees, post-operative bandages and checkups, and additional surgeries you will need to complete your phalloplasty.
Myth #3: The Only Reason to Have Phalloplasty Is for Gender Confirmation Surgery
Gender confirmation is the most common reason for a phalloplasty procedure, so part of the myth is true. However, there are other reasons one might need a penis reconstructed or entirely created. Accidents, genetic conditions, or cancer are three primary reasons for non-gender-affirming phalloplasty surgery.
Myth #4: You Will Lose All Sensation in the Area After Surgery
This is untrue. While the risk is there, as with any surgery that cuts through nerves and muscle, most phalloplasty patients report anywhere from mild to total return of sensation during the first year following their surgery.
Ejaculation may also be possible. While the fluid is not semen, some phalloplasty patients have this reaction upon orgasm after they’ve healed from their surgery.
Myth #5: Your Penis Will Look Strange or “Unnatural”
Phalloplasty has come a long way. Today’s techniques allow for a more realistic-looking result than ever before.
While the total size of your new penis may be limited by various factors, a skilled urogenital plastic surgeon can shape your phallus to look as natural as possible.
Myth #6: You Can Have Your Phalloplasty Completed in One Surgery
Phalloplasty involves several surgeries. You will need to spend several weeks healing between each one.
Besides the creation of a new phallus, you may need urethral lengthening so that you may urinate naturally while standing. You may also want an implant so that intercourse is easier.
Make sure you sit down and talk with your surgeon to ask exactly how long the process will take and what type of help you may need in the home while healing from each successive surgery.
Myth #7: If You Have Phalloplasty, You Won’t Need to Take Testosterone Anymore
Most phalloplasty patients assigned female at birth have had, or plan to have, an oophorectomy (removal of the ovaries). This reduces the amount of estrogen you have in your body, though both men’s and women’s bodies have some estrogen naturally.
Having a phalloplasty doesn’t mean you no longer have to take testosterone or other hormones. Generally, transgender men will need to take hormones for their lifetime.
Make sure to check in with your doctor frequently for updates to the hormones you take, and be sure that you follow your surgeon’s pre- and post-surgery directions exactly. This will ensure the most satisfying and affirming outcome possible for you.
