Radial Forearm (RF) and Anterolateral Thigh (ALT) Phalloplasty Reconstruction

Abstract

Gender affirmation phalloplasty comprises one of the most complex reconstructive challenges in the modern era. Unlike cancer or trauma reconstruction, phalloplasty reconstruction does not replace “like with like, " but instead requires construction of an entirely new organ with significant aesthetic and functional demands. Although numerous donor sites and flap designs have been proposed, the radial forearm flap and anterolateral thigh flap designs currently remain the most popular, providing the best balance between donor site morbidity and phalloplasty aesthetics while allowing standing micturition, penetrative intercourse after implant placement, and erogenous neurotization. Due to the life-changing nature of phalloplasty reconstruction, careful planning and meticulous surgical technique are essential to minimize postoperative complications and optimize outcomes. Subtle nuances can determine success versus complete flap loss. This chapter describes key points in patient selection, surgical planning and execution, and postoperative care.