Phalloplasty

Phalloplasty is considered the most significant surgical procedure in the masculinization process of the genitals. Dr. Brassard has been performing this surgery for over 20 years and, over this time, has improved and developed the technique by significantly reducing the risks and complications and, above all, by producing new genitals much more similar to biological male genitalia on both a functional and aesthetic level.

Dr. Brassard has been performing this surgery for over 20 years and, over this time, has improved and developed the technique by significantly reducing the risks and complications and, above all, by producing new genitals much more similar to biological male genitalia on both a functional and aesthetic level.

Phalloplasty mainly involves removing a flap of skin from a region of the body to create the phallus. The skin flap may be taken from the forearm. The surgical technique currently recommended by the team at GRS Montréal is phalloplasty by forearm free flap. This technique can achieve more realistic results, both physically and functionally, including the ability to urinate standing up.  

Phalloplasty – Forearm skin flap

Expected and desired results:

  • Complete creation of the external male genitalia including a medium-sized phallus, a glans, and a scrotum;
  • Construction of a penile urethra, allowing you to urinate standing up;
  • Possibility of sexual relations with penetration following insertion of the penile implant, as well as erogenous zones with the possibility of sexual pleasure and orgasm.

*Due to multiple factors that are unique to each individual, results may vary from one person to another. Be assured that our surgical team works with each patient individually to achieve the best results possible. To date, it is very rare for a patient to lose all ability to achieve orgasm. Nerve recovery depends on age, lifestyle, and the patient’s overall health.    

The surgical technique:

To complete masculinization of the genitals, 3-4 surgeries spanning a period of 1-2 years are required:

  1. Phalloplasty: includes the creation of the phallus, the glans, the scrotum, and the closure of the vaginal cavity
  2. Construction of the urethra: depending on the patient’s anatomy, your surgeon will be able to inform you when it will be performed. If it is performed at the same time then the first stage surgery, the complete phalloplasty may then comprise 2 surgeries rather than 3;
  3. Insertion of the testicular implant;
  4. Insertion of the penile implant.

*3. and 4. May be performed during the same surgical procedure for some patients.  

First stage surgery - Phalloplasty:

  1. A skin flap is taken using the entire thickness (skin, nerves, vein, and artery) of the forearm of the non-dominant arm in order to form the phallus (forearm free flap);
  2. Skin is taken from the side of the thigh, which is then grafted to the donor forearm. *Once the thigh wound has healed, it is possible that the dermis of the new skin will be slightly discoloured;
  3. Construction of the glans;
  4. Closure of the vaginal cavity;
  5. Creation of the scrotum using the skin of the labia majora;
  6. Burial of the clitoris at the base of the phallus;
  7. Lengthening of the biological urethra to the base of the new penile urethra (peno-scrotal urethra);
  8. Positioning of the phallus, connection of the vascular and nervous networks: a clitoral nerve and a genito-femoral nerve is connected to the nerves of the forearm flap (phallus);
  9. **Connection of the peno-scrotal urethra to the penile urethra: Only if indicated by the surgeon to construct the urethra during the initial surgery. Otherwise, will be performed during the Construction of the urethra procedure;
  10. Attachment of the phallus.
Required before surgery: 
  1. Hysterectomy including removal of the cervix must be performed at least 6 months before phalloplasty surgery. 
  2. Permanent hair removal in the area of the arm to be used for construction of the phallus is required before surgery. Treatments can be made by laser or electrolysis and must be completed before surgery. No regrowth of hair should be observed on arm before surgery. 
  3. Smokers are not candidates for phalloplasty. If you smoke, you must stop using tobacco and products derived from tobacco at least 6 months before and after surgery.

Postoperative care:

During your convalescence, you will be provided with the document Information and Postoperative Care – Phalloplasty. This document contains your surgeon’s instructions and will serve as a guide.

Download the document Information and Postoperative Care – Phalloplasty.

 

The surgical procedure, your stay and convalescence

Average length of the surgery

Admission to the CMC

Anesthesia

Hospitalization

Convalescence at Asclépiade

Convalescence at home

Return to physical activities and sports

6.5 hours The day of the surgery General

3 nights postoperatively

7 nights postoperatively 6 to 8 weeks 3 months
Medical follow-ups and appointments: Asclépiade provides personalized postoperative follow-ups to all patients. You will be getting a follow-up appointment with your surgeon one month after your surgery. If you cannot come to your appointment, your attending physician can follow-up with our surgeons by contacting the Asclépiade.