FTM Bottom Surgery
Dr. Keith has assembled a world-class team of health professionals to perform gender-affirming genital masculinizing surgery with the use of microsurgical technique. In addition to the expert surgeons of ECAPS, Dr. Keith routinely works with board-certified experts from urology and gynecology to safely perform these procedures. In 2018, Dr. Keith performed the first phalloplasty in the state of New Jersey.
Phalloplasty
A phalloplasty is a surgical procedure in which a male-anatomic appearing penis is constructed using autologous tissue (your own tissue from another part of your body). Phalloplasty is a multi-staged procedure, with the combination of stages taking place over at least one year. Each patient’s surgical plan is unique depending on their particular goals.
Phalloplasty Donor Sites:
- Radial forearm free flap phalloplasty (RFFF)
- Anterolateral thigh flap phalloplasty (ALT) – A flap is tissue, in this case skin and fat, taken with its own blood/nerve supply and transported to a different part of the body. This hyper-complex procedure is used to create a phallus while preserving erogenous sensation. Dr. Keith and his team will work to determine the best donor site for you. At your first consultation with us, we will examine both donor sites to determine your specific anatomy, as well as review each donor site option at length.
Stages of Phalloplasty
In order to perform surgery safely with the goal of achieving the best aesthetic and functional results with the least complications, phalloplasty is performed in various stages. Dr. Keith and his team will work with each patient individually to establish patient-specific goals, a surgical timeline as well as ongoing support as you move through this process. Below is an example of the various stages (remember, each patient’s surgical plan varies):
- Stage 1: Vaginectomy and hysterectomy (required if one of your goals is standing to urinate)
- A gynecologist will remove the vagina, as well as the uterus.
- Stage 2: Creation of the phallus, urethroplasty, and scrotoplasty
- During this stage, Dr. Keith creates the phallus using you chosen donor site, creates a neo-urethra (new urethra) inside that phallus, and creates a scrotum using your existing tissue.
- It is important to note that the neo-urethra (tubular structure within the phallus to eventually allow urine to exit from the bladder) takes time to heal. The new urethra is not connected to your native urethra until the next stage. While healing of the neo-urethra takes place, you will still urinate out of your existing, native urethra.
- Stage 3: Urethral hookup
- During this stage, our team works with a board-certified urologist to connect the new urethra in your phallus to your native urethra, in order for you to stand to urinate.
- Stage 4: Testicular implants and glansplasty
- Prosthetic saline-filled testicles placed into the scrotum
- A glansplasty is the surgical creation of the glans penis, creating the appearance of a circumcised penis
- Penile prosthesis
- This is typically the final stage of phalloplasty
- A prosthesis is placed inside the phallus in order to achieve the ability to have an erection and have penetrative intercourse with a partner
Hair Removal
If one of your goals is standing to urinate, hair removal from the donor site is critical prior to phalloplasty. Hair growth within your neo-urethra can lead to many complications, including stricture and fistula formation. Hair removal is typically performed through laser or electrolysis, and typically takes between 6-9 months to complete.
**We currently perform laser hair removal at our Manhattan office. If this location is not convenient for you, we will work with you to find a hair removal provider closer to home.
Postoperative Care
Phalloplasty is a rewarding but time-consuming commitment. Healing between each stage is very important and crucial to the success of the next stage. Frequent visits with our team as well as with the urologist are necessary throughout the process. Our entire office staff is well-educated to provide quality and individualized postoperative care
Metoidioplasty
A metoidioplasty is a surgical procedure in which your own, existing genital tissue is used to create a neo-phallus (new-penis). Special care is used to preserve erogenous sensation. This procedure can be performed with OR without urethral lengthening (urethral lengthening allows for the ability to eventually stand to urinate). It is important to note that the neo-phallus created during metoidioplasty typically cannot be used for penetrative intercourse. Metoidioplasty itself is a one-stage procedure, however, various additional procedures can be done either in conjunction with, before or after metoidioplasty, potentially making it a multi-stage process.
Optional Additional Procedures
- Scrotoplasty – The creation of the scrotal sac using the labia
- Placement of testicular Implants – Prosthetic saline-filled testicles placed into the scrotum
- Monsplasty – An incision is made across the lower abdomen to lift and tighten the mons pubis (tissue and skin covering the pelvic bone). This helps with the position of the neo-phallus and neo-scrotum.
