Phalloplasty using radial forearm osteocutaneous free flaps in female-to-male transsexuals.

Gender reassignment operations in female-to-male transsexuals are increasing in number as the skill of phalloplasty develops. The authors are performing phalloplasty 1 year after undergoing mastectomy, reduction of nipples, oophrectomy and hysterectomy in female-to-male transsexuals. The ideal penile reconstruction should be a single-stage procedure, creating a phallus with both tactile and erogenous sensibility, water-tight neourethra allowing for voiding in the standing position, enough bulk with stiffness, and an aesthetically acceptable appearance. We performed phalloplasty with radial forearm osteocutaneous free flaps on 40 female-to-male transsexual patients from March 1991 to December 2005. We investigated the results with regard to aesthetic and functional status and complications through physical examinations and interviews over a period of 14 years. The results are as follows: In conclusion, we have been able to construct a good phallus with radial forearm osteocutaneous free flaps that is aesthetically and functionally acceptable. In addition, complications have been minimal.