Options and Indications in Gender-Affirming Phalloplasty.

Phalloplasty, once guided only by binary ideals, has evolved into a patient-centered, individualized surgical process for transmasculine individuals seeking gender-affirming surgery. Modern approaches recognize that not all patients desire a comprehensive reconstruction; many opt for variations based on personal goals and risk profiles. Consultation involves thorough assessment of anatomy, expectations, and donor site suitability. Techniques include staged approaches to urethral lengthening, shaft-only phalloplasty alternatives and diverse donor site options. Composite phalloplasty techniques are reserved for select patients with specific anatomic constraints. Shared decision-making is essential at all points in care to address diverse outcome goals and minimize complications.