Phalloplasty is a complex surgery to create a penis, also known as a neophallus. It’s most often performed as gender-affirming surgery for transgender men. It’s also done for cisgender men who’ve experienced trauma or disease that impacts their penis.
Since 1946, surgical methods for phalloplasty have been improving. As acceptance of gender affirmation surgery has grown, so has the demand for phalloplasty.
Phalloplasty is a high-risk, high-reward procedure. As with any surgery, complications are possible. Although rare, death is among the potential complications. It’s important to understand the risks involved before pursuing this surgery.
This article explores the potential complications of phalloplasty, including the phalloplasty death rate. We’ll also look at ways to lower your risk and what to expect during recovery.
Defining Mortality in the Context of Phalloplasty
Death after phalloplasty, while possible, is extremely rare. It’s more important to understand the factors that could contribute to a fatal outcome than to fixate on a specific “phalloplasty death rate.” Reliable data on this is tough to come by, as reporting methods vary, and data collection isn’t always standardized.
Fatal outcomes are typically linked to complications stemming from the surgery itself, the anesthesia used, or pre-existing health conditions a patient may have. The risk is multifactorial.
Instead of chasing elusive mortality rates, we’ll focus on the types of complications that can arise and what factors might contribute to them.
Surgical Techniques and Associated Risks
Phalloplasty is a complex surgery, and it’s important to understand the different surgical methods and their potential risks.
Overview of Common Phalloplasty Techniques
Several techniques exist for creating a neophallus (new penis). The most common include:
- Radial Forearm Free Flap (RFFF): This method uses skin and tissue from the forearm to construct the neophallus.
- Anterolateral Thigh Flap (ALT): This technique uses tissue from the thigh.
- Groin Flap and Fibula Flap: These are less common methods that utilize tissue from the groin or fibula (lower leg bone), respectively.
Risk Profiles of Different Techniques
Each phalloplasty technique carries its own set of risks and potential complications. It’s crucial to have a thorough discussion with your surgeon about these risks before making a decision.
One common complication is the development of fistulas (abnormal connections between two body parts). Different flap types have varying fistula rates. For example, suprapubic abdominal flaps have a high fistula rate of around 55%. RFFF has reported fistula rates ranging from 22% to 68%. On the other hand, pedicled flaps, such as ALT and extended pedicle groin flaps, have the lowest reported fistula rates, typically less than 10%.
Partial or total neophallus loss is another potential risk, although it’s relatively rare. Studies have shown that partial or total neophallus loss occurred in about 7.8% of pALT (pedicled ALT) procedures and 3.4% of RFFF procedures.
Common Complications and Their Potential Severity
As with any major surgical procedure, phalloplasty carries the risk of complications. It’s important to understand these potential issues, both early and long-term, to make an informed decision and be prepared for the recovery process.
Early Complications
In the immediate post-operative period, wound breakdown, infection, and flap necrosis (tissue death) are primary concerns. Wound breakdown and infection are relatively common, and partial necrosis and flap loss can occur in as many as 18% of patients within the first 72 hours. Early detection and management of these complications are crucial to prevent more serious problems and ensure the best possible outcome.
Urethral Complications
Urethral complications, particularly strictures (narrowing of the urethra) and fistulas (abnormal connections between the urethra and other tissues), are significant risks associated with phalloplasty. Studies show that the overall urethral complication rate for radial forearm free flap (RFFF) phalloplasty is around 31.5%, while the rate for anterolateral thigh (pALT) phalloplasty is approximately 32.8%. Corrective surgery, often in the form of staged urethroplasty (surgical repair of the urethra), may be necessary. However, staged urethroplasty can carry more complications than primary urethroplasty.
Long-Term Complications
Long-term complications can also arise after phalloplasty. Post-void incontinence (leakage of urine after urination) is reported in a significant number of patients, with some studies suggesting it affects around 79% of individuals. Tissue distortion and wound contracture can also occur over time, potentially affecting the appearance and function of the neophallus. Finally, hypertrophic scars (thickened, raised scars) and keloid scars (scars that grow beyond the boundaries of the original wound) can develop, requiring further treatment.
Anesthesia and Systemic Risks
Any surgery that requires anesthesia carries risks, albeit small ones. Complications from anesthesia can, in very rare cases, contribute to mortality. A thorough pre-operative evaluation is key to spotting and managing any pre-existing conditions that might increase risk during surgery.
There are also potential systemic complications that can occur, such as blood clots, pulmonary embolisms (when a blood clot travels to the lungs), or cardiac events. Skilled anesthesiologists and careful monitoring during and after the procedure are essential to minimizing these risks.
While the phalloplasty death rate is low, it’s crucial to understand that no surgery is entirely without risk. A candid discussion with your surgical team about all potential complications is a must before proceeding.
Patient Factors and Surgeon Expertise
It’s important to remember that the overall success of phalloplasty, and the risk of complications, isn’t just about the procedure itself. Patient health and lifestyle choices play a significant role. For example, smoking and obesity can increase the risk of complications after any surgery, including phalloplasty.
Surgeon experience and expertise also matter. A surgeon who performs phalloplasty frequently is likely to have a lower complication rate than one who performs it rarely. It’s worth asking potential surgeons about their experience and complication rates, and it’s also important to research extended metoidioplasty surgeons, though remember that self-reported statistics can sometimes be less accurate. The field needs more standardized reporting to give patients the clearest picture.
Frequently Asked Questions
Can phalloplasty go wrong?
As with any surgery, phalloplasty carries potential risks, including complications like infection, graft failure, urethral stricture, and sensory issues. While surgeons take precautions to minimize these risks, they can occur. It’s important to have a thorough discussion with your surgical team about potential complications and their management.
How long does it take for a penis to “grow” via phalloplasty?
Phalloplasty doesn’t involve actual growth, but rather the creation of a penis using tissue from another part of the body. The initial construction happens during the surgery itself. Further procedures, like erectile device implantation, may be performed later, but the foundational structure is created in the primary operation.
How do you pee after phalloplasty?
One of the goals of phalloplasty is to create a functional urethra, allowing the individual to stand to urinate. However, this may require multiple stages and can be subject to complications. Initially, a catheter is used. Once the urethra is healed and functional, the catheter is removed, and the individual should be able to urinate through the newly created urethra.
Can MTF individuals feel pleasure after bottom surgery (vaginoplasty)?
This FAQ is not relevant to phalloplasty (a procedure for creating a penis, typically for transmasculine individuals). However, for those seeking information about sensation after vaginoplasty, the answer is yes, many MTF individuals experience pleasure after vaginoplasty. Surgeons take great care to preserve nerve function, allowing for the potential for both erogenous and tactile sensation.
How long does phalloplasty take to heal?
Healing from phalloplasty is a lengthy process, often taking 12-18 months for complete recovery. There are multiple stages involved, and each stage requires its own healing period. Factors like individual health, adherence to post-operative instructions, and the specific techniques used can all impact the healing timeline.
Conclusion
While death is rare following phalloplasty, it’s crucial to take every possible step to manage the risks involved.
The best approach is to select patients with care, use the most precise surgical techniques available, and act quickly if complications arise.
Surgical techniques are constantly improving, with the goal of further reducing the rate of complications.
It’s important for people considering phalloplasty to talk openly with their surgeons about the potential risks and benefits of the procedure. The better informed you are, the more confident you’ll be in your decisions about your health and your body.