Phalloplasty is a surgical procedure to construct a penis. It’s often a key part of gender affirmation surgery for trans men and nonbinary people.
But what if you already have a phallus and you want to make it smaller? That’s where reduction phalloplasty comes in. This surgery reduces the size of a phallus, whether it’s one that was created in a previous surgery or one that was naturally present from birth. The goal might be to improve size, function, or overall appearance.
In this article, we’ll explore the different surgical techniques for a reduction phalloplasty, the risks and potential complications of the procedure, and some of the alternative procedures you might consider.
Understanding the Need for Reduction Phalloplasty
People pursue reduction phalloplasty for various reasons. Some experience pain or discomfort because of the size or weight of their phallus. Others find that their size limits their daily activities. Some people simply aren’t happy with how it looks.
In some cases, reduction phalloplasty is needed to correct complications from a previous phalloplasty.
Phallus size can also have a significant psychological impact. Concerns about body image can affect self-esteem and confidence, and size can also impact sexual function and satisfaction.
Because everyone’s needs are different, it’s important that the surgical plan is tailored to the individual. Open and honest communication with the surgical team is essential for achieving the best possible outcome and ensuring patient satisfaction.
Surgical Techniques for Reduction Phalloplasty
If you’re considering a reduction phalloplasty, it’s helpful to understand the types of techniques a surgeon might use. These methods aim to reduce size, improve contour, and create a more natural appearance.
Resection and Reconstruction
Resection and reconstruction involve surgically removing excess tissue and reshaping the remaining tissue. This is often done to reduce overall size while carefully preserving blood supply and nerve function. The surgeon may also revise existing skin flaps used in the initial phalloplasty to address issues like excessive skin bulk or uneven contours.
- Direct tissue excision: Surgical removal of excess tissue to reduce overall size.
- Skin flap revision: Adjusting or reducing the size of existing skin flaps.
Liposuction
Liposuction is another technique used to remove excess fat from the phallus, helping to create a more refined and proportionate appearance. However, skin elasticity is a key consideration. The surgeon will evaluate your skin’s ability to retract properly after liposuction. In some cases, additional skin-tightening procedures might be necessary to achieve the desired result.
- Fat removal for contouring: Using liposuction to remove excess fat.
- Considerations for skin elasticity: Evaluating skin elasticity to ensure proper retraction.
Grafting
In some cases, surgeons use skin grafts to reshape the phallus and reduce its size and bulk. This technique involves removing skin grafts to achieve the desired contour and proportion.
Risks and Complications of Reduction Phalloplasty
Like any surgical procedure, reduction phalloplasty comes with potential risks. It’s important to discuss these with your surgeon to have a clear understanding before proceeding.
General Surgical Risks
- Infection: Post-operative wound infections can happen and might need antibiotics or even another surgery.
- Bleeding and hematoma: Blood can collect under the skin (hematoma) and may need to be drained.
- Scarring: Sometimes, scars can become thick and raised (hypertrophic) or develop into keloids. These may need further treatment. Keep in mind that keloids often come back (at least 70% of the time) after a simple excision.
- Anesthesia complications: There are risks associated with general anesthesia, like allergic reactions or breathing problems.
Specific Complications Related to Phalloplasty
- Flap-related issues: In procedures that involve tissue flaps, there’s a risk of partial or complete flap loss due to blood supply issues. Wound breakdown and delayed healing can also occur.
- Urethral complications: Urethral strictures (narrowing of the urethra) can develop, making it hard to urinate. Fistulas (abnormal connections between the urethra and skin) can also form.
- Sensory changes: You might experience altered sensation, like numbness or increased sensitivity. There’s also a risk of nerve damage during the surgery.
- Erectile dysfunction: It can be difficult to get or maintain an erection, especially if an implant is involved. Implants themselves can also lead to complications like infection or erosion.
Addressing Urethral Complications
Urethral complications are a possibility after reduction phalloplasty. Here’s a look at two potential issues and how they can be managed:
Urethral Strictures
This refers to a narrowing of the urethra, which can make it difficult to urinate. These typically show up about 6-12 months after the surgery.
Fistulas
A fistula is an abnormal connection that forms between the urethra and the skin. It usually requires surgical repair.
Management Strategies
There are a few options for dealing with these complications:
- Dilation procedures: These are used to widen the urethra.
- Surgical reconstruction: This involves surgically rebuilding the urethra.
Erectile Implants and Reduction Phalloplasty
If you are considering a reduction phalloplasty and are also interested in an erectile implant, there are a few things to consider. Surgeons need to make sure there’s enough tissue to properly cover the implant. You also may need to have the implant revised or even replaced down the road.
There are two main types of erectile implants:
- Inflatable implants are filled with saline and can be inflated or deflated on demand.
- Malleable implants are bendable rods that are always firm.
Like all surgeries, there are risks associated with getting an implant. These include:
- Infection
- Erosion
- Mechanical failure
Post-operative Care and Recovery
The period immediately after surgery involves several key elements:
- Pain management: Your surgical team will work with you to manage any post-operative pain, potentially including topical treatments. It’s important to be aware of potential EMLA cream side effects or other medications used for pain management.
- Wound care: Keeping the surgical site clean and properly cared for is essential for healing.
- Monitoring for complications: You’ll be closely watched for any signs of infection or other complications.
Long-term follow-up is also crucial. This includes:
- Regular check-ups: Staying in touch with your surgical team for routine evaluations.
- Addressing concerns: Promptly reporting and managing any issues that may arise during your recovery.
Physical therapy and rehabilitation may also play a role in your recovery, with a focus on:
- Exercises: Specific exercises designed to improve strength, flexibility, and sensation.
- Scar management: Techniques to minimize scarring and promote optimal healing.
What about metoidioplasty?
Metoidioplasty is another surgical option for transmasculine individuals seeking genital reconstruction. In this procedure, a phallus is created using existing tissues. It’s often considered less invasive than phalloplasty, making it an appealing alternative for some.
Compared to phalloplasty, metoidioplasty has some advantages. It avoids the potential complications associated with flap procedures (where tissue is transferred from another part of the body). However, the resulting phallus may be smaller. This is important to consider, as some clients find the size achieved through metoidioplasty more suitable for their goals.
If you’re primarily seeking a reduction in size, metoidioplasty might be a better option than phalloplasty, but you should discuss your goals with a surgeon.
Frequently Asked Questions
What are the downsides of phalloplasty?
Like any major surgery, phalloplasty carries potential downsides. These can include complications like infection, graft failure, urethral stricture, and sensory issues. There’s also the emotional and psychological adjustment to consider post-surgery, as well as the lengthy recovery period.
What is the failure rate of phalloplasty?
The failure rate of phalloplasty varies depending on the specific technique used and the surgeon’s experience. However, complications are not uncommon, and revisions may be necessary. Graft failure, where the transferred tissue doesn’t survive, is a significant concern, but advancements in surgical techniques have helped lower the risk.
What is the age limit for phalloplasty?
There isn’t a strict age limit for phalloplasty. However, surgeons typically prefer patients to be at least 18 years old to ensure they’ve reached physical maturity and can fully understand the implications of the surgery. For younger individuals, parental consent and a thorough psychological evaluation are usually required.
Do people regret phalloplasty?
While most individuals who undergo phalloplasty report high satisfaction rates, regret is possible. It’s crucial to have realistic expectations and a strong support system before proceeding with surgery. Thoroughly researching the procedure, consulting with multiple surgeons, and addressing any psychological concerns beforehand can help minimize the risk of regret.
Can you pee through a phalloplasty?
One of the goals of phalloplasty is to create a functional penis that allows for urination while standing. However, achieving this can be challenging, and urethral complications are relatively common. Some individuals may require additional procedures to correct any issues and ensure proper urinary function.
In Conclusion
Reduction phalloplasty is a complicated surgery with potential benefits and risks. To achieve the best results, surgeons must carefully choose patients and create a detailed surgical plan.
It’s important for patients to understand the procedure and have realistic expectations. They should be fully aware of all the possible risks and complications. Talking openly with the surgical team is key to a successful outcome.