![Page 1: FOREARM PHALLOPLASTY FOR FEMALE TO MALE ......TODAY’S FORMAT This is a “12 hour surgery” (Three surgeon working for 6-8 hours each with breaks) which doesn’t lend it easily](https://reader033.vdocuments.us/reader033/viewer/2022042309/5ed6101849af592c00577696/html5/thumbnails/1.jpg)
FOREARM PHALLOPLASTY FOR FEMALE TO MALE GENDER CONFIRMATION SURGERYRichard A. Santucci, MD, FACS, HON FC Urol(SA)
Crane Surgical Services-Austin
![Page 2: FOREARM PHALLOPLASTY FOR FEMALE TO MALE ......TODAY’S FORMAT This is a “12 hour surgery” (Three surgeon working for 6-8 hours each with breaks) which doesn’t lend it easily](https://reader033.vdocuments.us/reader033/viewer/2022042309/5ed6101849af592c00577696/html5/thumbnails/2.jpg)
BRIEF INTROI am a reconstructive urologist (18 years) who has decided to devote the rest of my career to the “Mount Everest” of transgender surgery.Newest member Crane Surgical Services (Austin).Formerly full professor and reconstructive urology Fellowship director at the Detroit Medical Center and newly (re)minted Texan.
Santucci 2019
2
![Page 3: FOREARM PHALLOPLASTY FOR FEMALE TO MALE ......TODAY’S FORMAT This is a “12 hour surgery” (Three surgeon working for 6-8 hours each with breaks) which doesn’t lend it easily](https://reader033.vdocuments.us/reader033/viewer/2022042309/5ed6101849af592c00577696/html5/thumbnails/3.jpg)
TODAY’S FORMATThis is a “12 hour surgery” (Three surgeon working for 6-8 hours each with breaks) which doesn’t lend it easily to a 20 minute video. Todays talk will summarize with slides then present necessarily too short video after.
thanks
Santucci 2019
3
![Page 4: FOREARM PHALLOPLASTY FOR FEMALE TO MALE ......TODAY’S FORMAT This is a “12 hour surgery” (Three surgeon working for 6-8 hours each with breaks) which doesn’t lend it easily](https://reader033.vdocuments.us/reader033/viewer/2022042309/5ed6101849af592c00577696/html5/thumbnails/4.jpg)
� Step 1: WPATH (World Professional Association for Transgender Health) appropriate clearance for gender confirmation surgery� Persistent, well-documented gender
dysphoria
� Capacity to make a fully informed decision and to consent for treatment
� Be of the age of majority in the country of surgery
� Significant medical or mental health concerns, if present, must be reasonably well controlled at the time of surgery
Santucci 2019
4
![Page 5: FOREARM PHALLOPLASTY FOR FEMALE TO MALE ......TODAY’S FORMAT This is a “12 hour surgery” (Three surgeon working for 6-8 hours each with breaks) which doesn’t lend it easily](https://reader033.vdocuments.us/reader033/viewer/2022042309/5ed6101849af592c00577696/html5/thumbnails/5.jpg)
� Step 2: (Generally) � Mastectomy/chest gender confirmation
surgery first
� Then (Usually minimally invasive) hysterectomy
� Depilitate the nondominant arm or donor leg
Santucci 2019
5
![Page 6: FOREARM PHALLOPLASTY FOR FEMALE TO MALE ......TODAY’S FORMAT This is a “12 hour surgery” (Three surgeon working for 6-8 hours each with breaks) which doesn’t lend it easily](https://reader033.vdocuments.us/reader033/viewer/2022042309/5ed6101849af592c00577696/html5/thumbnails/6.jpg)
INCIDENCE OF TRANSGENDERISMProbably not truly knownEstimates of up to 1/200 Americans : 1.6 millionPerhaps 25% of transgender men want surgery: maybe 1/100 have bottom surgeryPerhaps 50% of transgender women want surgery: up to 30% get bottom surgery
205,850 people (0.66%) in 18-24 age range967,1000 (0.58%) in 25-64 age range
Santucci 2019
6
![Page 7: FOREARM PHALLOPLASTY FOR FEMALE TO MALE ......TODAY’S FORMAT This is a “12 hour surgery” (Three surgeon working for 6-8 hours each with breaks) which doesn’t lend it easily](https://reader033.vdocuments.us/reader033/viewer/2022042309/5ed6101849af592c00577696/html5/thumbnails/7.jpg)
OUR PRACTICE HAD DONE OVER 600 PHALLOPLASTIES
IN ONE YEAR 2018 OUR PRACTICE DID:Phalloplasty- 108 Vaginoplasty-139
Top surgery-124
Penile Implants (in phalloplasty patients)-46
Metoidioplasty-24
Santucci 2019
7
![Page 8: FOREARM PHALLOPLASTY FOR FEMALE TO MALE ......TODAY’S FORMAT This is a “12 hour surgery” (Three surgeon working for 6-8 hours each with breaks) which doesn’t lend it easily](https://reader033.vdocuments.us/reader033/viewer/2022042309/5ed6101849af592c00577696/html5/thumbnails/8.jpg)
STEP 3: MARK THE ARM
Santucci 2019
8
![Page 9: FOREARM PHALLOPLASTY FOR FEMALE TO MALE ......TODAY’S FORMAT This is a “12 hour surgery” (Three surgeon working for 6-8 hours each with breaks) which doesn’t lend it easily](https://reader033.vdocuments.us/reader033/viewer/2022042309/5ed6101849af592c00577696/html5/thumbnails/9.jpg)
STEP 4: INCISE THE ARM, CREATING URETHAL, PENILE, AND CORONOPLASTYDOONR PORTIONS AND PRESERVING NERVE, VEIN AND ARTERY. TAKES HOURS Santucci 2019
9
![Page 10: FOREARM PHALLOPLASTY FOR FEMALE TO MALE ......TODAY’S FORMAT This is a “12 hour surgery” (Three surgeon working for 6-8 hours each with breaks) which doesn’t lend it easily](https://reader033.vdocuments.us/reader033/viewer/2022042309/5ed6101849af592c00577696/html5/thumbnails/10.jpg)
STEP 5: TUBULARIZE THE URETHRA/PENIS, CREATE CORONASantucci 2019
10
![Page 11: FOREARM PHALLOPLASTY FOR FEMALE TO MALE ......TODAY’S FORMAT This is a “12 hour surgery” (Three surgeon working for 6-8 hours each with breaks) which doesn’t lend it easily](https://reader033.vdocuments.us/reader033/viewer/2022042309/5ed6101849af592c00577696/html5/thumbnails/11.jpg)
STEP 6: CLOSE THE ARM WITH LOCAL TISSUE FLAPS AND THIGH STSG. COVER WITH WOUND VAC.Santucci 2019
11
![Page 12: FOREARM PHALLOPLASTY FOR FEMALE TO MALE ......TODAY’S FORMAT This is a “12 hour surgery” (Three surgeon working for 6-8 hours each with breaks) which doesn’t lend it easily](https://reader033.vdocuments.us/reader033/viewer/2022042309/5ed6101849af592c00577696/html5/thumbnails/12.jpg)
STEP 7: (BUT SIMULTANEOUS) VAGINECTOMYSantucci 2019
12
![Page 13: FOREARM PHALLOPLASTY FOR FEMALE TO MALE ......TODAY’S FORMAT This is a “12 hour surgery” (Three surgeon working for 6-8 hours each with breaks) which doesn’t lend it easily](https://reader033.vdocuments.us/reader033/viewer/2022042309/5ed6101849af592c00577696/html5/thumbnails/13.jpg)
STEP 8: FREE UP THE CLITORIS, URETHRAL LENGTHENINGSantucci 2019
13
![Page 14: FOREARM PHALLOPLASTY FOR FEMALE TO MALE ......TODAY’S FORMAT This is a “12 hour surgery” (Three surgeon working for 6-8 hours each with breaks) which doesn’t lend it easily](https://reader033.vdocuments.us/reader033/viewer/2022042309/5ed6101849af592c00577696/html5/thumbnails/14.jpg)
STEP 9: CLITORAL REDUCTION AND CREATION OF NEOPALLUS BASE Santucci 2019
14
![Page 15: FOREARM PHALLOPLASTY FOR FEMALE TO MALE ......TODAY’S FORMAT This is a “12 hour surgery” (Three surgeon working for 6-8 hours each with breaks) which doesn’t lend it easily](https://reader033.vdocuments.us/reader033/viewer/2022042309/5ed6101849af592c00577696/html5/thumbnails/15.jpg)
STEP 10: FIND AND EXPOSE A CLITORAL NERVESantucci 2019
15
![Page 16: FOREARM PHALLOPLASTY FOR FEMALE TO MALE ......TODAY’S FORMAT This is a “12 hour surgery” (Three surgeon working for 6-8 hours each with breaks) which doesn’t lend it easily](https://reader033.vdocuments.us/reader033/viewer/2022042309/5ed6101849af592c00577696/html5/thumbnails/16.jpg)
STEP 11: CREATE NEOSCROTUM
Santucci 2019
16
![Page 17: FOREARM PHALLOPLASTY FOR FEMALE TO MALE ......TODAY’S FORMAT This is a “12 hour surgery” (Three surgeon working for 6-8 hours each with breaks) which doesn’t lend it easily](https://reader033.vdocuments.us/reader033/viewer/2022042309/5ed6101849af592c00577696/html5/thumbnails/17.jpg)
STEP 12: MICROVASCULAR ANASTOMOSIS OF ARTERY/VEIN. CONNECT NERVE
Santucci 2019
17
![Page 18: FOREARM PHALLOPLASTY FOR FEMALE TO MALE ......TODAY’S FORMAT This is a “12 hour surgery” (Three surgeon working for 6-8 hours each with breaks) which doesn’t lend it easily](https://reader033.vdocuments.us/reader033/viewer/2022042309/5ed6101849af592c00577696/html5/thumbnails/18.jpg)
Voila
Santucci 2019
18
![Page 19: FOREARM PHALLOPLASTY FOR FEMALE TO MALE ......TODAY’S FORMAT This is a “12 hour surgery” (Three surgeon working for 6-8 hours each with breaks) which doesn’t lend it easily](https://reader033.vdocuments.us/reader033/viewer/2022042309/5ed6101849af592c00577696/html5/thumbnails/19.jpg)
QUICK INTRO TO ALTERNATE METHOD: ANTERIOLATERAL THIGH FLAP PHALLOPLASTY (ALT=“LEG”)Santucci 2019
19
![Page 20: FOREARM PHALLOPLASTY FOR FEMALE TO MALE ......TODAY’S FORMAT This is a “12 hour surgery” (Three surgeon working for 6-8 hours each with breaks) which doesn’t lend it easily](https://reader033.vdocuments.us/reader033/viewer/2022042309/5ed6101849af592c00577696/html5/thumbnails/20.jpg)
ALT
MarkMake urethra
Santucci 2019
20
Free up pedicle
![Page 21: FOREARM PHALLOPLASTY FOR FEMALE TO MALE ......TODAY’S FORMAT This is a “12 hour surgery” (Three surgeon working for 6-8 hours each with breaks) which doesn’t lend it easily](https://reader033.vdocuments.us/reader033/viewer/2022042309/5ed6101849af592c00577696/html5/thumbnails/21.jpg)
ALT STEPS
Move under muscles Inset (affix) in place
Santucci 2019
21
![Page 22: FOREARM PHALLOPLASTY FOR FEMALE TO MALE ......TODAY’S FORMAT This is a “12 hour surgery” (Three surgeon working for 6-8 hours each with breaks) which doesn’t lend it easily](https://reader033.vdocuments.us/reader033/viewer/2022042309/5ed6101849af592c00577696/html5/thumbnails/22.jpg)
NEOPHALLUS CAN BE MADE WITH LATISSUM DORSI FLAP TOO IF DESIREDGood for those who want NO visible scar.
We try to avoid this as all if its performance characteristics seems worse than ALT (leg) or RFF (arm)
Santucci 2019
22