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Current State of Female-to-Male Gender Confirming Surgery

  • Current Controversies (P Kleinplatz and C Moser, Section Editors)
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Abstract

Current advances in female-to-male gender confirming surgery allow for facial masculinization, chest masculinization, gynecologic removal of female sex organs, and genital reconstruction. With the breadth of approaches to each of these surgeries, it is important for providers as well as patients to be informed of the available options. In this review, the current state of female-to-male surgical approaches is discussed for the gender dysphoric patient who has typically initiated medical transition.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington D.C.; 2013.

  2. Benjamin H. The transsexual phenomenon. New York: Julian Press; 1966.

    Google Scholar 

  3. Byne W, Bradley SJ, Coleman E, et al. Report of the American Psychiatric Association task force on treatment of gender identity disorder. Arch Sex Behav. 2012;41(4):759–96.

    PubMed  Google Scholar 

  4. Cohen-Kettenis PT, Pfafflin F. The DSM diagnostic criteria for gender identity disorder in adolescents and adults. Arch Sex Behav. 2010;39(2):499–513.

    PubMed  Google Scholar 

  5. Lawrence AA. Gender assignment dysphoria in the DSM-5. Arch Sex Behav. 2014;43(7):1263–6.

    PubMed  Google Scholar 

  6. Selvaggi G, Bellringer J. Gender reassignment surgery: an overview. Nat Rev Urol. 2011;8(5):274–82.

    PubMed  Google Scholar 

  7. Hage JJ, Karim RB. Ought GIDNOS get nought? Treatment options for nontranssexual gender dysphoria. Plast Reconstr Surg. 2000;105(3):1222–7.

    CAS  PubMed  Google Scholar 

  8. Gooren LJ. Clinical practice. Care of transsexual persons. N Engl J Med. 2011;364(13):1251–7.

    CAS  PubMed  Google Scholar 

  9. Gooren LJ. Management of female-to-male transgender persons: medical and surgical management, life expectancy. Curr Opin Endocrinol Diabetes Obes. 2014;21(3):233–8.

    PubMed  Google Scholar 

  10. Monstrey S, Hoebeke P, Dhont M, et al. Surgical therapy in transsexual patients: a multi-disciplinary approach. Acta Chir Belg. 2001;101(5):200–9.

    CAS  PubMed  Google Scholar 

  11. Standards of care for the health of transsexual, transgender, and gender nonconforming people. 7th Version, 2011, The World Professional Association for Transgender Health.

  12. Selvaggi G, Dhejne C, Landen M, et al. The 2011 WPATH standards of care and penile reconstruction in female-to-male transsexual individuals. Adv Urol. 2012;2012:581712.

    PubMed Central  PubMed  Google Scholar 

  13. Christensen BS, Gronbaek M, Osler M, et al. Sexual dysfunctions and difficulties in Denmark: prevalence and associated sociodemographic factors. Arch Sex Behav. 2011;40(1):121–32.

    PubMed  Google Scholar 

  14. De Cuypere G, Van Hemelrijck M, Michel A, et al. Prevalence and demography of transsexualism in Belgium. Eur Psychiatr. 2007;22(3):137–41.

    Google Scholar 

  15. Fugl-Meyer AR, Fugl-Meyer K. Sexual disabilities, problems and satisfaction in 18–74 year old Swedes. Scand J Sexol. 1999;2:79–105.

    Google Scholar 

  16. Reed B, Rhodes S, Schofield P, et al. Gender variance in the UK; prevalence, incidence, growth and geographic distribution. GIRES 2009.

  17. Van Kesteren PJ, Gooren LJ, Megens JA. An epidemiological and demographic study of transsexuals in The Netherlands. Arch Sex Behav. 1996;25(6):589–600.

    PubMed  Google Scholar 

  18. Allen NE, Key TJ, Dossus L, et al. Endogenous sex hormones and endometrial cancer risk in women in the European Prospective Investigation into Cancer and Nutrition (EPIC). Endocrinol Cancer. 2008;15(2):485–97.

    CAS  Google Scholar 

  19. Cawood EH, Bancroft J. Steroid hormones, the menopause, sexuality and well-being of women. Psychol Med. 1996;26(5):925–36.

    CAS  PubMed  Google Scholar 

  20. Davis SR, Moreau M, Kroll R, et al. Testosterone for low libido in postmenopausal women not taking estrogen. N Engl J Med. 2008;359(19):2005–17.

    CAS  PubMed  Google Scholar 

  21. Gooren LJ, Giltay EJ. Review of studies of androgen treatment of female-to-male transsexuals: effects and risks of administration of androgens to females. J Sex Med. 2008;5(4):765–76.

    CAS  PubMed  Google Scholar 

  22. Gooren LJ, Giltay EJ, Bunck MC. Long-term treatment of transsexuals with cross-sex hormones: extensive personal experience. J Clin Endocrinol Metab. 2008;93(1):19–25.

    CAS  PubMed  Google Scholar 

  23. Mueller A, Gooren L. Hormone-related tumors in transsexuals receiving treatment with cross-sex hormones. Eur J Endocrinol. 2008;159(3):197–202.

    CAS  PubMed  Google Scholar 

  24. Turna B, Apaydin E, Semerci B, et al. Women with low libido: correlation of decreased androgen levels with female sexual function index. Int J Impot Res. 2005;17(2):148–53.

    CAS  PubMed  Google Scholar 

  25. Van Caenegem E, Wierckx K, Taes Y, et al. Bone mass, bone geometry, and body composition in female-to-male transsexual persons after long-term cross-sex hormonal therapy. J Clin Endocrinol Metab. 2012;97(7):2503–11.

    PubMed  Google Scholar 

  26. Wierckx K, Elaut E, Declercq E, et al. Prevalence of cardiovascular disease and cancer during cross-sex hormone therapy in a large cohort of trans persons: a case–control study. Eur J Endocrinol. 2013;169(4):471–8.

    CAS  PubMed  Google Scholar 

  27. Wierckx K, Elaut E, Van Caenegem E, et al. Sexual desire in female-to-male transsexual persons: exploration of the role of testosterone administration. Eur J Endocrinol. 2011;165(2):331–7.

    CAS  PubMed  Google Scholar 

  28. Wierckx K, Mueller S, Weyers S, et al. Long-term evaluation of cross-sex hormone treatment in transsexual persons. J Sex Med. 2012;9(10):2641–51.

    CAS  PubMed  Google Scholar 

  29. Ousterhout DK. Feminization of the forehead: contour changing to improve female aesthetics. Plast Reconstr Surg. 1987;79(5):701–13.

    CAS  PubMed  Google Scholar 

  30. Ousterhout DK. Dr. Paul Tessier and facial skeletal masculinization. Ann Plast Surg. 2011;67(6):S10–5.

    CAS  PubMed  Google Scholar 

  31. Monstrey S, Selvaggi G, Ceulemans P, et al. Chest-wall contouring surgery in female-to-male transsexuals: a new algorithm. Plast Reconstr Surg. 2008;121(3):849–59.

    CAS  PubMed  Google Scholar 

  32. Richards C, Barrett J. The case for bilateral mastectomy and male chest contouring for the female-to-male transsexual. Ann R Coll Surg Engl. 2013;95(2):93–5.

    CAS  PubMed Central  PubMed  Google Scholar 

  33. Beer GM, Budi S, Seifert B, et al. Configuration and localization of the nipple-areola complex in men. Plast Reconstr Surg. 2001;108(7):1947–52. discussion 1953.

    CAS  PubMed  Google Scholar 

  34. Berry MG, Curtis R, Davies D. Female-to-male transgender chest reconstruction: a large consecutive, single-surgeon experience. J Plast Reconstr Aesthet Surg. 2012;65(6):711–9. Most recent large-scale study of chest masculinization detailing complications, revision rates and patient satisfaction associated with mastectomy with FNG, periareolar and liposuction techniques.

    CAS  PubMed  Google Scholar 

  35. Colic MM, Colic MM. Circumareolar mastectomy in female-to-male transsexuals and large gynecomastias: a personal approach. Aesthet Plast Surg. 2000;24(6):450–4.

    CAS  Google Scholar 

  36. Monstrey SJ, Ceulemans P, Hoebeke P. Sex reassignment surgery in the female-to-male transsexual. Semin Plast Surg. 2011;25(3):229–44.

    PubMed Central  PubMed  Google Scholar 

  37. Namba Y, Watanabe T, Kimata Y. Mastectomy in female-to-male transsexuals. Acta Med Okayama. 2009;63(5):243–7.

    PubMed  Google Scholar 

  38. Hage JJ, Bloem JJ. Chest wall contouring for female-to-male transsexuals: Amsterdam experience. Ann Plast Surg. 1995;34(1):59–66.

    CAS  PubMed  Google Scholar 

  39. Hage JJ, Van Kesteren PJ. Chest-wall contouring in female-to-male transsexuals: basic considerations and review of the literature. Plast Reconstr Surg. 1995;96(2):386–91.

    CAS  PubMed  Google Scholar 

  40. Davidson BA. Concentric circle operation for massive gynecomastia to excise the redundant skin. Plast Reconstr Surg. 1979;63(3):350–4.

    CAS  PubMed  Google Scholar 

  41. Kluzak R. Sex conversion operation in female transsexualism. Acta Chir Plast. 1968;10(3):188–98.

    CAS  PubMed  Google Scholar 

  42. Lindsay WR. Creation of a male chest in female transsexuals. Ann Plast Surg. 1979;3(1):39–46.

    CAS  PubMed  Google Scholar 

  43. Pitanguy I. Transareolar incision for gynecomastia. Plast Reconstr Surg. 1966;38(5):414–9.

    CAS  PubMed  Google Scholar 

  44. Webster JP. Mastectomy for gynecomastia through a semicircular intra-areolar incision. Ann Surg. 1946;124(3):557–75.

    PubMed Central  Google Scholar 

  45. Nelson L, Whallett EJ, Mcgregor JC. Transgender patient satisfaction following reduction mammaplasty. J Plast Reconstr Aesthet Surg. 2009;62(3):331–4.

    CAS  PubMed  Google Scholar 

  46. Lazard A, Cravello L, Poizac S, et al. Hysterectomy and bilateral adnexectomy by laparoscopic single port access for female to male transsexualism. J Sex Med. 2013;10(5):1439.

    PubMed  Google Scholar 

  47. Vukadinovic V, Stojanovic B, Majstorovic M, et al. The role of clitoral anatomy in female to male sex reassignment surgery. Sci World J. 2014;2014:437378. Retrospective study on metoidioplasty comparing outcomes after urethral plate dissection and the use of either preputial skin or labia minora skin graft for urethroplasty.

    Google Scholar 

  48. Weyers S, De Sutter P, Hoebeke S, et al. Gynaecological aspects of the treatment and follow-up of transsexual men and women. Facts Views Vis Obgyn. 2010;2(1):35–54.

    CAS  PubMed Central  PubMed  Google Scholar 

  49. Ergeneli MH, Duran EH, Ozcan G, et al. Vaginectomy and laparoscopically assisted vaginal hysterectomy as adjunctive surgery for female-to-male transsexual reassignment: preliminary report. Eur J Obstet Gynecol Reprod Biol. 1999;87(1):35–7.

    CAS  PubMed  Google Scholar 

  50. Weyers S, Selvaggi G, Monstrey S. Two-stage versus one-stage sex reassignment surgery in female-to-male transsexual individuals. Gynaecol Surg. 2006;3:190–4.

    Google Scholar 

  51. Bogliolo S, Cassani C, Babilonti L, et al. Robotic single-site surgery for female-to-male transsexuals: preliminary experience. Sci World J. 2014;2014:674579. Preliminary study describing a less invasive method of hysterectomy in female-to-male patients associated with low complication rates and favorable aesthetic outcomes.

    Google Scholar 

  52. Perrone AM, Scifo MC, Martelli V, et al. Hysterectomy and bilateral salpingoovariectomy in a transsexual subject without visible scaring. Diagn Ther Endosc. 2010; 2010.

  53. Obedin-Maliver J, Light A, Dehaan G, et al. Vaginal hysterectomy as a viable option for female-to-male transgender men. Obstet Gynecol. 2014;123 Suppl 1:126S–7. Retrospective study can decrease cost, increase access to care and decrease morbidity in female-to-male transgender patients.

    PubMed  Google Scholar 

  54. Babaei A, Safarinejad MR, Farrokhi F, et al. Penile reconstruction: evaluation of the most accepted techniques. J Urol. 2010;7(2):71–8.

    Google Scholar 

  55. Monstrey S, Hoebeke P, Dhont M, et al. Phalloplasty: a review of 91 cases. ANIR-ANHP. 2004;6:193–9.

    Google Scholar 

  56. Monstrey S, Hoebeke P, Selvaggi G, et al. Penile reconstruction: is the radial forearm flap really the standard technique? Plast Reconstr Surg. 2009;124(2):510–8.

    CAS  PubMed  Google Scholar 

  57. Puckett CL, Reinisch JF, Montie JE. Free flap phalloplasty. J Urol. 1982;128(2):294–7.

    CAS  PubMed  Google Scholar 

  58. Salgado CJ, Chim H, Tang JC, et al. Penile reconstruction. Semin Plast Surg. 2011;25(3):221–8.

    PubMed Central  PubMed  Google Scholar 

  59. Selvaggi G, Elander A. Penile reconstruction/formation. Curr Opin Urol. 2008;18(6):589–97.

    PubMed  Google Scholar 

  60. Sutcliffe PA, Dixon S, Akehurst RL, et al. Evaluation of surgical procedures for sex reassignment: a systematic review. J Plast Reconstr Aesthet Surg. 2009;62(3):294–306. discussion 306–298.

    CAS  PubMed  Google Scholar 

  61. Alanis SZ. An innovation in total penis reconstruction. Plast Reconstr Surg. 1969;43(4):418–22.

    CAS  PubMed  Google Scholar 

  62. Chen YB, Chen HC. Penile reconstruction for a victim of electrical injury with bilateral below-elbow amputations. Plast Reconstr Surg. 1991;87(4):771–5.

    CAS  PubMed  Google Scholar 

  63. Garaffa G, Raheem AA, Ralph DJ. An update on penile reconstruction. Asian J Androl. 2011;13(3):391–4.

    PubMed Central  PubMed  Google Scholar 

  64. Gilbert DA, Horton CE, Terzis JK, et al. New concepts in phallic reconstruction. Ann Plast Surg. 1987;18(2):128–36.

    CAS  PubMed  Google Scholar 

  65. Hage JJ, Bloem JJ, Suliman HM. Review of the literature on techniques for phalloplasty with emphasis on the applicability in female-to-male transsexuals. J Urol. 1993;150(4):1093–8.

    CAS  PubMed  Google Scholar 

  66. Lumen N, Monstrey S, Selvaggi G, et al. Phalloplasty: a valuable treatment for males with penile insufficiency. Urology. 2008;71(2):272–6. discussion 276–277.

    PubMed  Google Scholar 

  67. Young VL, Khouri RK, Lee GW, et al. Advances in total phalloplasty and urethroplasty with microvascular free flaps. Clin Plast Surg. 1992;19(4):927–38.

    CAS  PubMed  Google Scholar 

  68. Selvaggi G, Elander A, Branemark R. Penile epithesis: preliminary study. Plast Reconstr Surg. 2010;126(5):265e–6.

    PubMed  Google Scholar 

  69. Hage JJ, Bouman FG, De Graaf FH, et al. Construction of the neophallus in female-to-male transsexuals: the Amsterdam experience. J Urol. 1993;149(6):1463–8.

    CAS  PubMed  Google Scholar 

  70. Hage JJ, De Graaf FH. Addressing the ideal requirements by free flap phalloplasty: some reflections on refinements of technique. Microsurgery. 1993;14(9):592–8.

    CAS  PubMed  Google Scholar 

  71. Durfee R, Rowland W. In: Laub DR, Gandy P, editors. Penile Substitution with clitoral enlargement and urethral transfer. Proceedings of the Second Interdisciplinary Symposium on Gender Dysphoria Syndrome. Stanford: Stanford University Press; 1973.

    Google Scholar 

  72. Lebovic GS, Laub DR. In: Ehrlich RM, Alter GJ, editors. Metoidioplasty. Reconstructive and plastic surgery of the external genitalia: adult and pediatric. Philadelphia: WB Saunders; 1999.

    Google Scholar 

  73. Djordjevic ML, Bizic MR. Comparison of two different methods for urethral lengthening in female to male (metoidioplasty) surgery. J Sex Med. 2013;10(5):1431–8.

    PubMed  Google Scholar 

  74. Hage JJ, Van Turnhout AA. Long-term outcome of metaidoioplasty in 70 female-to-male transsexuals. Ann Plast Surg. 2006;57(3):312–6.

    CAS  PubMed  Google Scholar 

  75. Oakley SH, Mutema GK, Crisp CC, et al. Innervation and histology of the clitoral-urethal complex: a cross-sectional cadaver study. J Sex Med. 2013;10(9):2211–8.

    PubMed  Google Scholar 

  76. Hage JJ. Metaidoioplasty: an alternative phalloplasty technique in transsexuals. Plast Reconstr Surg. 1996;97(1):161–7.

    CAS  PubMed  Google Scholar 

  77. Djordjevic ML, Bizic M, Stanojevic D, et al. Urethral lengthening in metoidioplasty (female-to-male sex reassignment surgery) by combined buccal mucosa graft and labia minora flap. Urology. 2009;74(2):349–53.

    CAS  PubMed  Google Scholar 

  78. Djordjevic ML, Majstorovic M, Stanojevic D, et al. Combined buccal mucosa graft and dorsal penile skin flap for repair of severe hypospadias. Urology. 2008;71(5):821–5.

    PubMed  Google Scholar 

  79. Djordjevic ML, Stanojevic D, Bizic M, et al. Metoidioplasty as a single stage sex reassignment surgery in female transsexuals: Belgrade experience. J Sex Med. 2009;6(5):1306–13.

    PubMed  Google Scholar 

  80. Perovic SV, Djordjevic ML. Metoidioplasty: a variant of phalloplasty in female transsexuals. BJU Int. 2003;92(9):981–5.

    CAS  PubMed  Google Scholar 

  81. Bogoras N. Über die volle plastische Wiederherstellung eines zum Koitus fähigen Penis (Peniplastica totalis). Zentralbl Chir. 1936;22:1271–6.

    Google Scholar 

  82. Bogoras N. Plastic restoration of the penis. Sov Khir. 1936; 303.

  83. Gillies H. Congenital absence of the penis. Br J Plast Surg. 1948;1(1):8–28.

    CAS  PubMed  Google Scholar 

  84. Gillies H, Millard R. The principles and art of plastic surgery. Vol. II. Boston: Little, Brown & Company; 1957.

    Google Scholar 

  85. Kaplan I. A rapid method for constructing a functional sensitive penis. Br J Plast Surg. 1971;24(4):342–4.

    CAS  PubMed  Google Scholar 

  86. Maltz M. In: Maltz M, editor. Maltz reparative technique for the penis. Evolution of plastic surgery. New York: Froben Press; 1946.

    Google Scholar 

  87. Terrier JE, Courtois F, Ruffion A, et al. Surgical outcomes and patients’ satisfaction with suprapubic phalloplasty. J Sex Med. 2014;11(1):288–98. Retrospective study on phalloplasty using suprapubic flaps in 24 patients. Results show high patient satisfaction.

    PubMed  Google Scholar 

  88. Akoz T, Kargi E. Phalloplasty in a female-to-male transsexual using a double-pedicle composite groin flap. Ann Plast Surg. 2002;48(4):423–7. discussion 427.

    PubMed  Google Scholar 

  89. Bettocchi C, Ralph DJ, Pryor JP. Pedicled pubic phalloplasty in females with gender dysphoria. BJU Int. 2005;95(1):120–4.

    PubMed  Google Scholar 

  90. Davies DM, Matti BA. A method of phalloplasty using the deep inferior epigastric flap. Br J Plast Surg. 1988;41(2):165–8.

    CAS  PubMed  Google Scholar 

  91. Puckett CL, Montie JE. Construction of male genitalia in the transsexual, using a tubed groin flap for the penis and a hydraulic inflation device. Plast Reconstr Surg. 1978;61(4):523–30.

    CAS  PubMed  Google Scholar 

  92. Santi P, Berrino P, Canavese G, et al. Immediate reconstruction of the penis using an inferiorly based rectus abdominis myocutaneous flap. Plast Reconstr Surg. 1988;81(6):961–4.

    CAS  PubMed  Google Scholar 

  93. Shaeer O, El-Sebaie A. Construction of neoglans penis: a new sculpturing technique from rectus abdominis myofascial flap. J Sex Med. 2005;2(2):259–65.

    PubMed  Google Scholar 

  94. Ranno R, Hyza P, Vesely J, et al. An objective evaluation of contraction power of neo-phallus reconstructed with free re-innervated LD in female-to-male transsexuals. Acta Chir Plast. 2007;49(1):8–12.

    CAS  PubMed  Google Scholar 

  95. Ranno R, Vesely J, Hyza P, et al. Neo-phalloplasty with re-innervated latissimus dorsi free flap: a functional study of a novel technique. Acta Chir Plast. 2007;49(1):3–7.

    CAS  PubMed  Google Scholar 

  96. Vesely J, Hyza P, Ranno R, et al. New technique of total phalloplasty with reinnervated latissimus dorsi myocutaneous free flap in female-to-male transsexuals. Ann Plast Surg. 2007;58(5):544–50.

    CAS  PubMed  Google Scholar 

  97. Zhang Y, Lu L, Zhang W, et al. A simple and effective method for phalloplasty in female-to-male transsexuals. Plast Reconstr Surg. 2010;126(5):264e–5.

    PubMed  Google Scholar 

  98. Hoebeke P, Selvaggi G, Ceulemans P, et al. Impact of sex reassignment surgery on lower urinary tract function. Eur Urol. 2005;47(3):398–402.

    PubMed  Google Scholar 

  99. Hoebeke PB, Decaestecker K, Beysens M, et al. Erectile implants in female-to-male transsexuals: our experience in 129 patients. Eur Urol. 2010;57(2):334–40.

    PubMed  Google Scholar 

  100. Hage JJ, Winters HA, Van Lieshout J. Fibula free flap phalloplasty: modifications and recommendations. Microsurgery. 1996;17(7):358–65.

    CAS  PubMed  Google Scholar 

  101. Papadopulos NA, Schaff J, Biemer E. Usefulness of free sensate osteofasciocutaneous forearm and fibula flaps for neophallus construction. J Reconstr Microsurg. 2001;17(6):407–12.

    CAS  PubMed  Google Scholar 

  102. Papadopulos NA, Schaff J, Biemer E. The use of free prelaminated and sensate osteofasciocutaneous fibular flap in phalloplasty. Injury. 2008;39 Suppl 3:S62–7.

    PubMed  Google Scholar 

  103. Schaff J, Papadopulos NA. A new protocol for complete phalloplasty with free sensate and prelaminated osteofasciocutaneous flaps: experience in 37 patients. Microsurgery. 2009;29(5):413–9.

    PubMed  Google Scholar 

  104. Mcroberts JW, Sadove RC. Penile reconstruction with a free sensate osteocutaneous fibula flap in the surgical management of the intersex patient. Adv Exp Med Biol. 2002;511:283–7. discussion 287–288.

    PubMed  Google Scholar 

  105. Sengezer M, Ozturk S, Deveci M, et al. Long-term follow-up of total penile reconstruction with sensate osteocutaneous free fibula flap in 18 biological male patients. Plast Reconstr Surg. 2004;114(2):439–50. discussion 451–432.

    PubMed  Google Scholar 

  106. Felici N, Felici A. A new phalloplasty technique: the free anterolateral thigh flap phalloplasty. J Plast Reconstr Aesthet Surg. 2006;59(2):153–7.

    CAS  PubMed  Google Scholar 

  107. Lee GK, Lim AF, Bird ET. A novel single-flap technique for total penile reconstruction: the pedicled anterolateral thigh flap. Plast Reconstr Surg. 2009;124(1):163–6.

    CAS  PubMed  Google Scholar 

  108. Morrison SD, Son J, Song J, et al. Modification of the tube-in-tube pedicled anterolateral thigh flap for total phalloplasty: the mushroom flap. Ann Plast Surg. 2014;72 Suppl 1:S22–6.

    CAS  PubMed  Google Scholar 

  109. Mutaf M. A new surgical procedure for phallic reconstruction: Istanbul flap. Plast Reconstr Surg. 2000;105(4):1361–70.

    CAS  PubMed  Google Scholar 

  110. Hasegawa K, Namba Y, Kimata Y. Phalloplasty with an innervated island pedicled anterolateral thigh flap in a female-to-male transsexual. Acta Med Okayama. 2013;67(5):325–31.

    PubMed  Google Scholar 

  111. Rubino C, Figus A, Dessy LA, et al. Innervated island pedicled anterolateral thigh flap for neo-phallic reconstruction in female-to-male transsexuals. J Plast Reconstr Aesthet Surg. 2009;62(3):e45–9.

    CAS  PubMed  Google Scholar 

  112. Doornaert M, Hoebeke P, Ceulemans P, et al. Penile reconstruction with the radial forearm flap: an update. Handchir Mikrochir Plast Chir. 2011;43(4):208–14. Retrospective study of outcomes of the radial forearm free flap for phalloplasty in the largest female-to-male cohort study done to date. Also covers sensation and donor-site morbidity along with scrotoplasty.

    CAS  PubMed  Google Scholar 

  113. Chang TS, Hwang WY. Forearm flap in one-stage reconstruction of the penis. Plast Reconstr Surg. 1984;74(2):251–8.

    CAS  PubMed  Google Scholar 

  114. Fang RH, Lin JT, Ma S. Phalloplasty for female transsexuals with sensate free forearm flap. Microsurgery. 1994;15(5):349–52.

    CAS  PubMed  Google Scholar 

  115. Koshima I, Tai T, Yamasaki M. One-stage reconstruction of the penis using an innervated radial forearm osteocutaneous flap. J Reconstr Microsurg. 1986;3(1):19–26.

    CAS  PubMed  Google Scholar 

  116. Ma S, Cheng K, Liu Y. Sensibility following innervated free radial forearm flap for penile reconstruction. Plast Reconstr Surg. 2011;127(1):235–41.

    CAS  PubMed  Google Scholar 

  117. Ma S, Liu Y, Chang T, et al. Long-term follow-up of sensation recovery of the penis reconstructed by Cheng’s method. Plast Reconstr Surg. 2011;127(4):1546–52.

    CAS  PubMed  Google Scholar 

  118. Lumen N, Monstrey S, Decaestecker K, et al. Erectile implants in female-to-male transsexuals: our experience in 130 patients (Abstract EAU 2008). Eur Urol Suppl. 2008;7:117.

    Google Scholar 

  119. Selvaggi G, Monstrey S, Ceulemans P, et al. Genital sensitivity after sex reassignment surgery in transsexual patients. Ann Plast Surg. 2007;58(4):427–33.

    CAS  PubMed  Google Scholar 

  120. De Cuypere G, T’sjoen G, Beerten R, et al. Sexual and physical health after sex reassignment surgery. Arch Sex Behav. 2005;34(6):679–90.

    PubMed  Google Scholar 

  121. Matti BA, Matthews RN, Davies DM. Phalloplasty using the free radial forearm flap. Br J Plast Surg. 1988;41(2):160–4.

    CAS  PubMed  Google Scholar 

  122. Biemer E. Penile construction by the radial arm flap. Clin Plast Surg. 1988;15(3):425–30.

    CAS  PubMed  Google Scholar 

  123. Fang RH, Kao YS, Ma S, et al. Phalloplasty in female-to-male transsexuals using free radial osteocutaneous flap: a series of 22 cases. Br J Plast Surg. 1999;52(3):217–22.

    CAS  PubMed  Google Scholar 

  124. Song C, Wong M, Wong CH, et al. Modifications of the radial forearm flap phalloplasty for female-to-male gender reassignment. J Reconstr Microsurg. 2011;27(2):115–20.

    PubMed  Google Scholar 

  125. Koshima I, Inagawa K, Okuyama N, et al. Free vascularized appendix transfer for reconstruction of penile urethras with severe fibrosis. Plast Reconstr Surg. 1999;103(3):964–9.

    CAS  PubMed  Google Scholar 

  126. Selvaggi G, Monstrey S, Hoebeke P, et al. Donor-site morbidity of the radial forearm free flap after 125 phalloplasties in gender identity disorder. Plast Reconstr Surg. 2006;118(5):1171–7.

    CAS  PubMed  Google Scholar 

  127. Bardsley AF, Soutar DS, Elliot D, et al. Reducing morbidity in the radial forearm flap donor site. Plast Reconstr Surg. 1990;86(2):287–92. discussion 293–284.

    CAS  PubMed  Google Scholar 

  128. Boorman JG, Brown JA, Sykes PJ. Morbidity in the forearm flap donor arm. Br J Plast Surg. 1987;40(2):207–12.

    CAS  PubMed  Google Scholar 

  129. Richardson D, Fisher SE, Vaughan ED, et al. Radial forearm flap donor-site complications and morbidity: a prospective study. Plast Reconstr Surg. 1997;99(1):109–15.

    CAS  PubMed  Google Scholar 

  130. Van Caenegem E, Verhaeghe E, Taes Y, et al. Long-term evaluation of donor-site morbidity after radial forearm flap phalloplasty for transsexual men. J Sex Med. 2013;10(6):1644–51. In depth analysis of donor-site morbidity after radial forearm free flap phalloplasty in female-to-male patients compared with natal female patients.

    PubMed  Google Scholar 

  131. Vriens JP, Acosta R, Soutar DS, et al. Recovery of sensation in the radial forearm free flap in oral reconstruction. Plast Reconstr Surg. 1996;98(4):649–56.

    CAS  PubMed  Google Scholar 

  132. Branemark PI, Adell R, Breine U, et al. Intra-osseous anchorage of dental prostheses. I. Experimental studies. Scand J Plast Reconstr Surg. 1969;3(2):81–100.

    CAS  PubMed  Google Scholar 

  133. Tolman DE, Tjellstrom A, Woods JE. Reconstructing the human face by using the tissue-integrated prosthesis. Mayo Clin Proc. 1998;73(12):1171–5.

    CAS  PubMed  Google Scholar 

  134. Selvaggi G, Branemark R, Elander A, et al. Titanium-bone-anchored penile epithesis: preoperative planning and immediate postoperative results. J Plast Surg Hand Surg. 2014; 1–5. Proof of concept study for penile epithesis using five female-to-male patients who did not want phalloplasty, but desired a phallus. Titanium rods were placed in the pelvis of these patients and showed osseous integration.

  135. Hage JJ, Bouman FG, Bloem JJ. Constructing a scrotum in female-to-male transsexuals. Plast Reconstr Surg. 1993;91(5):914–21.

    CAS  PubMed  Google Scholar 

  136. Millard Jr DR. Scrotal construction and reconstruction. Plast Reconstr Surg. 1966;38(1):10–5.

    PubMed  Google Scholar 

  137. Reid CF, Wright Jr JH. Scrotal reconstruction following an avulsion injury. J Urol. 1985;133(4):681–2.

    CAS  PubMed  Google Scholar 

  138. Sengezer M, Sadove RC. Scrotal construction by expansion of labia majora in biological female transsexuals. Ann Plast Surg. 1993;31(4):372–6.

    CAS  PubMed  Google Scholar 

  139. Still 2nd EF, Goodman RC. Total reconstruction of a two-compartment scrotum by tissue expansion. Plast Reconstr Surg. 1990;85(5):805–7. discussion 808.

    PubMed  Google Scholar 

  140. Selvaggi G, Hoebeke P, Ceulemans P, et al. Scrotal reconstruction in female-to-male transsexuals: a novel scrotoplasty. Plast Reconstr Surg. 2009;123(6):1710–8.

    CAS  PubMed  Google Scholar 

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Conflict of Interest

Shane D. Morrison, Marcelina G. Perez, Michael Nedelman, and Curtis N. Crane declare no conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA

    Shane D. Morrison

  2. Stanford University School of Medicine, Stanford, CA, USA

    Marcelina G. Perez & Michael Nedelman

  3. Brownstein and Crane Surgical Services, 575 Sir Francis Drake Blvd, Suite 1, Greenbrae, CA, 94904, USA

    Curtis N. Crane

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  1. Shane D. Morrison
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  2. Marcelina G. Perez
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  3. Michael Nedelman
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  4. Curtis N. Crane
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Correspondence to Curtis N. Crane.

Additional information

Shane D. Morrison and Marcelina G. Perez contributed equally to this work.

This article is part of the Topical Collection on Current Controversies

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Morrison, S.D., Perez, M.G., Nedelman, M. et al. Current State of Female-to-Male Gender Confirming Surgery. Curr Sex Health Rep 7, 38–48 (2015). https://doi.org/10.1007/s11930-014-0038-2

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