Rigi10™ Malleable Penile Prosthesis
Also Known As
Penile construction, neophallus creation, phallic reconstruction, gender affirmation phalloplasty, transmasculine bottom surgery, FTM bottom surgery, penis construction surgery, penoplasty3.
Definition
Phalloplasty is a complex set of surgical procedures designed to construct or reconstruct a penis (neophallus)1˒2˒3. It is most commonly performed as a part of gender-affirming surgery for transgender men, but can also be indicated for cisgender men requiring penile reconstruction due to trauma, congenital conditions, or disease1˒3. The primary purpose of phalloplasty is to create a neophallus that is aesthetically similar to a natal penis and, depending on the patient’s goals, allows for standing urination, tactile and erogenous sensation, and the ability to achieve an erection for penetrative intercourse1.
The procedure typically involves harvesting a flap of tissue, which includes skin, fat, nerves, arteries, and veins, from a donor site on the patient’s own body, such as the forearm (radial forearm free flap – RFFF), thigh (anterolateral thigh flap – ALT), or side/back (musculocutaneous latissimus dorsi flap – MLD)1˒2. This tissue flap is then meticulously shaped and transferred to the genital area to form the shaft of the neophallus1˒2. Phalloplasty is a multi-stage process that can include various components tailored to the individual’s needs and surgical plan. These components may encompass the creation of the penile shaft, urethral lengthening (urethroplasty) to enable voiding from the tip of the neophallus, glansplasty (creation of the glans or head), scrotoplasty (creation of a scrotum), vaginectomy (removal of the vagina), hysterectomy and oophorectomy (removal of uterus and ovaries), and the eventual placement of testicular and erectile implants1˒2.
Clinical Context
Phalloplasty is primarily indicated for individuals undergoing female-to-male (FTM) gender affirmation, also known as transmasculine individuals, who seek surgical masculinization of their genitalia to align their physical characteristics with their gender identity¹ˇ²ˇ³. It is also a reconstructive option for cisgender men who have experienced penile loss or damage due to trauma (e.g., accidents, burns, combat injuries), congenital anomalies (e.g., aphallia, micropenis, epispadias, hypospadias when other repairs are insufficient), or oncological resection (e.g., penile cancer)¹.
Careful patient selection is critical and generally involves a comprehensive assessment by a multidisciplinary team, including plastic surgeons, urologists, mental health professionals, and endocrinologists¹ˇ². For gender-affirming cases, this typically includes a confirmed diagnosis of persistent gender dysphoria, the ability to provide informed consent, legal adulthood, and well-managed medical and mental health conditions². Letters of support from qualified mental health professionals are commonly required³. Patients should have realistic expectations about the outcomes, potential complications, and the staged nature of phalloplasty procedures¹ˇ².
Phalloplasty is a modular surgery, tailored to each patient’s goals. Key components may include:
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Phallic Shaft Creation: Construction of the neophallus using a tissue flap such as the radial forearm free flap (RFFF), anterolateral thigh (ALT), or latissimus dorsi (MLD )¹ˇ².
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Urethroplasty (Urethral Lengthening): This procedure is performed if the patient desires to urinate while standing. It extends the urethra through the neophallus and carries a higher risk of complications such as fistulas or strictures¹ˇ²ˇ³.
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Vaginectomy: Often conducted alongside urethral lengthening to remove vaginal tissue, which may aid in reconstruction and reduce complication risks¹.
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Scrotoplasty: Creation of a scrotum using labia majora tissue, designed to accommodate future testicular implants¹ˇ².
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Glansplasty: Formation of the glans penis, typically done in a later stage to improve the appearance of the neophallus¹.
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Hysterectomy and Oophorectomy: Removal of the uterus and ovaries, if not already completed, is often required for gender affirmation¹.
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Implant Placement: Testicular implants and a penile prosthesis (either inflatable or malleable) are usually inserted in later stages, often 12 months or more after initial surgery, to support erectile function and allow for penetrative intercourse¹ˇ².
Expected outcomes depend on the surgical techniques used and individual healing responses. Desired results include an aesthetically pleasing phallus, the ability to void while standing (if urethroplasty is performed), protective sensation, and the capacity for penetrative sex with the aid of a prosthesis¹ˇ³. Recovery is typically prolonged, involving multiple surgical stages over over a year¹ˇ². Initial hospital stays range from 4 to 7 days, with follow-up stages generally requiring shorter or outpatient stays¹ˇ². Despite the complexity, overall satisfaction rates are high, although complications such as urethral fistulas, strictures, flap loss, infection, and prosthetic issues remain significant considerations¹ˇ³.