Vaginal and/or vulva preservation: Several patients request that the vaginal canal and/or parts of the vulva be kept in-tact with the creation of a penis. Vaginal preservations are only possible when the original urethra is kept intact; this means a patient could only urinate while sitting down or with the use of an assistive device, as opposed to being able to pee out of the tip of their penis. Likewise, the clitoris/natal penis and labia can be kept intact so long as the patient does not wish to have a urethral lengthening..  Urethral lengthening: If a patient wishes to get a urethral lengthening to pee out of the tip of …

The RFF phalloplasty takes a large skin graft from the sensitive forearm region to construct a phallus. The ALT phalloplasty takes a large skin graft from the sensitive outer thigh region to construct a phallus. Nerve innervation microsurgery allows the patient to experience erogenous sensation in their penis by hooking up one of the clitoral nerves to the sensory nerve of the forearm or thigh. A very noticeable scar is left on the forearm or outer thigh from the skin graft. 2-4 weeks after the flap is taken from the forearm, Dr. Ley will cover the donor site with a split or full-thickness skin graft from the thigh. The illustrations …

Groin flap phalloplasty uses groin tissue to create the new penis. Using groin tissue allows the scars from this surgery to be more easily concealed, and allows a penis of adequate length and girth for most patients.  The groin flap does not have erogenous sensation; most patients experience normal levels of tactile sensation in their new penis. If a patient wishes to urinate standing up, our surgeon can perform a urethral lengthening using a forearm or hip skin flap. An advantage of a radial forearm flap is that nerve innervation microsurgery can be performed. This allows for the possibility of erogenous sensation to be felt in the new penis, as …