Numerous female-to-male (FTM) phalloplasty techniques have been described. Two of the most common methods are the radial forearm and the anterolateral thigh (ALT) phalloplasty techniques. Both techniques require expertise in microvascular and peripheral nerve surgery.
The radial forearm is the most commonly performed phalloplasty technique at the Buncke Clinic. Because of the thin nature of the forearm skin and its robust blood supply, patients undergoing radial forearm phalloplasty can have single stage urethral lengthening to the tip of the phallus and can almost always have an immediate glansplasty. The sensation of the forearm skin is excellent and patients typically have good return of erogenous sensation. The main drawback of the radial forearm phalloplasty is the donor site, which is more visible than that of the ALT flap. We prefer to use thick split thickness skin grafts to maximize the aesthetic appearance of the donor site. While urethral strictures and fistulas are a significant risk of all phalloplasties, these risks appear to be somewhat lower for the radial forearm flap.
The anterolateral thigh phalloplasty is typically feasible in patients who have thin thigh tissue (skin and subcutaneous tissues). Even in the thinnest patients, however, the ALT flap results in a bulkier phallus. This may or may not be desired by the patient and therefore, donor site selection is a very personal choice. Patients who have very thin thigh tissue, may have single stage urethral lengthening to the tip of the phallus. However, the glansplasty is performed at a later stage due to the difference in blood supply of the anterolateral thigh versus the radial forearm flap. Patients with thick thigh tissues who elect to have an ALT phalloplasty will likely require a two-stage urethral lengthening procedure. The sensation of the ALT flap, while good, tends to be slightly less dense than that of the radial forearm. The donor site is also less visible as it is typically covered by clothing. The ALT flap, however, does tend to have higher rates of partial flap loss as well as urethral fistulas and strictures compared to the radial forearm.
Due to their microsurgical expertise, the world-renowned and award-winning microsurgeons at the Buncke Clinic have performed hundreds of phalloplasties (both radial forearm and anterolateral thigh) with no cases of complete flap loss. They are active members of the American Society for Reconstructive Microsurgery, the American Society for Peripheral Nerve, The American Society for Surgery of the Hand, and the American Association for Hand Surgery. These areas of expertise are all needed to maximize the form and function of not only the radial forearm and ALT phalloplasty, but also their donor sites.