Penis Reconstruction

About Penis Reconstruction

Penis reconstruction is a highly specialised microsurgical procedure that helps men regain identity, function and self-confidence after losing the penis to trauma, cancer surgery, severe infection or as part of gender-affirming care. The aim is to create an aesthetic, sensate organ that allows the patient to void while standing and, ideally, to engage in sexual intercourse comfortably.

Patients typically come to our Lucknow clinic for reconstruction after road traffic accidents, severe burns, animal bites, post-cancer ablation or congenital absence. Each case begins with a confidential consultation and detailed planning. Dr. Agarwal, FRCS Edinburgh, shares both what is achievable and the practical limits of phalloplasty so expectations are clear from the very start.

The radial artery flap from the forearm is widely accepted as the gold standard donor site for phalloplasty. A long strip of skin and soft tissue is harvested with its artery, veins and nerves, and shaped using a tube-in-a-tube technique to create both an outer phallus and an inner urethra. The forearm donor site is then resurfaced with a skin graft.

Surgery is performed by two operating teams working simultaneously to minimise time. The forearm flap is transferred to the groin, where the urinary tube of the new phallus is joined to the existing urethra. Microsurgical anastomosis links the radial artery and veins to vessels in the groin, restoring blood supply to the new organ.

Sensation is restored by joining one forearm nerve to the ilioinguinal nerve for protective sensation and another to a dorsal nerve for erogenous feedback. After six to twelve months of healing, when sensation has reached the glans, a penile implant can be placed to allow erections and penetrative intercourse. Patients typically remain in hospital for around ten to fourteen days.

What to expect

• Confidential consultation and goal setting
• Detailed vascular and nerve mapping
• Two-team simultaneous microsurgical procedure
• Radial forearm tube-in-a-tube phallus
• Microvascular artery, vein and nerve coaptation
• Forearm donor site grafting and rehabilitation
• Staged penile implant after sensation returns

Recovery

• Initial close monitoring of the flap in hospital
• Hospital stay of around ten to fourteen days
• Urinary catheter and dressings for several weeks
• Forearm donor site care and physiotherapy
• Gradual return to routine activity over six to eight weeks
• Implant surgery typically planned after one year