Phalloplasty
Phalloplasty is the surgical construction of a penis from the person's own tissue, in several operative stages, usually undergone by biological women living as trans men. It is an extensive procedure with a high number of complications. Outcomes such as urinary function, tactile and erogenous sensation and appearance are reported poorly and in varying ways in the studies; the authors of a 2026 systematic review therefore call for standardised, high-quality research (source).
Techniques and donor sites
The most commonly used technique is the radial forearm free flap (RFF). A large piece of skin and subcutaneous tissue, including blood vessels and nerves, is removed from the forearm and connected at the pubic area. In a systematic review of 45 studies with 2,586 patients, 65.3 percent had an RFF phalloplasty; in the more recent studies the use of pedicled flaps increased (source).
Donor site
The RFF requires a large skin flap. Researchers describe that this goes together with a large scar and questions about arm function (source). In a study of 20 patients, the questionnaires indicated on average minimal to no functional impairment, but the larger the wound surface, the worse the score for sport and music (source). In another study of 37 patients, 31 had minimal to mild pain in the donor arm and 6 had moderate to severe pain, which noticeably affected quality of life (source).
Complications
The 2026 systematic review counted 0.74 (studies from 2000-2010) and 0.66 (studies from 2011-2025) complications per patient. Urethral fistulas occurred in 25.7 and 36.6 percent of patients and urethral strictures in 16.1 and 12.8 percent (source). An earlier systematic review of 11 retrospective studies found that in the RFF studies almost a third of patients developed a stricture or fistula, and in the studies on the anterolateral thigh flap about a quarter; the quality of those studies was low (source). The WPATH Standards of Care 8 state that urethral lengthening in metoidioplasty and phalloplasty is associated with a greatly increased complication rate (source). An overview of the complications is available on transgids.nl.
Metoidioplasty as an alternative
Metoidioplasty is a different technique for constructing a penis. In the same 2022 review, in the six metoidioplasty cohorts a quarter of patients had a stricture or fistula, 74 percent could successfully urinate standing, and average penile length was 6 cm (source). See also testosterone, fertility, Waiting times and care pathway, Detransition and Cass Review.