Phalloplasty is a complex, multi-stage surgical procedure that constructs a phallus using tissue transferred from another part of the body. For transmasculine individuals who desire a full-sized penis capable of standing urination and, with a penile prosthesis, penetrative intercourse, phalloplasty represents the most comprehensive option available. Honesty about the complexity and timeline is essential, as this is a journey that unfolds over several surgeries, but the results can be profoundly life-changing.
What Is FTM Phalloplasty?
Phalloplasty involves the surgical construction of a neo-phallus using a free tissue flap harvested from a donor site on the body, most commonly the forearm, thigh, or back. The procedure is performed in multiple stages over a period of months to years, with each stage addressing a specific aspect of the reconstruction: the phallus itself, urethral lengthening to enable standing urination, glansplasty to shape the head of the penis, and, if desired, the placement of an erectile prosthesis and testicular implants.
This is among the most technically demanding procedures in all of reconstructive surgery, requiring microsurgical expertise to connect blood vessels and nerves at the recipient site. Thailand's partner surgeons have trained extensively in microsurgical reconstruction and work within multidisciplinary teams that include urologists, plastic surgeons, and dedicated aftercare coordinators. Under WPATH Standards of Care (SOC 8), phalloplasty typically requires two referral letters, at least 12 months of continuous hormone therapy, and thorough informed consent reflecting the multi-stage nature and realistic outcomes of the procedure.
Common Concerns FTM Phalloplasty Can Address
- Significant distress caused by the absence of male external genitalia
- Inability to urinate while standing
- Desire for anatomy that affirms your male gender identity
- Impact of genital dysphoria on intimate relationships and daily life
Are You a Good Candidate?
- Persistent, well-documented gender dysphoria with two referral letters per WPATH SOC 8
- At least 12 months of continuous testosterone therapy (unless medically contraindicated)
- Good overall health with adequate donor site tissue and no uncontrolled medical conditions
- Realistic understanding of the multi-stage process, recovery timeline, and achievable outcomes
Techniques & Options
The choice of donor flap is the most critical decision in phalloplasty planning. Each flap has different characteristics regarding size, sensation potential, scarring at the donor site, and suitability for urethral lengthening. During consultation, your anatomy, body composition, lifestyle, and priorities are all assessed to determine the best approach.
The three principal flap options are:
Radial Forearm Free Flap (RFF)
Tissue is harvested from the non-dominant forearm and microsurgically transferred to the groin. The radial forearm flap is thin and pliable, producing a phallus with a natural appearance and excellent potential for erogenous and tactile sensation due to the rich nerve supply of the forearm skin. Urethral lengthening is typically incorporated within the flap during the initial stage.
- Excellent sensory potential with two distinct nerve connections
- Thin, pliable tissue produces a natural contour and appearance
- Well-established technique with the longest published track record
Anterolateral Thigh Flap (ALT)
A section of skin and tissue is taken from the outer thigh and transferred microsurgically to the groin. The ALT flap can provide a larger volume of tissue, and the donor site scar is easier to conceal under clothing. It may be thicker than the forearm flap, and some patients require a secondary defatting procedure to refine the contour.
- Donor site scar hidden on the thigh and easily concealed
- Larger tissue volume available for patients needing more bulk
- Good sensory potential with nerve coaptation at the recipient site
Musculocutaneous Latissimus Dorsi Flap (MLD)
Tissue is harvested from the upper back, including a portion of the latissimus dorsi muscle. This flap provides robust, well-vascularised tissue and may be suitable for patients whose forearm or thigh anatomy is not ideal. The donor site scar is located on the back and is generally well-concealed. Urethral lengthening may be staged separately.
- Robust tissue with reliable blood supply
- Donor site scar on the back is easily concealed by clothing
- Suitable alternative when forearm or thigh options are not viable
Recovery Timeline
Days 1–7
You will remain in hospital with close monitoring of flap blood flow using a Doppler probe. A catheter drains urine while the urethra heals. Bed rest is required for the first few days, with gradual mobilisation under supervision. Pain management includes patient-controlled analgesia and oral medications.
Weeks 2–6
The catheter is typically removed once urethral healing is confirmed, usually at 2–3 weeks. The donor site heals under dressings during this period. Swelling gradually subsides, and you will attend regular follow-up appointments. Light walking is encouraged, but strenuous activity is strictly avoided.
Months 2–4
Sensation begins to develop as nerves regenerate, a process that continues for 12–24 months. You can gradually resume light exercise and daily routines. The phallus continues to settle in shape and contour. Planning for subsequent stages (glansplasty, erectile prosthesis) may begin.
Months 6–18
Subsequent surgical stages are performed once the initial flap has fully healed. These may include glansplasty to shape the glans, placement of an erectile prosthesis for penetrative function, and insertion of testicular implants. Full sensory maturation may take up to two years after the initial surgery.
What to Expect
Safety & Risks
Phalloplasty is the most complex procedure in gender-affirming surgery, and it is essential that you understand the full scope of potential risks and complications. Being well-informed is part of being well-prepared, and your surgical team will discuss each risk in detail.
- Urethral fistula (abnormal opening in the urethra), the most common complication
- Urethral stricture (narrowing) requiring dilation or revision
- Partial or complete flap loss due to vascular compromise (rare with experienced surgeons)
- Infection at the surgical or donor site
- Donor site scarring, delayed healing, or reduced function
- Need for multiple revision surgeries beyond the planned stages
- Prosthesis-related complications including erosion, malfunction, or infection
- Reduced sensation or prolonged numbness in the neo-phallus
Urethral complications are the most frequently encountered issue, occurring in a significant minority of patients and sometimes requiring additional corrective procedures. Experienced microsurgeons mitigate the risk of flap failure through meticulous vascular technique and post-operative monitoring. Your surgical team will be transparent about complication rates and what to expect at each stage of your journey.
How Much Does FTM Phalloplasty Cost in Thailand?
Our pricing is transparent and all-inclusive, and your quote covers everything from surgeon fees to hospital stay.
FTM Phalloplasty
All-inclusive surgical package- Board-certified surgeon fee
- Anaesthesia & operating theatre
- Hospital stay & nursing care
- Post-operative medications
- Follow-up appointments
- Dedicated care coordinator
Common Questions About FTM Phalloplasty
Everything you need to know before your procedure
Dr. Kanokwan Pattanaporn
MEDICALLY REVIEWEDDr. Kanokwan Pattanaporn
MEDICALLY REVIEWEDGender Affirmation Surgeon · Bangkok
Last reviewed: February 24, 2026
Medical References
- WPATH Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 (2022)
- Monstrey SJ et al. Penile Reconstruction: Is the Radial Forearm Flap Really the Standard Technique? — Plastic and Reconstructive Surgery (2009)
- Morrison SD et al. Phalloplasty: A Review of Techniques and Outcomes — Plastic and Reconstructive Surgery (2016)
- Santucci RA. Urethral Complications After Phalloplasty — Translational Andrology and Urology (2019)
- American Society of Plastic Surgeons — Gender Affirmation Surgery
Medical disclaimer: Content on this site is provided for informational purposes and should not be treated as medical advice. Outcomes, timelines, and eligibility differ from person to person. Speak with an experienced gender-affirming surgeon before proceeding with any procedure.
What's Included
- Board-certified surgeon fee
- Anaesthesia & operating theatre
- Hospital stay & nursing care
- Post-operative medications
- Follow-up appointments
- Dedicated care coordinator
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