Phalloplasty

Phalloplasty is an umbrella term for procedures with different aims, from reconstruction after trauma or a congenital condition to selected corrections of shape or size.

It is not a single operation but a group of techniques chosen according to each patient’s specific problem. Some aim to restore a structure affected by an accident, illness or previous surgery. Others correct, within clear limits, aspects of shape or situations in which the penis appears smaller because of the surrounding tissues, for example excess fat in the pubic area. At Detalii Med in Baia Mare, assessment and surgery are carried out by Dr Marius Pruna and Dr Valeria Pruna, plastic surgeons.

Suitability depends on anatomy, function, medical history and a realistic objective. Not every aesthetic concern is an indication for surgery.

An assessment may be useful, for example, in situations such as:

• after-effects of injury, infection or surgery;
• congenital anomalies of the penis;
• scars or deformities affecting shape or function;
• a diminished appearance of the penis caused by the surrounding tissues.

Many people concerned about penile size are, in fact, within the normal range. In these cases, accurate information and sometimes psychological support may be more helpful than an operation.

In selected cases it may improve form or function. There is no universal technique, and promises of major risk-free enlargement are not realistic.

Depending on the case, surgery may restore certain structures, correct scars or deformities and improve the appearance of the area. It cannot guarantee a particular increase in length or girth, does not on its own treat erectile dysfunction and does not resolve relationship or self-confidence difficulties that have other causes. Changes in size, where indicated, are usually moderate.

The confidential consultation includes examination, sexual and urinary function, expectations, alternatives and the impact of scarring.

The surgeon listens to why the patient is seeking an assessment and what they hope to achieve. Associated conditions, previous surgery, medication and smoking are discussed. Where the situation calls for it, a urological or psychological assessment may also be recommended before a decision is made. The patient receives information about surgical and non-surgical options, risks and what can realistically be expected. The decision is not rushed, and the patient has time to ask questions.

The operation may involve local tissue rearrangement, grafts or flaps depending on the indication. A precise plan can only follow direct assessment.

Local rearrangement uses tissue in the area to correct shape or a scar. Grafts involve transferring tissue from another region of the body, while flaps move tissue together with its own blood supply, usually in more complex reconstructions. The length of the operation, the number of stages and the need for a hospital stay vary widely from case to case. Some corrections are done in a single stage, while others require several operations planned over time.

The type of anaesthesia depends on the extent of surgery and is agreed with the anaesthetist.

For limited corrections, local anaesthesia or local anaesthesia with sedation may be considered, while more extensive operations are usually performed under general anaesthesia. Before surgery, the patient has a pre-anaesthetic assessment.

Recovery varies considerably. Careful hygiene, temporary sexual abstinence and follow-up appointments are necessary.

• Swelling, bruising and discomfort may occur in the first days and are managed with the recommended treatment.
• A special dressing or, for certain operations, a temporary urinary catheter may be needed.
• The length of sexual abstinence is set by the surgeon according to the technique; as a rough guide, it is a matter of several weeks.
• Strenuous exercise, cycling and impact sports resume only with the surgeon’s approval.

Regular follow-up allows any healing problems to be spotted early.

Risks may include bleeding, infection, scarring, sensory change, asymmetry, erectile or urinary problems and the need for revision.

Prolonged swelling, delayed healing, scar contraction or a result different from what was expected may also occur. With grafts and flaps, there is also a risk that part of the transferred tissue does not take, as well as risks related to the donor site. Some complications can affect sexual or urinary function, which is why the indication is weighed carefully. Individual risks are discussed in detail before any decision.

The result is evaluated after complete healing and tissue maturation. Function and safety take priority over purely aesthetic change.

In the first weeks, swelling may temporarily alter the appearance of the area, so the result cannot be judged straight away. Progress is usually assessed after a few months, and scars continue to mature afterwards. In multi-stage reconstructions, the final result takes shape only once all operations have been completed. Some changes may evolve over time, for example through scar contraction or partial resorption of transferred tissue.

Phalloplasty is not a standard procedure but an individual medical decision. It can help in selected cases, particularly in reconstruction or in correcting deformities, but it has clear limits and risks that can affect function. A confidential assessment, realistic expectations and a discussion of alternatives are the essential steps before any surgery.