Penile replacement surgery, often referred to as penile reconstruction or phalloplasty, is a surgical procedure used to construct or reconstruct a penis. The procedure is commonly sought by transgender men (female-to-male) as part of their gender-affirming surgeries, but it’s also performed on cisgender males due to congenital conditions, trauma, disease, or penile cancer.

Here’s an overview:

1. Phalloplasty for Transgender Men:
   • This surgery involves creating a neophallus using tissue grafts, often from the forearm, thigh, or back (depending on the patient’s preference and anatomy).
   • The new penis can have a urethra constructed, allowing for urination from a standing position.
   • Sensation is an essential aspect of the surgery. Surgeons often try to maintain and reestablish nerve connections, which, in successful cases, allows for tactile and potentially erotic sensation in the neophallus over time.
   • A scrotoplasty, or creation of a scrotum using labial tissue, is often performed concurrently. Testicular implants can be placed in the neoscrotum for a more typical male appearance.
   • Erectile implants can be added later to facilitate penetrative intercourse.
2. Penile Reconstruction for Cisgender Men:
   • In cases of trauma, cancer, or congenital absence, penile reconstruction might involve using tissue grafts from other parts of the body, similar to the process for transgender men.
   • Additionally, in certain cases, a prosthetic penis can be implanted to restore function and appearance.
3. Risks and Complications:
   • Phalloplasty and penile reconstruction are complex procedures. Potential complications include:
     • Infections
     • Complications with wound healing
     • Urethral complications (strictures, fistulas)
     • Loss of sensation
     • Complications with erectile or testicular implants
     • Unsatisfactory cosmetic outcomes
   • Multiple surgeries or revisions might be needed over time.
4. Postoperative Care:
   • Following the surgery, patients will need a significant recovery period and will have various post-op instructions, including wound care and potentially dilation of the neourethra to maintain its patency.
   • Sensation and function can take time to develop and may require further interventions or therapies.
5. Total Penile Transplants:
   • An emerging field of penile replacement involves total penile transplants from deceased donors. This has been explored for cases involving traumatic penile loss, such as in severe combat injuries. As of my last training data in September 2021, only a few such transplants had been conducted worldwide.

It’s essential for individuals considering penile replacement or reconstruction to consult with experienced surgeons to understand the potential benefits, risks, and long-term implications. Proper support, both medically and psychologically, is crucial throughout the process.