A successful Phalloplasty surgery – penile reconstruction and implant to transform a female to a male (FTM) – has not only effected a physical transformation of 34-year-old Gayatri but also helped her fulfill her dream to marry Shalini, her "childhood sweetheart". Rechristened as Mahesh, he, is now discharging the responsibilities of a husband.
However, the journey to transform from a female to male has not been easy for the patient, reveal the doctors at the Delhi-based Sir Ganga Ram Hospital. Gender dysphoria is a term that describes a sense of unease or psychological discomfort that a person may have because of a mismatch between their biological sex and their gender identity.
“Gayatri, a resident of Uttar Pradesh, who was suffering from Gender Dysphoria had visited us two months ago to get completely transformed into a male. She had over the past six years transitioned from female to male, having been put on male hormone replacement therapy since 2016, undergoing bilateral breast removal in 2017, as well as uterus, ovary and vaginal removal in 2019.
“After her psychological evaluation, we found that although the patient was a female but mentally she was a male, a condition which is called Gender Dysphoria,” said Dr. Bheem Singh Nanda, Senior Consultant, Department of Plastic & Cosmetic Surgery, Sir Ganga Ram Hospital.
According to Dr Nanda, “We decided to perform penile reconstruction (Phalloplasty) for complete male transformation by state-of-the-art micro-surgical technique of tissue transfer. Our aim was to give good shape, length, urethra (to pass urine) and erotic sensation to the patient.
“Of all the techniques we chose the forearm as a donor for penile reconstruction. This was a challenging surgery as the penis was fabricated on the forearm with preservation of vessels and all the important nerves. The next step was to implant the reconstructed penis from the forearm to the genital area of the patient.”
Dr. Nanda continued, “The second challenge was to join the urethra (urine tube) and then connect the vessels to establish the blood circulation again in the reconstructed penis. The last and the most important step was to join the nerves of the reconstructed penis with the erotic nerves (Pudendal nerve and nerve to clitoris) which is the most important pre-requisite for penile implant and sexual satisfaction later.”
It was a successful surgery which took about eight hours with minimal blood loss, said the doctor.
Six weeks post-surgery, the patient is completely male with five inches of male sexual organ (penis). Now Gayatri is Mahesh and passes urine in standing position and uses male urinal.
“Phalloplasty has matured considerably over the last decades in reconstructive options and technical refinements, thanks to increasing recognition of Gender Dysphoria. The primary goals of performing a phalloplasty are to facilitate sexual penetration, protective sensation, orgasm, standing micturition, and natural aesthetic, ideally in few stages and with minimal morbidity.
“Radial forearm free flap and anterolateral flap are the most common options, each with a unique profile of complications, aesthetic, and functional outcomes,” said Dr Nanda.
Choices for reconstruction must be tailored to the individual patient’s goals and available tissue characteristics. In Gayatri’s case we chose radial forearm flap technique because it gives better shape, urethra quality and good sensation as compared to other techniques, said the doctor.