Construction of the neophallus in female-to-male transsexuals: the Amsterdam experience.

Until April 1991, 31 phalloplasties were performed in 28 patients at our hospital. Operative techniques and results of the use of the superficial inferior epigastric pedicled skin flap, rectus abdominis myocutaneous pedicled flap and radial forearm free flap for phalloplasty are presented and discussed. Functionally and cosmetically, the microsurgical free flap phalloplasty techniques lead to the best results. In all cases of free flap phalloplasty in our series tactile sensitivity recurred in the neophallus. However, erogenous sensibility should not be expected. We regard use of the infraumbilical flap to be a technique with few indications and it should not be applied to obese patients. Use of the rectus abdominis myocutaneous pedicled flap is a reliable technique. Primary connection of the pars fixa and pars pendulans urethrae often leads to formation of fistulas at the level of the anastomosis. Genital reassignment surgery in female-to-male transsexuals can seldom be achieved in 1 stage and this should be made clear to the patient before any form of surgery is done.