Abdominal phalloplasty

Abdominal or suprapubic phalloplasty is an option for gender-affirming genital surgery in transmasculine and nonbinary people. We review the relevant anatomy, preoperative evaluation and counseling, surgical techniques, advantages, limitations, and complications of abdominal phalloplasty. Abdominal phalloplasty can be performed either as a single-stage pedicled phalloplasty for patients who desire a phallus but do not wish to stand to urinate or want an erectile implant or as a staged procedure with subsequent urethroplasty and penile implant placement. The key advantages of abdominal phalloplasty include a satisfactory phallus size, the absence of a microsurgical anastomosis, homogeneous skin color of the phallus and the groin, and an inconspicuous donor site scar. Limitations may include a lack of nerve coaptation to the dorsal clitoral nerve, thick subcutaneous tissue limiting tubularization, and potential for variability in the blood supply. Abdominal and suprapubic phalloplasty results in a satisfactory phallus for many patients with a comparatively low risk of complications.