New Delhi, November 21, 2022:

Department of Plastic & Cosmetic Surgery, Sir Ganga Ram Hospital, received a 34 years female Gayatri, (name changed) 2 months back from Uttar Pradesh who wanted to get completely transitted into a male. By all proportions and psychiatric evaluations it was found that although patient was female but mentally she was a male, a condition which is called Gender Dysphoria.

In last 6 years Gayatri had already undergone bilateral breast removal in 2017 and uterus, ovary and vaginal removal in 2019. She was on male hormone replacement therapy since 2016. At the time of arrival at Sir Ganga Ram Hospital, patient had all male characteristics including beard, hairs on chest, male voice and male behaviours. Only requirement was Penile reconstruction (Phalloplasty) and implant to transform her to male .

According to Dr. Bheem Singh Nanda, Senior Consultant, Department of Plastic & Cosmetic Surgery, Sir Ganga Ram Hospital, “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 forearm as 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 8 hours with minimal blood loss. 6 weeks post-surgery the patient is completely male. Now Gayatri is Mahesh and passes urine in standing position and uses male urinal.

Mahesh is now married to Shalini, who was love of his life since student days.

Dr. Nanda added, “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. 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.”



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