CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2021; 06(02): e57-e62
DOI: 10.1055/s-0041-1732373
Original Article

Flap Selection Algorithm Based on the Body Mass Index for Phalloplasty in Female-to-Male Transgender: Techniques and Outcomes

Toshiyuki Watanabe
1   Department of Plastic and Reconstructive Surgery, Okayama University Hospital, Plastic and Reconstructive Surgery, Okayama, Japan
,
Yuzaburo Namba
1   Department of Plastic and Reconstructive Surgery, Okayama University Hospital, Plastic and Reconstructive Surgery, Okayama, Japan
,
Yoshihiro Kimata
1   Department of Plastic and Reconstructive Surgery, Okayama University Hospital, Plastic and Reconstructive Surgery, Okayama, Japan
› Author Affiliations

Abstract

Background Various phalloplasty methods have been reported; however, a consensus has not been reached. Therefore, we suggest an alternative algorithm for an ideal phalloplasty considering the factors that affect flap selection.

Methods We retrospectively examined 32 phalloplasty cases of female-to-male transgender. Flaps used for phalloplasty were classified into three groups as follows: (1) radial forearm (RF) group, (2) anterolateral thigh (ALT) group, and (3) flap combination (FC) group. Statistical analyses were performed to determine the significance of age and body mass index (BMI) as well as differences in the rates of postoperative complication, reoperation, esthetic acceptability, tactile or erogenous sensibility, and the ability to urinate while standing.

Results Ten cases were included in the RF group and 7 and 15 cases in the ALT and FC groups, respectively. With respect to BMI, the RF group (mean [standard deviation (SD)] = 25.9 [3.3]) showed significantly higher BMI than the ALT (21.7 [0.9]) or FC group (22.2 [4.5]). The RF (mean [SD] = 3.7 [0.4]) and ALT groups (3.5 [0.9]) had significantly higher esthetic acceptability evaluation scores (from 1 to 4) than the FC group (2.5 [1.2]). Moreover, the RF and ALT groups were superior than the FC group in terms of tactile or erogenous sensibility rates.

Conclusion BMI effected flap choices for phalloplasty because of the correlation between BMI and skin thickness. FC becomes an option between ALT flap and RF flap in terms of flap choice based on BMI. Our alternative algorithm for an ideal phalloplasty based on BMI will be useful for objective flap choices.



Publication History

Received: 02 November 2020

Accepted: 07 May 2021

Article published online:
22 July 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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