Doctors of Delhi’s Sir Ganga Ram Hospital have successfully performed a micro-surgical technique of tissue transfer to reconstruct the penis, called phalloplasty, on a 34-year-woman from UP. 

After the successful surgery, the woman, Gayatri (name changed) married to his childhood friend.

The woman came to the Department of Plastic and Cosmetic Surgery, SGRH, two months back from Uttar Pradesh with a desire of changing her gender.

The doctors said that after physical and psychiatric evaluation the doctors found that person was a woman carrying a male mindset encased in a female body, a condition called Gender Dysphoria, a term that describes a sense of unease that a person may have because of a mismatch between their biological sex and their gender identity.

In the last six years, Gayatri had already undergone bilateral breast removal in 2017 and uterus, ovary and vaginal removal in 2019.
She was put on male hormone replacement therapy in 2016. At the time of arrival at SGTH, the patient had all male characteristics including a beard, hairs on her chest, a male voice and male behaviours.
 
The only requirement was for penile reconstruction (Phalloplasty) and an implant to transform her into a male.  

Dr Bheem Singh Nanda, Senior Consultant, Department of Plastic and Cosmetic Surgery, SGRH, said, “We decided to perform penile reconstruction (Phalloplasty) for complete male transformation by the state of 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 the 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 added.
Dr Nanda pointed out that 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,” he added.

“It was a successful surgery which took about eight hours with minimal blood loss. Six weeks post-surgery the patient is completely male with 5 inches of male sexual organ (penis). Now Gayatri is Mahesh and passes urine in standing position and uses male urinal,” Dr Nanda said.

Mahesh is now married to his childhood sweetheart Shalini, who.
Dr Nanda stressed that 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,” he added.

“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 the radial forearm flap technique because it gives better shape, urethra quality and good sensation as compared to other techniques,” Dr Nanda said.