FFF Phalloplasty is a good alternative for patients, who do not want the forearm scar that is left by radial forearm phalloplasty. This procedure offers several advantages. For one, there is less prominent scarring. The complications of the forearm donor-site can be avoided. The free fibula flap offers natural rigidity and length according to the flap’s vascular pedicle. Interpositional vein grafts are unnecessary and dissection of the inferior epigastric artery system can be avoided. The results are usually most favourable after up to 1 year of follow-up.

However there are risks of resorption, curving and fracture of autologous bone transplants. Furthermore the rigid appearance of the phallus can be difficult to conceal and may be awkward for the patient. Follow-up surgery is usually required to slim down the phallus and glansplasty is further recommended. The clitoris can be buried if the patient wishes. The skin of the phallus will continually grow hair so the patient may also wish to shave the phallus to improve aesthetics.


The implant device used in this procedure is an osteocutaneous fibula flap. The harvested fibula bone is transplanted and fixed to the pubic symphysis. Scars will be left on the patient’s calf.

The patient will be able to urinate standing and sexual intercourse is possible. Some patients claim erotic sensations and orgasms, however this is not the expected result. Therefore the contralateral clitoral dorsal nerve and the clitoris should not be disturbed in order to maintain erogenous sensation. The ilioinguinal nerve does provide tactile and protective sensation in the dorsal area of the neophallus and in some of the frontal area.



ZSI is the only European manufacturer of artificial urinary sphincters and of malleable and inflatable penile implants, as solutions for male urological problems (incontinence), sexual complications (Erectile Dysfunction), and gender identity procedures (prostheses for trans men and women).



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