Trans 101: Ep 26 - Phalloplasty (Bottom Surgery) [CC] - YouTube

Chase: Hi, and welcome to another episode of the Trans 101.

My name is Chase, and today we're talking about bottom surgery!

More specifically, we're going to be talking about the second time of bottom surgery, which is Phalloplasty.

The first type that I discussed was Metoidioplasty, which was in the previous video.

If you'd like more information on that one, please take a look at that video before this one.

It is going to be very hard to keep this video short, and I apologize!

Phalloplasty is a very complicated surgery that has a lot of steps,

so I will try to give you the most simple description. Now, please keep in mind, just a little disclaimer,

a lot of surgeons do this surgery differently.

A lot of surgeons do it in different stages. A lot of surgeons do it in one stage.

Um, there are different methods to do it, there are different places that do it,

there are different surgeons that do it. All of these things can be different.

But I will give you the most basic form of Phalloplasty explanation that I can.

And we’re just gonna go from there and I’ll explain more and more after.

So what I’m going to tell you right now is the most common form of Phalloplasty that I have seen people get.

Alright, so! Phalloplasty, what is it? You are creating a penis, alright?

And by the way, i will be using anatomically correct terms, so if that triggers anyone, I am very sorry.

But I want everyone to understand 100% what I am talking about.

So, in order to create a phallus in Phalloplasty, you need to get donor skin from your body; a donor graft.

Now, the most common graft that there is out there is the forearm.

The Forearm Phalloplasty is the most common Phalloplasty out there.

Where they basically--which is what I’m going to explain.

Uh, they basically would take the skin off of the arm here, they usually go about up to here.

Some surgeons go higher, some don’t. It’s different for everyone. But let’s just say that it goes here.

So they are taking the skin off of your arm.

And then they’re going to create the phallus with this skin.

Now in order for this arm to be covered, they are going to take a Split-Thickness Graft from your leg, usually.

So this is a very thin, thin skin that the will put onto your arm in order to cover the arm.

And this will act as your skin graft.

Over time is does heal, a lot of people it heals to either a pinkish hue or it’ll match your skin colour,

um, or it’ll just look a little bit bumpy.

Some people have gotten tattoos in order to hide it.

But that is usually, um, it usually just ends up being a very big scar,

but for some people really you can get a tattoo over it and you don’t even see a difference.

Whereas with others you can see that there is a visible difference.

Now, in order to create the phallus, you’re going to need a urethra as well.

So, how do you create a urethra?

With the skin that they have taken, from your arm, they’re going to take a little piece of it in order to create the urethra.

So with the new urethra, they connect it to your old urethra.

So they sew it together.

And then the new urethra now connects to the new penis, the new phallus

that has now been created from the skin and the tissue that you have in your arm.

And then, so the new urethra comes out of the tip of the penis.

Now. Some surgeons put the urethra at the tip of the penis.

Other, other surgeons put it kind of three-quarters of the way,

so that the urethra comes out of the base, like the bottom of the penis instead of the tip.

It depends on the surgeon, it depends on the method, like I said but most people get it through the tip.

Now this is the part that gets a little bit complicated.

This is where I’m talking about Microsurgery, and the connection of nerves,

and sexual function, and full sensation in the new penis.

Alright, so. There is a nerve that most surgeons will use that is connected,

It’s kinda, I can’t show you, I wish I could. It’s like on your hip,

Kinda on your hip but like, up in the front?

And so they usually do an incision right over here in order to connect the nerve.

Now where are they getting this nerve from?

There is a nerve in your arm that they take, alright.

So, it is, that’s why this is one of the most popular Phalloplasties

because the skin is very sensitive, very good skin to use for Phalloplasty.

But also because one of the main nerves in here is perfect for Phalloplasty.

They will connect this nerve, to the nerve that you have here, and bring it up to the phallus,

So that you can have sensation.

A lot of people, a lot of myths around Phalloplasty is no--you can’t feel anything.

They’re literally doing Microsurgery and connecting these nerves together in order for you to be able to have sensation.

Now there is another thing that you can do to have another nerve in order to increase sensation.

You will still have your clitoris, alright?

And that is, you have two, you have two options okay?

You can either leave it out, so it will be at the base of your penis, of your new penis that is now created.

So you will have the phalloplasty, and you will have your clitoris underneath.

Some people do this, that’s fine.

Other people will bury the clitoris inside the phallus, and they will take the nerves

that are in the clitoris, and they are going to attach them to the other nerve.

This can increase sensation for people.

Sensation is not guaranteed for everyone, but I have never met anyone in my personal life,

And I talk to a lot of people that have Phalloplasty, that have ever had zero sensation in their phallus.

If it’s not sexual sensation, then they can at least have some tactile sensation,

and the erotic sensation that they’ll get is usually from the base of their penis.

Now I have some very close friend who have had Phalloplasty, and

when they talk about sensation, they always talk about how "it’s so interesting how bodies are,

because the most sensation that I feel at my penis is the tip of the penis."

Now you would think that you could probably only feel the base, maybe the middle of

the penis, but really the most sensation they have is at the tip of the penis.

So you have your choice basically of what you want to do there,

but also some surgeons do it one specific way, so please do your research on the surgeon.

Have consultations, talk to surgeons, talk to people who’ve had surgery with that surgeon

if you know somebody and who is comfortable talking to you about it.

Now the next aspect is the scrotum. They’re going to build the scrotum, just like they do in Metoidioplasty,

They take the lips that you have, they kinda separate underneath in order to build the scrotum.

Some surgeons will fuse the scrotum together, some will have two separate sacs, um, and then they implant testicles.

Testicle implants are usually not implanted in the first stage of Phalloplasty.

I did not talk about stages because it can get very confusing if we do that.

So now I’m just telling you all of the information on what Phalloplasty is.

And then I’ll break it down into substages that are the most popular.

And then of course there is the Vaginectomy. Same thing as in the Metoidioplasty, it is the closure of the vagina.

So basically, if you look at someone’s genitals, it’ll look like they never had a vagina,

because it will be completely closed, there will be no hole at all.

Okay! So these are your genitals. And guess what, you can do whatever you want with

them, you just have the find the surgeon that does it.

So, you can have Phalloplasty where they create the new phallus without a new urethra.

So you’ll still pee out of where you pee out of right now, which means you’ll probably be peeing sitting down.

You can also get it without the nerve hook-up and the micro surgery,

you can also get it without the scrotum, and you can also get it without the Vaginectomy.

So common question is: Can you get Phalloplasty with the urethral lengthening,

the nerve hook-up, the, um, scrotum, but not the Vaginectomy.

Because some people would like to still use their hole and still have Phalloplasty.

This is a possibility. But it does increase the complications.

Now there are a lot of complications with Phalloplasty,

and there are a lot of complications with any surgery that exists, okay that's the point.

The most common complications are going to be the complication with the urethra.

Now there are two main things that could happen to the urethra.

One is a Fistula. Which is basically a hole in the urethra.

So it’s basically like if you’re drinking from a straw, and there’s like a little hole,

and when you’re drinking and sipping it a little water comes outta that little hole, that’s what a Fistula is.

That can either repair itself on it's own or

you need to get surgical intervention, order revision in order to close that up.

Now, the second thing is a Stricture, now that is a narrowing of the urethra.

Usually when that happens you need to go to a surgeon in order to get the urethra

dilated and reopened up to make sure that it doesn't close up again and in

Order for you to pee because a lotta people: okay but when that happens how do you pee?

Add a subpubic catheter so that you're able to actually urinate.

So, remember how I told you it's very complicated surgeries and there's a lot

of different things that you can do? Well I only talked about the arm Phalloplasty.

So there are so many different things that you can do now, the one--the second

most common one that I've seen is the thigh Phalloplasty. Now with the thigh

Phalloplasty you will have a girthier phallus because there is more tissue in

that area, usually that's what happens. So it's basically the same thing as the

arm, they will take the skin off of the thigh and they will create the phallus

with it and in order to cover that area they will take skin from your other thigh,

the very thin skin that I was talking about, and they will cover the thigh with

it in order for that not to be exposed and for you to be able to have it's

basically a skin graft so that you can, um, so that they can close up. Now there are

other places where some surgeons can take, I have seen the back here. There's

also the pubic Phalloplasty where they take the groin skin on the stomach

There's also I've seen calf muscle, there's--butt. I've also seen butt, so I

can't tell you all of these special things, but I can tell you exactly that

is what Phalloplasty usually is. So how many stages are there really in

Phalloplasty? I have seen one stage, up to four stages. Some surgeons do four stages

because they do the urethra in a completely different stage, which means

that you need to have surgery four times. You don't need to have the erectile

device put in but, I'm going to talk about that just a little bit because

everyone's always asking questions about sex, which I can understand because

They're your genitals and you want to know if there can be functioning. So

can you have sex with Phalloplasty? Absolutely. And how I said that not

everyone gets an erectile device, but how can you still have sex without an

erectile device? Ha! Well, so basically what is an erectile device? Well, it's a

device that they put into the phallus in order for you to get erect and in order

for you to be able to penetrate someone. There are a lot of different types of

erectile devices. The main ones are: the pump, so it's two cylinders that are in

the phallus and you usually pump it and the pump is usually in like the scrotum

so it acts as a ball, so you pump it and it goes up and then you click like a

little switch and then it goes down again.

Now the other one that's popular is a semi-rigid rod. That one is not, it's kinda,

it's not fused to your pelvic bone, but it is kind of tied to your pelvic

bone. And it is a semi rigid rod. So it's a rod that will always be a little bit

hard so you always kind of have a semi. In order to put it down you put it down

like that and then if you want to have sex you want to be erect you just kind

of click it up and it will stay like that. Keep in mind that with Phalloplasty

the penis will always be the same size. It is not like a cis penis where it

gets smaller when it is not erect and when it is erect it gets bigger. Your

penis will always be that size, so if you choose to have a six inch dick you will

always have six inches in your pants. This is not a problem for some people

but other people have said that it's hard to get used to. A friend that I

have who has just gotten the erectile device put in, he got the semi-rigid

rod, is having a little hard time right now trying to find underwear that helped

his bulge because his bulge is so big. It's also hard to wear sweatpants and to

wear other types of clothes, you just kind of have to readjust, but not

everyone gets the erectile device and if you don't get the erectile device and

you want to have sex there are different ways that you can do that. I won't get

into that because this is supposed to be a basic 101 Phalloplasty video, but I'm

getting into like crazy detail right now. I'm going to answer a very basic

question: can you cum? Well, you can orgasm, you can climax, you can finish.

You're great. Everything is good. Most people can, okay. Almost every single person that

I know has been able to have sexual function in their phalloplasties. Now can

you ejaculate? Do you have semen that will now ejaculate out of your penis? No.

That doesn't happen, we don't have those parts, we cannot get those parts

implanted into us. So you will not be able to ejaculate and something will

literally come out of your penis. Some people have said that they can do it and

it's very rare, but it doesn't shoot out and just kind of like leaks out a little

bit. But that's very rare and it's not common, it's not sperm. It's the stuff that

they had originally, that made them wet. This is what I have understood from that

but that's not something that a lot of people talk about, so that's not I can't

give you a "100% that is exactly what happens." So how much is Phalloplasty?

Like every other surgery video I've done, I cannot give you a number. But, phew, get ready

for this, it's very intense surgeries... I have seen an amount from $40,000

all the way up to $200,000. Most surgeons will take insurance in America, from what

I understand and there are a lot more insurances that do cover it. I can't give

you an example... "Hey I know someone who worked at Apple

we've got everything covered." Like, yes, but those are like examples for my

personal story, from my personal life and I can't tell you if that's 100% accurate

for everyone who would work at Apple. You know what I'm saying? So it is a very costly

surgery and it depends on how many stages you want and if you want multiple

stages it can go up to $300,000, it could go up to $500,000, it really depends but

like I said, usually most people don't pay for this out of pocket, they usually have

insurance. If you live in Canada, it is covered by health insurance. The recovery

time is different for everyone, from what I understand from my friends it

sometimes can take six weeks and I have seen people go hiking two weeks post-op

and I'm like what are you doing?! I feels oh my god and then I have seen some people

take three months to recover. So uh and be able to do normal life activities and be

able to slowly go back to the gym and go upstairs and all of this stuff like go

upstairs without having like uh, like to think about it. But it's different for

everyone some people heal longer some people--[giggling] Longer huh? No. The last thing I

want to mention is: can you take the side of your dick? Because I know a lot of

people will ask this question. Technically you can. It really depends on

the surgeon. There is someone that I know who really wanted to have a very large

penis, so they found this surgeon who said yes they will be able to do that.

Because most surgeons will say no, because it can increase the risk of

complications. And I say that because the urethra is longer and usually

they take the skin from here and people don't usually have a lot of skin, like

i have thin, i have thin risks, wrists, risks? Wow. Wrists and forearms, so I wouldn't be

able to have a very girthy penis if I wanted to get like Forearm Phalloplasty as

an example, but usually, usually ends up being around five inches usually but you

can typically ask if you want to six inch, it really depends on the surgeon

okay? I literally I can't--some, some want smaller because they know that it'll be

the same size forever, so like I just want three inches.

Anyways that's it, I'm so sorry this video is very long. It's hard to talk about

Phalloplasty with that and there's so much more information that I'm not

telling you, because it would go on forever. If you have any questions I will

put all the links in the description below. And some blogs that you can look

at of people who have had Phalloplasty and who talk about it openly and will give you

the experiences that they've had. A lot of information that I have gotten have been

from these people who have shared their stories, so I would like to thank them

because that is fantastic that they're doing that to help other people. So

please take a look at those links in the description below. And I hope that you

were able to understand a little bit about Phalloplasty, if you have any

questions please let me know. And I will see you later. Have a great day! Bye!