Phalloplasty: How to Prepare

In This Article

Phalloplasty, sometimes known as “bottom surgery,” involves using skin tissue from other parts of the body—usually the arm or thigh—to construct or rebuild a penis. Most often, this procedure is an integral part of gender reassignment and affirmation for transgender men and trans-masculine persons, though it may be indicated in some other cases.

Depending on the approach taken, this work may require several stages, with each requiring a hospital stay of five or more days. As such, there’s a lot that goes into preparing for the day of surgery. As you look towards the procedure and get your body ready, make sure you’re communicating with your doctor and clarifying all information with them.

Surgeon prepares for phalloplasty surgery
Shannon Fagan / Digital Vision / Getty Images

Location

Phalloplasty is a very complex, multi-stage procedure, with each surgery expected to take six to eight hours. It occurs while you’re put to sleep, with recovery happening in the hospital.

After a final consultation and check-up in a pre-op room, patients are taken to the operating room and given anesthetics intravenously. What sort of equipment can you expect there? Here’s a quick breakdown:

  • Operating table: Patients are placed on an operating table that allows surgical staff a good working environment.
  • Operating room lamps: These will be necessary to ensure good lighting for the surgeon.
  • Monitor screens: Monitors will display your heart rate, oxygen level, and blood pressure during the procedure.
  • Ventilator: You’ll be attached to a ventilator to assist with breathing while you’re asleep.
  • Instruments: Trays with sterile surgical tools will be readily available for the team.        
  • Other equipment: Diathermy machines, which control bleeding, and video monitoring equipment are often a part of the operating room set-up. 

What to Wear

Keep in mind that recovery from phalloplasty is quite extensive; you can expect to spend at least five days in the hospital. When it comes to planning clothing on the day of surgery, there are several things to keep in mind:

  • Loose clothing: It’s easiest if you wear the same, loose-fitting and comfortable outfit to and from the hospital. Steer clear of tighter fits.
  • Skip jewelry: Your best bet is to leave jewelry and other valuables at home.
  • Comfortable wear: Since you’ll be staying in the hospital for some time, it’s always a good idea to bring along slippers and a robe. 

Food and Drink

As with all major surgeries, you’ll need to follow some strict dietary guidelines in the run-up to surgery. It’s absolutely essential that you keep up with these to ensure the best possible outcome. What does the pre-op diet look like? Here are some tips:

  • Eat a high protein diet in the months preceding surgery, as this will help your body recover.
  • Make sure you’re getting vitamins and consider taking a daily multivitamin to help prepare your body for surgery.
  • Keep an eye on nutrition to help ensure a better outcome; prior to surgery, you’ll take an albumin test, which measures level of nutrition.

Special precautions also need to be taken in the two days before surgery. These include avoiding certain foods:

  • Fruits with seeds
  • Peas
  • Red meats
  • Dairy
  • Beans
  • Nuts
  • Spicy foods
  • Fried food

Finally, for the final 24 hours before surgery, some other changes need to be made. In preparation, don’t eat any solid foods after lunch the day before your procedure, and drink only clear liquids, meaning:

  • Water
  • Tea
  • Sports drinks
  • Black coffee
  • Clear broth
  • Popsicles

Medications

Since the body—specifically the bowels—need to prepare for phalloplasty, your doctor may ask you to use several over-the-counter medications and products. These typically include:

  • Magnesium citrate oral solution: This laxative, among others, helps prepare the bowel for the procedure and should be taken 24 hours prior to surgery.
  • Fleet enema: This fast-acting laxative should be used once, on the afternoon before surgery.
  • Dulcolax tablets (bisacodyl): This laxative should be taken the morning of your surgery.

Of course, exact instructions can vary, so make sure you have a clear sense of what you’re doctor wants you to do.

If you’re seeking gender confirmation surgery and are taking hormones, you’ll be asked to stop taking them for the three weeks prior to surgery. Not only that, both prescribed and over-the-counter drugs you’re taking can also influence outcomes. For the last week before your procedure, make sure to stop taking the following:

  • Aspirin
  • Motrin, Advil (ibuprofen)
  • Aleve, Naproxen (naprosyn)
  • Vitamin E
  • Multivitamins
  • Herbs (fish oil, garlic oil, gingko, and others)

Since some prescription drugs can also interfere with the body’s ability to recover from surgery, be sure to let your doctor know what you’re taking.

What to Bring

Since recovery from phalloplasty requires at least five days in the hospital, patients need to prepare for a lengthy stay. What should you bring along? What arrangements need to be made? Here are some quick tips:

  • Arrange transportation: Since you’ll be undergoing major surgery and be taking pain-relieving medications afterward, make sure to have a loved one or friend give you a ride to and from the hospital. If this can’t be arranged, your hospital can certainly help arrange transportation.
  • Electronics: During recovery, you’ll need to pass the time; many patients bring along iPads or other electronic devices to watch TV, movies, or play games.
  • Reading: Of course, another way to entertain yourself during your hospital stay is to bring along a book or some magazines to read.
  • Personal items: You may want to bring some personal hygiene items with you, such as dry shampoo, a shaving kit (though don’t try to shave healing areas), moisturizer, and lip balm. For the hospital stay, an eye mask and earplugs may also help you with sleep.
  • Support network: Family and friends of patients can be advocates and helpers for those in recovery. Let them know that you’re undergoing surgery and see if anyone would be able to visit you as you rest and heal.
  • Insurance information: Since phalloplasty involves multiple assessments and consultations, your hospital should have your information on file by the time you’re heading into surgery. It still might be a good idea to bring along your insurance card or have a loved one or friend have it ready for you.

Pre-Op Lifestyle Changes

All major surgeries require you to make significant lifestyle adjustments to get your body ready, and phalloplasty is no different. The goal of these changes is to ensure successful gender affirmation for transgender men or transmasculine people and complication-free recovery for all who are undergoing this procedure.

You’ll get counseling from your doctor throughout the process, but here’s a rough guide of what you can expect:

  • Hormone therapy: For transgender men or transmasculine people, you need to take androgen hormone therapy for at least 12 months prior to surgery (except for the final three weeks before your appointment, as noted above). Your doctor will go over how to correctly and safely take hormones.
  • Identification: Another key component of gender confirmation through phalloplasty is a demonstrated and documented desire and ability to live as the preferred gender. Part of the process of evaluation involves talking to and seeking the approval of a mental health professional who can affirm this experience.
  • Quit smoking: Smoking tobacco or cannabis can harm lung function, which can affect healing and recovery from major surgery. Nicotine use is tested prior to phalloplasty, and you need to be cigarette, cigar, or smokeless tobacco free for at least six weeks prior to surgery.
  • Exercise: Phalloplasty takes a huge toll on the body, and the healthier you are, the better you’re recovery will be. As part of your pre-op health plan, be sure to do what you can to get regular exercise.  

A Word From Verywell

There’s no doubt that preparation for a major surgery like phalloplasty is a significant undertaking. Especially if you’re undergoing this procedure as part of gender confirmation, there’s a lot that you’ll need to keep track of as you move towards the date of your operation.

This can be a difficult time—which is why mental health counseling is an essential part of the process—so remember that, alongside family and friends, your medical team is there to help.

Furthermore, there are many informative and supportive resources for those going through with transition, such as the National Center for Trans Equality and the Trans Lifeline, among others. With the right support, there’s no doubt that you’ll be ready for your phalloplasty.   

Was this page helpful?
Article Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Crane C. Phalloplasty and metoidioplasty - overview and postoperative considerations. UCSF Transgender Care. 2016. 

  2. Heston A, Esmonde N, Dugi D, Burli J. Phalloplasty: techniques and outcomes. Transl Androl Urol. 2019;8(3):254–265. doi:10.21037/tau.2019.05.05

  3. University of Rochester Medical Center. Preparing for surgery: the operating room. 2020. 

  4. University of Utah Health. Phalloplasty guide: how to prepare & what to expect during your recovery. 2020. 

  5. Larowe E. Gender reassignment surgery phalloplasty pre-operative instructions. University of Michigan Health System. 2014.