Bluebond‐Langner, Rachel

Abstract Introduction Many transmen chose to pursue penile prosthesis (PP) implantation as a stage of genital gender affirming surgery. The prosthesis facilitates penetrative intercourse, as the neophallus lacks rigid erectile tissue. While PP placement is a well-established and relatively low-risk surgical treatment option for erectile dysfunction is the cis-male population, published series of post-phalloplasty prosthesis placement have demonstrated a higher rate of complications and subsequent explant. Objective To demonstrate that an integrated surgical team that participates in all stages of phalloplasty creation can improve penile prosthesis outcomes in transmen. Methods We performed a retrospective review of all transmen who underwent PP implantation at our institution from January 2015 through October 2021, yielding a cohort of 44 men. Men who underwent phalloplasty for another reason (trauma, infection, priapism) were excluded. Both malleable (MPP) and inflatable (IPP) prostheses were included in the cohort. Home phalloplasty refers to phalloplasty performed at our institution, and outside phalloplasty at another institution. The surgical technique emphasizes exclusion of urinary flora from the operative field and avoiding excess anchor material to minimize niduses for infection. We analyzed preoperative, operative, and post-operative characteristics, stratified by whether the phalloplasty was performed at our institution. We also performed logistic regression for predictors of explant in the cohort. Results Cohort characteristics and outcomes are represented in Table 1. 44 PPs were implanted 28 at our institution, 16 at an outside institution. Average age was 32 and 33 in the cohorts, respectively. IPPs were more commonly implanted than MPP. Notably, operative time was significantly lower if the phalloplasty had been constructed at our institution (p=0.014). 16 men total required explant, 7/28 (25%) in the home phalloplasty group and 9/16 (56.3%) in the outside phalloplasty group. Predictors of explantation are shown in Table 2. Significant predictors included age (p=0.013), smoking (p=0.030), operative time (p=0.007), whether the phalloplasty was performed at our institution (p=0.043), and the number of pre-PP revision surgeries (p=0.047). On multivariate logistic regression including all variables significant on univariate analysis, only age (p=0.032) and operative time (p=0.010) remained significant predictors. Conclusions We present a large post-phalloplasty penile prosthesis cohort, demonstrating exceedingly low infection rate and improved explant rate in a cohort of men who all underwent both phalloplasty and prosthesis placement with the same surgical team. Our analysis suggests that phalloplasty characteristics, patient characteristics, and operative time can influence penile prosthesis outcomes. Disclosure No

Summary: As the field of plastic surgery continues to advance, so too do the number and complexity of ethical challenges faced by plastic surgeons. There is a paucity of literature, however, focusing on ethics in plastic surgery. Therefore, the authors offer a timely special topic series discussing ethical issues relevant to the field of plastic surgery. The goals of this series are four-fold: (1) to increase awareness of both frequently and less commonly encountered ethical issues in plastic surgery, (2) to foster discussion and debate of relevant and significant ethical issues, (3) to facilitate clinical ethics education and scholarship in plastic surgery, and (4) to apply an understanding and analysis of ethical issues in a way that optimizes clinical decision-making and delivery of patient care. In this introductory article, the authors discuss the current state of medical ethics scholarship in plastic surgery and introduce the first of several topics that will be detailed in the series. Ultimately, the hope is that increased awareness of the ethical challenges faced by surgeons and patients will improve the practice of plastic surgery.