Skip to content

MLD Phalloplasty

Re-innervated Latissimus Dorsi Free Flap Phalloplasty

Re-innervated Latissimus Dorsi Free FlapNovel Phalloplasty Procedure Gives Patients Ability for Sexual Intercourse Without a Prosthesis

This variation of MLD Phalloplasty gives the patient ability for having sexual intercourse without the need for prosthesis. The voluntary contraction of the phallus appears soon after the surgery, and this leads to the changes of diameter length and shape - the "paradox erection" (a stiffening, widening and shortening of the penis.) Some patients are able to take advantage of these properties for sexual intercourse.

In a 2008 study led by Dr. Ranno at Masaryk University, Brno, Czech Republic, the latissimus dorsi musculocutaneous reinnervated free flap was used in phalloplasty surgeries to allow voluntary rigidity of the neopenis. From the first 22 patients, 18 obtained motoric function of the reconstructed penis. The researchers concluded that this voluntary contraction of the penis is a consequence of the re-innervation of the transferred muscle, and the contraction is strong enough to stiffen the penis. In this procedure, the thoracodorsal nerve is sutured to the anterior branch of the obturator nerve which runs to the gracilis muscle.

The described technique allows for subsequent reconstruction of the urethra if the patient desires.

Surgeons who offer this type of phalloplasty:

  • Dr. Veselý (CZ)
  • Dr. Justan (CZ)

Read the full article:

Neophalloplasty With a Reinnervared Latissimus Dorsi Free Flap: A Functional Study Of a Novel Technique
Ranno R., Veselý J., Hýža P., Stupka I., Justan I., Dvorák Z., Monni N., Novák P., Ranno S., Scripta Medica (BRNO) – 81 (1): 1#–22, April 2008

Also see:

Photos of MLD Phalloplasty Results at 8 weeks and 9 months post-operative. Surgery performed by Dr. Jirí Veselý.

New technique of total phalloplasty with reinnervated latissimus dorsi myocutaneous free flap in female-to-male transsexuals.
Vesely J, Hyza P, Ranno R, Cigna E, Monni N, Stupka I, Justan I, Dvorak Z, Novak P, Ranno S. Ann Plast Surg. 2007 May;58(5):544-50.
The described technique of neophalloplasty proved to be a reliable technique and the muscle movement in the neophallus can be expected in almost all cases. The muscle contraction in the neophallus leads to "paradox" erection-stiffening, widening, and shortening of the neopenis, which allows for sexual intercourse in some patients.

An objective evaluation of contraction power of neo-phallus reconstructed with free re-innervated LD in female-to-male transsexuals.
Ranno R, Hýza P, Veselý J, Dessy LA, Kadanka Z., Acta Chir Plast. 2007;49(1):8-12.
The advantage of this technique is non-requirement of the prosthesis for sexual activity due to the d



FTM Surgery