(281) Predictors of Complications and Flap Survival in Cisgender Total Phallic Construction: A Tertiary Referral Center Analysis

Abstract Introduction Phalloplasty in cisgender males is an uncommon yet highly complex reconstructive procedure, primarily indicated following traumatic, iatrogenic, or oncologic penile loss. Evidence regarding predictive factors for postoperative outcomes in this population remains limited, as most available literature focuses on gender-affirming surgery. Objective This study aimed to evaluate perioperative outcomes and potential predictors of complications in cisgender patients undergoing phalloplasty at a tertiary referral center. Methods A retrospective observational analysis was conducted on all cisgender male patients who underwent total phallic costruction between 2010 and 2025 in a tertiary referral center. Demographic and clinical variables included age at surgery, smoking status, diabetes, body mass index (BMI), and type of phalloplasty. Surgical complications were reported both intraoperatively and postoperatively. The primary endpoints were incidence of postoperative complications, emergency vascular anastomosis revision and partial/total flap loss. Statistical analysis was performed using Jamovi (v2.6), employing multiple linear regression models to identify independent predictors of each outcome. Results A total of 11 cisgender male patients were included. The mean follow-up time was 24.5±14.9 months. The mean age at surgery was 42.6±18.4 years, and the mean BMI was 25.0±4.1 kg/m2. Six patients underwent radial forearm phalloplasty (RAP), two anterolateral thigh (ALT) phalloplasty, and three pubic phalloplasty. Only one patient experienced an intraoperative complication (venous thrombosis). The overall postoperative complication rate was 27%, with vascular revision required in 18% and total flap loss in 9% of cases. Regression analysis revealed no significant predictive effect of age, smoking, diabetes, or flap type on postoperative complications or emergency vascular revision on flap-related complications. However, BMI showed a slight association with total flap loss (p=0.05). Conclusions Our study represents one of the few focused on cisgender phalloplasty outcomes. Despite the small sample size, higher BMI appears to correlate with an increased risk of flap failure, highlighting the importance of preoperative weight optimization and careful patient selection. Larger multicenter studies are needed to corroborate these preliminary results and to refine the understanding of risk factors in cisgender phallic construction. Disclosure No