Dr. Bauback Safa, MD is an internationally renowned Reconstructive Microsurgeon at the Buncke Clinic in San Francisco, widely considered to be the birthplace of microsurgery. Dr. Safa serves as Clinical Assistant Professor of Surgery at both Stanford and UCSF divisions of plastic surgery. He is highly sought after as a surgical educator and has trained hundreds of surgeons around the world in all aspects of microsurgery.
Latest Research
Phalloplasty Flap Salvage Using a Superficial Circumflex Iliac Artery Perforator Propeller Flap. [FULL TEXT]
Rochlin DH, Lin W, Reitz RJ, Chen M, Buntic R, Watt A, Safa B. Plast Reconstr Surg Glob Open. 2024 Jan 29;12(1):e5522.
Partial phalloplasty flap loss presents an evolving challenge, largely due to the complex demands required for both aesthetics and function. We describe our novel experience using the superficial circumflex iliac perforator (SCIP) propeller flap for neophallus salvage when skin grafting alone provides insufficient soft tissue bulk or coverage.
Microsurgical Gender Affirmation Surgery. [FULL TEXT]
Watt AJ, Safa B, Chen ML. Semin Plast Surg. 2022 Nov 11;36(4):274-284.
This manuscript will review techniques for the creation of perineal urethral segment as well as primary flaps available for the creation of neophallus. Particular emphasis is given to our preferred method of reconstruction: single-stage urethral lengthening with radial forearm flap phalloplasty including a review of surgical techniques and complications.
Modification of the single-tube radial forearm phalloplasty technique to allow for urinary meatal reconstruction: A report of two cases.
Miller TJ, Saberski ER, Safa B, Watt AJ. Microsurgery. 2022 Oct;42(7):728-731.
The risk of complications and a lack of desire for standing urination are reasons patients elect for single-tube phalloplasty. However, to date, single-tube phalloplasties lack creation of a urinary meatus, which affects the aesthetics of the reconstruction. The purpose of this report is to describe a technique for creating an aesthetic urinary meatus in single-tube phalloplasty.
Immediate Lymphovenous Bypass Treated Donor Site Lymphedema during Phalloplasty for Gender Dysphoria [FULL TEXT]
Walter Lin, Bauback Safa, Mang Chen, Ming-Huei Cheng. Plast Reconstr Surg Glob Open. Sept 17 2021;9(9):e3822.
The extended radial forearm flap phalloplasty remains one of the most commonly performed gender-affirming phalloplasty techniques. One potential morbidity that has emerged is postoperative donor site lymphedema, which was susceptible to develop after harvest of extended radial forearm flap. In the setting of preventative or immediate lymphovenous bypass (LVB) with axillary lymph node dissection for the treatment of breast cancer, it is possible that a subset of patients undergoing gender-affirmation surgery would benefit from immediate lymphatic reconstruction at the time of primary phalloplasty. Lymphography showed no dermal backflow at 5 months follow-up; at 13 months, the patient demonstrated no signs or symptoms of lymphedema in the left forearm or hand.
Transgender Scrotoplasty and Perineal Reconstruction With Labia Majora Flaps: Technique and Outcomes From 147 Consecutive Cases
Travis J Miller, Walter C Lin, Bauback Safa, Andrew J Watt, Mang L Chen. Ann Plast Surg. Sept 1 2021; 87(3):324-330.
We retrospectively reviewed the outcomes of phalloplasty patients who underwent either primary or secondary labia majora flap scrotoplasty and perineal reconstruction from October 1, 2017, to December 1, 2019. Bilateral elevation and rotational flap advancement from the posterior to anterior position formed a pouch-like scrotum. Perineal reconstruction involved multilayered closure with apposition of the inner thigh skin. Minor wound complications are common and frequently heal with conservative management. Wounds that do not heal may be associated with urethral complications.
Infrapubic Insertion of Penile Implants in Transmen After Phalloplasty
Mang L Chen, Darshan P Patel, Rachel A Moses, Isak A Goodwin, Bauback Safa, Andrew J Watt, James M Hotaling. Urology. Jun 2021; 152:79-83.
Our infrapubic prosthesis insertion after phalloplasty technique with modifications to commercially available implants may help reduce the risk of postoperative complications.
Neourethra Creation in Gender Phalloplasty: Differences in Techniques and Staging
Berli JU, Monstrey S, Safa B, Chen M. Plast Reconstr Surg. 2021 May 1;147(5):801e-811e.
Neourethra reconstruction is the most challenging aspect of phalloplasty, with widely varying techniques and staging between providers. In this expert opinion article, the authors strive to give an overview of the principles behind, and a detailed explanation of, the technical details of creating the penile and bulbar urethra during phalloplasty. The authors focus on the three most common strategies: single-stage phalloplasty; two-stage phalloplasty with a metoidioplasty-first approach; and two-stage phalloplasty with a phalloplasty-first (Big Ben method) approach. It is not the authors’ intent to establish the “best” or “only” way, but rather to compile different options with their respective pros and cons.
Gender-Affirming Health Insurance Reform in the United States.
Ngaage LM, Xue S, Borrelli MR, Safa B, Berli JU, Bluebond-Langner R, Rasko YM. Ann Plast Surg. 2021 Jan 19.
In May 2014, the US Department of Health and Human Services prohibited insurance discrimination of transgender individuals. Despite this, insurance plans often lack explicit guidelines on gender transition-related care and coverage of surgical procedures is extremely varied. We evaluated the evolution of insurance coverage of gender-affirming care following the 2014 legislative change.
An abnormal clinical Allen’s Test is not a contraindication for free radial forearm flap.
Miller TJ, Safa B, Watt AJ, Chen ML, Lin WC. Clin Case Rep. 2020
Jul 15;8(11):2191-2194.
An abnormal clinical Allen’s test is not a definitive exclusion criterion for free radial forearm flap use. A surgical Allen’s test may be useful to determine whether flap harvest is feasible in patients with an abnormal clinical Allen’s test.
Single-Stage Phalloplasty.
Chen ML, Safa B. Urol Clin North Am. 2019 Nov;46(4):567-580.
Single-stage phalloplasty may be accomplished by having both the microsurgical and the reconstructive urology team operate simultaneously. The single-staged approach is favored in patients whose ultimate goal is to have an aesthetic, sensate, and functional phallus and scrotum.
Current Concepts in Feminizing Gender Surgery.
Safa B, Lin WC, Salim AM, Deschamps-Braly JC, Poh MM. Plast Reconstr Surg. 2019 May;143(5):1081e-1091e.
This CME article reviews key terminology and standards of care, and provides an overview of various feminizing gender-affirming surgical procedures.
Current Concepts in Masculinizing Gender Surgery.
Safa B, Lin WC, Salim AM, Deschamps-Braly JC, Poh MM. Plast Reconstr Surg. 2019 Apr;143(4):857e-871e.
This CME article reviews key terminology and standards of care, and provides an overview of various masculinizing gender-affirming surgical procedures.
Gender Surgery: A Truly Multidisciplinary Field.
Schechter LS, Safa B. Clin Plast Surg. 2018 Jul;45(3):xiii.
This issue of Clinics in Plastic Surgery has brought together a multidisciplinary group of experts in all aspects of transgender care to critically review current concepts in the field. Throughout the issue, we have attempted to cover aspects of transgender care that are pertinent to the surgical care of such patients, including medical, endocrine, and mental health aspects. We have also set out to give objective evidence for the currently available techniques in gender surgery.
Introduction to Phalloplasty.
Schechter LS, Safa B. Clin Plast Surg. 2018 Jul;45(3):387-389.
Surgical techniques for phalloplasty continue to evolve. Although many surgeons prefer the radial forearm free flap technique, a visible flap donor site makes this procedure less desirable for some patients. Other surgical options are available and include the anterolateral thigh flap, sometimes in conjunction with secondary flaps, and the musculocutaneous latissimus dorsi flap.
