Dr. Andrew Watt, MD is a Reconstructive Microsurgeon at the Buncke Clinic, widely considered to be the birthplace of microsurgery. He is a highly accomplished Phalloplasty surgeon, having performed hundreds of microvascular Phalloplasty and related procedures with his team in San Francisco.
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.
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.
An abnormal clinical Allen’s Test is not a contraindication for free radial forearm flap
Travis J Miller, Bauback Safa, Andrew J Watt, Mang L Chen, Walter C Lin. Clin Case Rep. Jul 15 2020. ;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.
The Pedicled Anterolateral Thigh Phalloplasty
Xu KY, Watt AJ. Clin Plast Surg. 2018 Jul;45(3):399-406.
The primary advantages of the ALT flap are the inconspicuous donor site and flexibility in phallus length. The disadvantages of the ALT flap are a higher incidence of both flap and urethral complications compared with a Radial Forearm Phalloplasty. Although ALT phalloplasty can achieve the primary goals of standing micturition, penetrative intercourse, and an aesthetic phallus, multiple stages and revisions are often necessary. Careful patient selection is paramount in attaining acceptable results.
