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Varies with flap type and complications."},"diagnostic_duration_minutes":null,"diagnostic_preparation":null,"diagnostic_referral_needed":null,"diagnostic_result_time_hours":null,"exercise_resume_weeks":{"min":6,"max":12,"unit":"weeks","qualifier":"Light activity and walking earlier; strenuous exercise, heavy lifting and donor-site loading usually after surgeon clearance."},"final_result_months":{"min":12,"max":18,"unit":"months","qualifier":"Swelling resolution and sensory recovery; later stages (e.g., erectile implant) extend the overall timeline."},"fly_home_after_days":{"min":28,"max":42,"unit":"days","qualifier":"After catheter or stent removal, wound checks and surgeon clearance; plan to stay nearby."},"follow_up_visits":[{"purpose":"wound_check","requirement":"routine","after":{"min":7,"max":14,"unit":"days","qualifier":"Flap and donor-site check after discharge."}},{"purpose":"suture_removal","requirement":"routine","after":{"min":14,"max":21,"unit":"days","qualifier":"Dressing and suture or graft-site management."}},{"purpose":"assessment","requirement":"routine","after":{"min":28,"max":60,"unit":"days","qualifier":"Urinary catheter/stent removal and voiding assessment, timing varies."}},{"purpose":"result_review","requirement":"routine","after":{"min":90,"max":180,"unit":"days","qualifier":"Healing, sensation and need for further stages."}}],"indications":["Gender-affirming surgery for transgender men and non-binary adults with dysphoria","Penile reconstruction after trauma, cancer surgery or congenital absence/severe hypoplasia"],"main_risks":["Flap loss or partial necrosis","Wound infection and delayed healing","Bleeding or hematoma","Donor-site complications (graft loss, scarring, reduced function or sensation)","Altered or reduced sensation","Need for further revision surgery","Anesthesia and thromboembolic risks","Urethral problems: stricture, fistula, voiding difficulties (spraying, dribbling)","Implant complications (infection, malfunction, extrusion) if placed"],"pain":"Moderate to significant pain in the first 1-2 weeks at both the genital and donor sites, controlled with prescribed analgesia; gradually settles over several weeks.","preparation":["Mental health and endocrine assessments for gender-affirming care","Pre-operative surgical consultation and imaging of donor site as needed","Stop smoking and nicotine well ahead of surgery","Hair removal at donor site and/or urethral area where planned","General pre-anesthetic assessment and blood tests","Arrange help at home and aftercare","Plan clot prophylaxis; review all medicines with surgeon, no self-changes"],"recovery_timeline":[{"phase":"Hospital stay (days 0-10)","description":"Flap monitoring, bed rest then gradual mobilisation, urinary catheter and suprapubic drainage.","restrictions":["Limited mobility initially","Keep flap protected and warm"]},{"phase":"Weeks 2-4","description":"Wound healing while staying nearby with catheter/stent in place; dressing care and donor-site management.","restrictions":["No heavy lifting or strenuous activity","Avoid pressure on the flap"]},{"phase":"Weeks 4-12","description":"Catheter/stent removal and voiding assessment around weeks 4-8; desk work from about week 6, then gradual activity.","restrictions":["Avoid heavy exercise until cleared","No sexual activity until cleared"]},{"phase":"Months 3-12+","description":"Swelling subsides, sensation develops; further stages such as glansplasty or erectile implant may follow.","restrictions":["Follow surgeon guidance before further stages"]}],"rehabilitation_days":{"min":21,"max":42,"unit":"days","qualifier":"Light daily activities resume about 3–6 weeks after surgery, limited by catheter or stent, wound care, and fatigue."},"result_longevity":"Phalloplasty is intended as permanent reconstruction, though revision procedures may be needed and erectile function requires a separate implant.","revision_rate_pct":{"min":30,"max":50,"unit":"percent","qualifier":"Unplanned revision within 1–2 years, mainly for fistula (26–37%) and stricture (13–16%); planned implant stages excluded."},"scars":"Visible scarring at the donor site (e.g., forearm, which may carry a skin graft) and at the genital/pubic region; scars mature over 12 months or more.","sessions_or_stages":{"sessions":{"min":2,"max":3,"unit":"visits","qualifier":"Surgical stages requiring travel; excludes follow-up checks. Varies with revision needs and whether an erectile implant is placed."},"stages":[{"code":"phallus_construction","label":"Free-flap phallus construction with urethral reconstruction","after":{"min":0,"max":0,"unit":"days","qualifier":"First-stage surgery; may include vaginectomy and scrotal work depending on plan."}},{"code":"glans_scrotal_stage","label":"Glansplasty, scrotoplasty and revision stage","after":{"min":90,"max":240,"unit":"days","qualifier":"Timing depends on swelling resolution, sensation and urethral healing."}},{"code":"erectile_implant","label":"Erectile implant placement","after":{"min":365,"max":540,"unit":"days","qualifier":"Optional; done after sensation returns and tissues have healed."}}],"qualifier":"Staged reconstruction; the number of stages depends on urethral complications, patient goals and implant choice."},"success":{"metric":"Flap survival (viable neophallus without total flap loss)","value":95,"unit":"percent of patients","horizon":"3 months after 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side photos","Gender dysphoria assessment letters","Testosterone therapy duration and dose record","Previous genital or pelvic surgery reports"],"travel_trips":{"min":2,"max":3,"one_trip_possible":false,"qualifier":"Staged surgery: flap phalloplasty with 5-10 night stay, then glans/scrotal stage months later; erectile implant is a further stage."},"clinic_checks":{"status":"ok","items":[{"id":"C1","text":"Check whether the surgeon is fully trained in the specific procedure you want","scope":"treatment_abroad","source":{"url":"https://www.nhs.uk/conditions/cosmetic-procedures/cosmetic-surgery-abroad/","host":"nhs.uk","quote":"It can be difficult to find out if a surgeon is fully trained in the procedure you want.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}},{"id":"C2","text":"Ask for examples of the surgeon's experience with this specific 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sign","scope":"treatment_abroad","source":{"url":"https://travelaware.campaign.gov.uk/surgery-abroad-cut-out-the-risk/","host":"travelaware.campaign.gov.uk","quote":"Don’t be pressured into quick decisions either through forceful persuasion or cheap, time limited offers.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}},{"id":"F2","text":"Websites selling cosmetic surgery bundled as a holiday are a warning sign in an ad","scope":"treatment_abroad","source":{"url":"https://www.nhs.uk/conditions/cosmetic-procedures/cosmetic-surgery-abroad/","host":"nhs.uk","quote":"Be cautious of websites selling cosmetic surgery as part of a holiday.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}},{"id":"F3","text":"An advert guaranteeing complete success should raise concerns about the offer","scope":"treatment_abroad","source":{"url":"https://travelaware.campaign.gov.uk/surgery-abroad-cut-out-the-risk/","host":"travelaware.campaign.gov.uk","quote":"Any advert or information that guarantees complete success should raise concerns.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}},{"id":"F4","text":"Advice that comes only from sales representatives or travel agents is a warning sign","scope":"treatment_abroad","source":{"url":"https://travelhealthpro.org.uk/news/699/travelling-abroad-for-treatment","host":"travelhealthpro.org.uk","quote":"Do not accept advice from a travel agent, sales representatives or administrators.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}}],"checked_at":"2026-11-12","next_check_at":"2027-11-12","version":1},"warning_signs":{"status":"ok","items":[{"id":"W1","text":"Excessive bleeding or blood-soaked dressings","urgency":"emergency","general":false,"source":{"url":"https://my.clevelandclinic.org/health/procedures/21585-phalloplasty","host":"my.clevelandclinic.org","quote":"Excessive bleeding or blood-soaked dressings.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}},{"id":"W2","text":"Abnormal swelling in groin or lower leg","urgency":"emergency","general":false,"source":{"url":"https://my.clevelandclinic.org/health/procedures/21585-phalloplasty","host":"my.clevelandclinic.org","quote":"Signs of blood clots, like abnormal swelling in your groin or lower leg.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}},{"id":"W3","text":"Difficulty or pain while peeing","urgency":"contact_clinic","general":false,"source":{"url":"https://my.clevelandclinic.org/health/procedures/21585-phalloplasty","host":"my.clevelandclinic.org","quote":"Difficulty or pain while peeing.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}},{"id":"W4","text":"Discoloration or skin changes on neophallus","urgency":"contact_clinic","general":false,"source":{"url":"https://my.clevelandclinic.org/health/procedures/21585-phalloplasty","host":"my.clevelandclinic.org","quote":"Discoloration or other skin changes in your neophallus.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}}],"checked_at":"2026-11-12","next_check_at":"2027-11-12","version":1},"take_home":{"status":"ok","items":[{"id":"T1","text":"Your home doctor can review the imaging taken during your treatment","document":"scans and x-ray copies","source":{"url":"https://travelhealthpro.org.uk/news/699/travelling-abroad-for-treatment","host":"travelhealthpro.org.uk","quote":"Remember to ask for copies of all your treatment records, including prescriptions, scans and x-rays before you leave.","tier":"tier1_medical","fetched_at":"2026-11-12","http_status":200}},{"id":"T2","text":"Home doctor needs the dates for required blood tests and follow-up appointments","document":"written aftercare plan","source":{"url":"https://sbuhb.nhs.wales/about-us/individual-patient-commissioning/ipc-folder/advice-on-accessing-treatment-abroad","host":"sbuhb.nhs.wales","quote":"This should include any medication and doses, as well as any dates that blood tests and follow-up appointments must be carried out.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"T3","text":"Ask for written details of the procedure before you leave the hospital","document":"written procedure details","source":{"url":"https://rcseng.ac.uk/patient-care/cosmetic-surgery/after-surgery/","host":"rcseng.ac.uk","quote":"After your surgery, before you leave the hospital, ask for written information about the procedure you've had.","tier":"tier1_medical","fetched_at":"2026-11-11","http_status":200}},{"id":"T4","text":"Home doctor needs the clinic's follow-up recommendations in a written discharge summary","document":"discharge 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