Surgical techniques vary from surgeon to surgeon.

• Skin, nerves, veins and arteries from your forearm or another site such as the thigh are removed. This is called a graft.
• A small part of the graft is used to extend your urethra.
• A larger part of the graft is wrapped around the urethra to create the penis shaft and glans, the head of the penis.
• The labia are repositioned and reshaped to make a scrotum.
• The vagina may be removed or closed (if desired).
• If the forearm is the site used, skin from the thigh is used to cover the graft site.
• A surgery to reposition the urethra through the penis (urethral lengthening) may be done a minimum of 6 months after the creation of the penis.
• Testicular implants and an erectile device may be put in at a later stage (if desired).