Phalloplasty represents the most complete genitoperineal transformation. Because it requires complex, staged procedures as well as the use of tissue from remote sites, patients must be well informed as to the nature of surgery. 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.