June 17, 2005 -- The patient was lucky. They had caught the cancer early. But to keep it from spreading, the doctors would have to remove his penis. Though the surgery had saved his life, the disfigurement was crippling him socially and emotionally.
"I love to hunt. I love to fish. I love to golf," said the patient, who asked to remain anonymous. But now, unable to urinate while standing up, the patient gave up his hobbies rather than be seen squatting behind the trees. He could no longer be intimate with his wife and took to going to bed only after she had fallen asleep.
But the final blow came one day when he was changing in a men's locker room at a water park. A little boy began pointing at his groin and the boy's father joined in laughing. "It was humiliating," the man recalled in his slow Texas drawl. "I couldn't get out of that locker room fast enough."
The 63-year-old began looking for a plastic surgeon who could reconstruct his penis. "I went to 12 urologists," he said. "They all said, 'It can't be done, it can't be done.'"
The shame was taking its toll, and the man had grown depressed. Concerned about his patient, the man's physician managed to track down two doctors who might be able to help: a plastic surgeon, Dr. Gordon Lee, and a urologist, Dr. Erin Bird, at Scott & White Hospital in Temple, Texas.
After hearing the patient's story, the doctors decided to try some inventive techniques to reconstruct the man's penis.
The Art of Plastic Surgery
Dr. Garry Brody, a plastic surgeon at the University of Southern California in Los Angeles, calls his profession an art. "Because plastic surgery by its very nature must correct an almost infinite variety of defects and deformities," he explained, "we must have a bag full of variations."
Lee and Bird began using every variation in the book.
Because of his previous amputation, the patient did not have a urethra long enough to allow him to urinate while standing up. "I fully value the complaints of women who say there aren't enough commodes," he said.
In October 2004, the patient had skin removed from the inside of his mouth, which Bird then rolled into a tube to create a new, longer urethra. The patient was given six months to heal.
Ten days ago, doctors selected a relatively hairless part of the man's outer thigh to make the shaft of the penis. Normally, the skin section is taken from a person's forearm. But Lee pointed out that this operation leaves a large scar in a very visible place. "You don't really want to say when people ask you, 'Hey, what happened to your arm?' … 'Oh, it's my penis.'"
Instead of cutting the section of the thigh completely away from the body, Lee left some of the blood vessels attached "like a leash." Normally, all the blood vessels are severed and then carefully reattached at the new site.
By leaving the blood vessels attached, Lee ensured that the piece of skin would never be without oxygen. Loss of oxygen -- a sensation commonly felt as "pins and needles" -- can be dangerous for transplanted tissue, causing it to swell, become damaged or even die.
But leaving the blood vessels attached presented another challenge -- how to get the skin from the thigh to the groin area without snipping its tethers.
To do this, the doctors made a tunnel under the skin and fed the piece of flesh through to the groin area. There it was rolled into the shape of a shaft and connected to the artificial urethra.
From there, Lee worked to reattach the nerves to the stump of the man's former penis and sculpt a passable head for it.
"It took us 10 hours," Lee said.
And the final product? "It looks great!" said the patient. "I'm just ecstatic about what they've been able to do."
A Lesson in Manhood
The patient had been ashamed by the loss of his penis, not just for sexual reasons, but because of how it affected his idea of what it means to be a man.
"Losing the penis, I'd have moments when I'd just break out crying," he said. He started looking around on the Internet and found that many other men were suffering from similar disfigurement. He was especially moved by the stories of soldiers who had had their genitals damaged.
"Hopefully this will help other people who've been told it couldn't be done," the patient said.
When asked what he was most looking forward to, the patient replied, "Do you really want to know? I want to go outside, find a big tree, get behind it and take a leak."
But he admitted that mostly he is excited "just to have the freedom to be a man again."
He is currently recovering with his wife by his side and plans to leave the hospital on Saturday.