The History of the World's First Trans Phalloplasty

By Nick Peplow·Founder and editor

Last reviewed 17 September 2026· How this site is researched

In 1946 a British medical student called Michael Dillon went into Harold Gillies's plastic surgery unit for the first of a long series of operations. Gillies was already famous for rebuilding the faces of First World War soldiers. Together they were attempting something with no precedent: constructing a penis for a transgender man.

It was not one operation. It was somewhere around thirteen, spread over three years. If you are researching phalloplasty today, almost everything about the modern procedure, the staging, the flaps, the urethral problems, the implants, traces back to what these two worked out in a hospital in Hampshire nearly eighty years ago. This is the story as the record tells it, with the gaps left as gaps.

Michael Dillon

Dillon was born in 1915 into an Anglo-Irish family with a title in it, and grew up in Kent. He went to Oxford in the 1930s, rowing for the women's boat club and deeply uncomfortable the whole time. The vocabulary for what he was experiencing barely existed. There was no community to find, no clinic to be referred to, and no path anyone had walked before him.

Towards the end of the 1930s he found a doctor in Bristol willing to prescribe testosterone, which makes him one of the first trans men in Britain known to have taken hormones. His voice dropped, he grew facial hair, and he began living as a man while working in a garage during the war. In 1942 he had a double mastectomy in Bristol, and around the same time managed to get his birth certificate re-registered as male, which mattered enormously for everything that followed.

He wanted more than that. He had read about the reconstructive work being done on injured servicemen, and his reasoning was simple: if a surgeon could rebuild a penis for a soldier who had lost one, why not for him? That question led him to Gillies. Dillon was not a passive patient. He was already at medical school in Dublin by the time the surgeries started, and in 1946 he published a short book, Self: A Study in Ethics and Endocrinology, arguing that people like him should be treated medically rather than psychiatrically. It is one of the earliest English-language texts to make that case.

Harold Gillies

Gillies is usually called the father of modern plastic surgery, and the title is earned. He ran the Queen's Hospital at Sidcup during and after the First World War, treating soldiers with catastrophic facial injuries, and it was there he developed the tubed pedicle flap.

The idea is easy to describe and hard to do. A strip of skin and fat is partly detached, rolled into a tube so the raw surface is protected, and then moved across the body in stages while it stays connected to its blood supply at one end. Each stage means weeks of healing before the next. Infection was a constant risk. But it worked, and Gillies refined it over hundreds of cases through both wars.

He had already used it to reconstruct penises for men with genital injuries. So the anatomy and the mechanics were familiar. What was different about Dillon was the intent: this was not repair, it was construction from scratch. Gillies agreed, and he seems to have treated it exactly as he treated everything else, as a surgical problem worth solving. He did not seek publicity, and when he wrote the case up he disguised the patient.

The operations, 1946 to 1949

Gillies raised a tubed pedicle from Dillon's abdomen, shaped it, and walked it down to the groin over several stages. A urethra was built inside it so that Dillon could urinate standing. For rigidity, Gillies tried a graft of Dillon's own rib cartilage.

The problems were the problems phalloplasty has had ever since. Infections, even with penicillin newly available. Fistulas, where urine leaks out through a hole that should not be there, needing further operations to close. And the cartilage graft, which the body gradually reabsorbed, so the rigidity did not last. Dillon spent long stretches in hospital between stages waiting for tissue to settle before the next one could start.

By 1949 it was done. The result would not pass for a modern one, but it was a phallus with a working urethra, built for a trans man, and nobody had done that before. Gillies included the case in his 1957 textbook with the patient's identity hidden. The notes read like a surgeon who was methodical, honest about what failed, and prepared to change course when it did.

Secrecy, and what happened afterwards

There was no legal framework for any of this in post-war Britain. It was not illegal, but it was not sanctioned either, and homosexuality was still a crime. Both men understood that exposure would be ruinous. Dillon qualified as a doctor in 1951 and worked as a ship's surgeon for years without his history becoming public.

That ended in 1958, when a discrepancy between two peerage directories, one listing him as a daughter and one as a son, was noticed by the press. He left for India, took Buddhist vows, and wrote under the name Lobzang Jivaka. He died there in 1962, aged 47. Gillies had died two years earlier, celebrated for his work on the faces of soldiers and almost never credited for this.

The relationship between them was unusual for the 1940s. Dillon was educated, articulate and deeply invested, and from what survives he was involved in decisions about staging and technique rather than simply receiving them. Gillies never publicly expressed regret, and he treated the case as a legitimate contribution to reconstructive surgery.

What changed between then and now

The tubed pedicle was the best available tool in the 1940s and it had obvious limits: many operations, a large abdominal donor site, and a phallus with little or no sensation.

Microsurgery changed that. The radial forearm free flap, described for phalloplasty by Chang and Hwang in 1984, moves skin, fat, nerves and blood vessels from the forearm to the groin and reconnects them under a microscope. The anterolateral thigh flap followed as an alternative with a less visible donor site. Both are covered on the phalloplasty page. Stage counts came down from a dozen or more to typically two or three, and results improved in both appearance and function. The principle, though, is still Gillies's: build it from the patient's own tissue.

Two of his problems are still with us. The urethra remains the most complication-prone part of the operation. Fistulas and strictures are the commonest reasons for a return trip to theatre, and while staged urethroplasty and grafts have reduced them, no technique has got rid of them. And rigidity is still solved with something put inside: the reabsorbing cartilage graft has been replaced by inflatable or semi-rigid erectile implants, which bring their own risks of infection and mechanical failure, and which surgeons will not usually place until the phallus has healed for a year or so.

The biggest single improvement is sensation. Because the flap's nerves are connected to the clitoral and nearby nerves, many people develop protective and, often, erogenous sensation over the following one to two years. That was not possible in Dillon's era at all.

Why it matters

This is not just a medical curiosity. Trans people have always existed and have always sought care, and Dillon spent years constructing the argument for it before anyone in medicine had a framework to hear it. Gillies had the skill and the disposition to take the problem seriously.

If you are considering phalloplasty now, the outcomes are in a different league from what Dillon lived with: fewer stages, lower complication rates, realistic sensation. The underlying challenge has not moved an inch. It is still about building something that works and feels right from a person's own body, one stage at a time. The techniques have changed. The nerve it takes has not.

This is history, not medical advice. For the current procedure, its stages, risks and costs, see phalloplasty and the bottom surgery hub.