CPT® Code 54440

The CPT® Code 54440 refers to a plastic operation of the penis specifically performed for injury, commonly known as phalloplasty. This complex surgical procedure is typically executed in multiple stages to reconstruct the penis following trauma or congenital anomalies. The initial stage of the procedure involves the meticulous harvesting of tissue from a donor site, which is most frequently the musculocutaneous latissimus dorsi (MLD) muscle. This harvested tissue is then fashioned into a neo-phallus, which is subsequently attached to the genital area. The surgical process begins with a skin incision that is extended down to the deep fascia, allowing the surgeon to create a plane between the latissimus dorsi and the serratus cutaneous muscles. During this stage, the flap of tissue is carefully divided and lifted to reveal the neurovascular pedicle, which is crucial for maintaining blood supply to the neo-phallus. The procedure requires the preservation of a small strip of muscle to ensure adequate vascularization. The dissection continues proximally to the axillary vessels, where the thoracodorsal nerve and its accompanying blood supply are identified and isolated. The neo-phallus is constructed while still attached to its blood supply, ensuring viability. In parallel, a second surgical team prepares the recipient site in the groin area, which involves making an inguinal incision to access and mobilize critical vascular structures such as the superficial femoral artery and saphenous vein. A Y-incision is created over the pubis, facilitating the connection between the inguinal site and the neo-phallus. The transfer of the neo-phallus from the chest to the pubis is executed using microsurgical techniques, establishing anastomoses between the arteries and veins to ensure proper blood flow. Following the successful implantation of the neo-phallus, additional stages may include urethroplasty and penile prosthesis insertion, which are separately reportable procedures. The urethroplasty can be performed concurrently with the initial phalloplasty stage if a buccal mucosa graft is utilized, or it may be conducted later once the neo-phallus has stabilized. The insertion of penile implants typically occurs 3 to 6 months after a successful urethroplasty, completing the reconstruction process.