An Afghanistan war veteran who lost his genitals and both legs above the knee due to injuries from a roadside bomb recently received the first full penis-scrotum transplant ever performed. The 11-surgeon team at Johns Hopkins Hospital in Baltimore included Steven C. Bonawitz, head of plastic and reconstructive surgery at Cooper University Health Care in Camden.
The 14-hour surgical feat was performed in March, and surgeons have said they are optimistic about recovery prospects of the patient, who is remaining anonymous to protect his privacy. Cooper shared the news of Bonawitz’s participation in the surgery recently, but the surgeon hasn’t been available for an interview.
Although two other penis transplants have been successful in the last four years — one in South Africa and the other at Massachusetts General Hospital — those procedures were less extensive. The Hopkins patient also received the scrotum and part of the abdominal wall from a deceased donor.
Bonawitz was invited to join eight other plastic surgeons and two urological surgeons because of his history with Johns Hopkins School of Medicine’s “composite” transplant program, which requires attaching blood vessels, bones, nerves, muscles, and soft tissues. As an adjunct faculty member, Bonawitz has helped with some of these challenging surgeries at Hopkins.
The patient was on the waiting list for more than a year. During that time, Bonawitz traveled to Baltimore to rehearse the complex, staged procedure.
His role was to help remove damaged and scarred tissue from the combat veteran, then locate and prepare the vital blood vessels that were attached to the transplanted tissue.
“It was a very humbling experience to be able to participate as a member of a team of this caliber and to be able to help someone who had given so much through his own service,” Bonawitz said in a statement from Cooper. “Advances like this offer the hope of returning to a more normal life following devastating injuries.”
The transplant leader, W.P. Andrew Lee, director of plastic and reconstructive surgery at the Johns Hopkins School of Medicine, called Bonawitz “a consummate microvascular surgeon.”
“We are fortunate that he was involved in both the extensive preparation and execution of our penile transplant operation,” Lee said.
Composite transplantation of faces, hands, and genitals remains controversial because, unlike major organ replacements, it is not lifesaving. Patients must take immune-suppressing drugs to prevent transplant rejection, just like organ recipients, and these drugs have significant side effects.
For the wounded veteran, the loss of his genitals was so traumatic that he struggled with depression. He was unable to tell anyone but those closest to him about the full extent of his injury, and thought he would never be in a relationship, he said in an interview with the New York Times.
“That injury, I felt like it banished me from a relationship,” he told the Times. “Like, that’s it, you’re done, you’re by yourself for the rest of your life. I struggled with even viewing myself as a man for a long time.”
Initially, he consulted Lee about the possibility of reconstructing a penis using tissue from other parts of his body. But a prosthetic implant would have been necessary to achieve an erection.
The patient said the transplant immediately made him feel a new sense of recovery.
“When I first woke up, I felt finally more normal… [with] a level of confidence as well. Confidence… like finally I’m OK now,” he said.
Lee said, “We are hopeful that this transplant will help restore near-normal urinary and sexual functions for this young man.” (He will not be able to father children; the donor’s testes were not transplanted for ethical reasons.)
Bonawitz honed his skills and interest in difficult restorative microsurgeries through training and fellowships at the University of Rochester, the Medical College of Wisconsin, and the University of Pittsburgh Medical Center. In addition to composite transplantation, he specializes in surgery to treat cancer or correct defects of the neck, face and jaws. He also does breast reconstruction in cancer patients who have had unsatisfactory results or problems with previous attempts.