Yes, in TIF phalloplasty, the patient's own skin is used to construct the fauxphallus, and since there's no donor tissue, this kind of surgery doesn't have the same kind of rejection issues that transplant surgeries do. Still, even when one's own tissue is used, phalloplasties in females have a very high rate of all sorts of complications, from infection to necrosis. (Interestingly, phalloplasty complication rates are considerably higher in females who get these surgeries than in males.)

One of the main reasons TIFs apparently have phalloplasty is so they can stand up to pee like a man. But it turns out, more than half of phalloplasties done on women result in "urethral stricture," meaning a narrowing or blockage of the urethra due to scarring and/or inflammation. This makes peeing in any position - standing, sitting, lying down - difficult, sometimes impossible, and often extremely painful, too.

Also, not being able to void properly can lead to secondary infections in the bladder and kidneys.

Correcting urethral strictures in TIF phalloplasties requires additional surgery in 94-96% of cases where such strictures occur - and the additional surgery of course brings more risk of infection, bad reactions to anesthesia, and other post-op complications.

But the corrective surgeries themselves are only successful half the time! So often additional surgeries are needed. And yet in the end, "lifelong perineal ureterostomy are often required" - meaning a new opening has to be made near the anus for urine to empty out of. Which means these women not only end up unable to achieve their dream of being able to pee standing up, they actually end up having to pee out of a new, surgically-created middle/rear hole next to their asshole. Which, as you can imagine, makes them highly susceptible to UTIs from contamination with fecal bacteria - more susceptible even than would have been the case if they hadn't tried to alter their female plumbing in the first place.

In turn, people who require perineal ureterostomy often get pudendal neuralgia too. PN is a severe, often disabling, chronic pain condition, and over time it tends to lead to anal leakage and fecal continence. Which increases the risk of UTIs via the new pee hole even further, and means many patients will spend their last decades in diapers.

Radial forearm free flap phalloplasty (RFFP) is the current standard of care for most FTM gender confirmation surgeries. This procedure is associated with a rate of urethral stricture as high as 51%, which falls only to 23-35% even among the most experienced contemporary surgeons. While some modifications have been proposed to combat this high complication rate, it still remains a major source of lasting morbidity. The method involves literature review of RFFP literature. Lowest stricture rates are found when neourethra is made with a long, meticulously constructed tube of well-vascularized perivaginal/periurethral and labia minora tissue.

In cases of urethral stricture, urethroplasty is required in 94-96% of patients. Surgery should be delayed until all acute inflammation has subsided. Urethroplasty is technically challenging and fails in up to 50% of cases. Repeated surgery or salvage urethral exteriorization procedures, which can leave the patient with lifelong perineal urethrostomy, are often required. Patient and physician knowledge regarding the high burden and poor treatment options for urethral stricture after phalloplasty is incomplete, and patient acceptance of this reality is crucial for honest understanding of the potential complications of this increasingly common but extremely complex surgery. Clin. Anat. 31:187-190, 2018. © 2018 Wiley Periodicals, Inc.

https://onlinelibrary.wiley.com/doi/abs/10.1002/ca.23021