Penile reconstruction has been performed for more than 70 years and is currently performed mainly by the double-tube method. Complete penile reconstruction includes reconstruction of the penile body, urethra, support body and sensory nerves and is done in a single operation. Currently, there are five main surgical methods: skin tube penile reconstruction, penile reconstruction with tipped flap, penile reconstruction with free flap, Cheng’s penile reconstruction and composite free flap penile reconstruction. In order to pursue the reconstructed penis with good feeling, realistic appearance and certain sexual function Shanghai Ninth People’s Hospital Plastic Surgery Department has spent more than 30 years on continuous research and improvement of the method, and has established the “gold standard” of penile reconstructive surgery completely. Skin tube penile reconstruction (one generation) is rarely used now. This method has more operations, more complications, poor appearance, no sensation in the reconstructed penis, and poor postoperative function. However, it can be the only option when there is no other option for the patient with severe trauma. Penile reconstruction with a tipped flap (second generation) This method is more commonly used and can be performed with basic knowledge of plastic surgery and urological experience. Optional donor areas such as the abdominal and anterolateral femoral flaps are commonly used. This method can complete penile reconstruction in a single operation, but complications such as partial flap necrosis often occur, and the flap has thick subcutaneous fat, a thicker postoperative penile shape, poorer sensation of the reconstructed penis, and poorer postoperative function. Forearm free flap grafting for penile reconstruction (third generation) This method is currently used to reconstruct the penis in most patients, and this flap is considered to be the first choice for penile reconstruction. However, the operator must have a good grounding in microsurgery and plastic surgery. This method allows penile reconstruction to be completed in a single operation. A large flap is removed from the forearm in one operation and a supporting body is implanted along with a shaped penile body and urethra. The thin subcutaneous fat of this flap has a better penile shape after reconstruction, and the penis can be reconstructed with good sensation through the anastomosis of the lateral dermal nerve of the forearm and the dorsal penile nerve, and the postoperative function is also more satisfactory. Other flaps such as the latissimus dorsi flap, scapular flap, lateral upper arm flap and lateral calf flap cannot be used as the preferred flap. Cheng’s penile reconstruction (three and a half generations) This method was invented in 1984, and the article was published in the American Journal of Plastic Surgery in 1997 and named Cheng’s penile reconstruction. This method uses a 2.5 cm penile stump graft to reconstruct the glans, while taking a free flap of the forearm to reconstruct the penile body and urethra, and tandem anastomosis of blood vessels between the two, and tandem anastomosis of the dorsal penile nerve and the lateral forearm cutaneous nerve to complete Cheng’s penile reconstruction. The glans of the reconstructed penis has an erectile function, and the glans has a realistic shape, and the whole penis feels good. The long term morphological and sensory effects do not change much, and the glans two-point discrimination is 8-10 mm. The couple is satisfied with the function and appearance. However, there are fewer patients with indications conditions, the operation is very complicated and the operation time is very long. Composite free flap penile reconstruction (fourth generation) The conditions of patients with penile defects cannot be chosen, but there is always a method that is most suitable for the patient. The principles of penile reconstruction method selection must be considered in terms of reconstructed penile shape, sensation, function and less damage to the donor area. Composite free flap penile reconstruction was created in accordance with this. When a patient is too traumatized or overly obese to provide a tissue flap for penile reconstruction, composite free flap penile reconstruction is an excellent option. For example, a combination of forearm and dorsalis pedis flap, dorsalis pedis and anterolateral femoral flap, and forearm and abdominal flap are used to reconstruct the penis. To have a better shape we often use forearm flaps to reconstruct the penile body and dorsalis pedis flaps to reconstruct the glans. Currently, the best shape, sensation and function can be achieved with this method. The choice of penile reconstruction method is based on the conditions of the patient’s donor area, the shape, sensation and function of the reconstructed penis, and the principle of not causing serious damage to the donor area. It is also required that the entire procedure be completed in a single operation. The operator must have a good foundation in plastic surgery, excellent microsurgery skills and a certain foundation in urology.