Background: Patients who have undergone reconstruction of bladder extrophy can have an extremely short penis, which can be functionally and psychologically debilitating. Penile reconstruction with the radial forearm free flap has the potential to provide these patients with improved genital appearance and sexual function. Quality of life after penile reconstruction is an important outcome measure in evaluation of the procedure. Methods: We describe five patients who underwent total penile reconstruction with radial forearm free flaps and interview them with a quality of life questionnaire. Results: Responses were overwhelmingly positive with regard to improved self-image as well as sexual function. Conclusions: This series supports the overwhelmingly positive change in quality of life to be gained with radial forearm free flap penile reconstruction for patients with an extremely short native penis in the adult exstrophy patient. ? 2010 The Authors. ANZ Journal of Surgery ? 2010 Royal Australasian College of Surgeons.