Virtual surgical planning and three-dimensional (3D) printing represent emerging technologies in anterolateral thigh (ALT) flap phalloplasty that offer significant advantages in flap design, operative efficiency, and surgical education. This chapter outlines a comprehensive workflow integrating computed tomography angiography (CTA), digital modeling, and 3D printing to enhance preoperative planning and intraoperative navigation. Given the anatomical variability of perforators from the lateral circumflex femoral artery, preoperative imaging is critical in identifying optimal side to harvest the flap, location of the larger perforators, pedicle length and minimizing complications. Collaboration between surgical, radiologic, and engineering teams facilitates the creation of patient-specific models that accurately represent the vascular and muscular anatomy. These models guide surgical decisions, reduce flap harvest time, and improve perforator localization. They also serve as effective teaching tools for patients and trainees. The process involves image segmentation, digital reconstruction, and multi-material 3D printing, with attention to both anatomical detail and practical utility. Challenges include ensuring high-resolution imaging, accurate segmentation, and balancing model complexity with cost. Early outcomes suggest improved operative planning and educational value, with future directions aimed at visualizing the final neophallus for setting patient expectations. This interdisciplinary approach offers a promising avenue for advancing gender-affirming surgical care and reconstructive microsurgery.