Penile amputation is a rare and complex medical condition that demands prompt and specialized management, addressing both physical and psychological aspects. The first successful penile replantation was reported in 1929 by Ehrich, and since then, advancements in microsurgery have significantly improved outcomes. Management of penile amputation typically involves immediate replantation, provided the amputated organ is preserved using hypothermic techniques. Microsurgical replantation is preferred, aiming to reconnect the deep dorsal veins, arteries, nerves, and urethra. Successful outcomes are possible even when replantation occurs within 24 h, although complications such as skin necrosis and urethral stricture can arise. In cases where replantation is not feasible or the amputated segment is unavailable, phallic reconstruction using free flaps, such as the forearm flap, has shown good cosmetic and functional results. Additionally, mental health assessment and intervention are critical, particularly when self-mutilation is involved, often linked to psychiatric conditions such as schizophrenia or gender dysphoria. A multidisciplinary approach, including psychiatric care and urological surgery, is essential for optimal outcomes. The evolving field of penile transplantation offers hope for patients with complex cases. This review underscores the importance of timely intervention, advances in surgical techniques, and a holistic approach to treating patients with penile amputation.