Simultaneous correction of breast hypertrophy and vaginal agenesis: Aesthetic surgery to the aid of reconstructive surgery

Abstract

Mayer‐Rokitansky‐Küster‐Hauser syndrome is characterized by aplasia of the uterus and the upper ⅔ of the vagina, with normal female genotype (46,XX) and the development of secondary sexual characters. One of the most popular surgical treatment is the McIndoe procedure, which major drawbacks are the scar of split thickness skin graft (STSG)harvesting, and risk of vaginal stenosis for graft retraction. We report the case of a patient, operated modifying the McIndoe technique, by harvesting a full thickness skin grafts (FTSG) from patient's breasts, undergone simultaneous reduction mammoplasty. The FTSG provided a complete lining of the reconstructed neovagina. At 6 months, we observed complete mucinous metaplasia of the vaginal walls and 1 year after surgery no sign of stenosis, without the use of the mold. The advantages of this technique are reduced donor site morbidity, when compared with traditional McIndoe technique, and reduced risk of neovagina retraction ensured by FTSG, compared with STSG. If future patients’ series confirm the good results achieved, we could consider it as a first‐line option in patients undergoing neovagina reconstruction, seeking breasts or body contouring surgery.

Classical McIndoe Technique Versus the McIndoe Technique with a Neovaginal PACIENA Prosthesis® and No Skin Graft

“…The use of a skin graft is justified and cannot be considered a disadvantage when the patient needs a second intervention with skin removal. This is the case of gender confirmation surgery or if the neovaginal procedure is performed with simultaneous abdominoplasty or reduction mammoplasty [7][8][9]. It requires a careful selection of patients, with certain characteristics and with a double surgery indication.…”