Total sex‐reassignment surgery in female‐to‐male transsexuals: a one‐stage technique

Abstract

IndicationsTheoretically, the ideal female-to-male sex reassignment surgery should be a one-stage procedure. The resulting neophallus should be cosmetically acceptable to both patient and partner, should have sufficient rigidity for vaginal penetration, and should maintain tactile sensitivity. Furthermore, scarring in the donor area should be minimized, and a neourethra constructed to allow voiding while standing [1].Although many patients would like to be able to use the phallus sexually and/or to void while standing, others only express a desire for a good cosmetic appearance to be accepted as males in society. Unfortunately, sex-reassignment surgery usually requires several operations, which are very invasive and time-consuming.Herein we present our recent experience with singlestage sex-reassignment surgery in female-to-male transsexuals, where mastectomy and chest contouring are carried out with oophorectomy and hysterectomy at the same time as the pedicled pubic phalloplasty. MethodsDuring the last 2 years three female-to-male transsexuals underwent one-stage sex-reassignment surgery in our departments. All patients had been cross-dressing, living as men and receiving testosterone for a long time. Before surgery each underwent a complete psycho-sexological evaluation. Hormonal therapy was discontinued 1 month before the intervention.Two operative teams are necessary; while the first team performs subcutaneous adenomammectomy and mastopexy using the round-block technique, hysterooophorectomy, phalloplasty and testicular prosthesis implantation are carried out by the second team (Fig. 1).The mastoplasty technique used in the one-stage procedure in these patients consists of subcutaneous adenomammectomy and mastopexy using the round-block technique (Fig. 2). Cutaneous excision depends upon the size and volume of the breast skin. A second round-block excision for a better aesthetic result is optional, but it is always undertaken when the breast is particularly big, and a large amount of skin removed. In some cases, a high degree of ptosis may require an inferior pedicle mastopexy technique, leaving only peri-areolar and inframammary fold scars [2].The phallus is fashioned from a flap of anterior abdominal wall skin, 10 ¥ 10 cm, measured from the base of the clitoris. Skin, subcutaneous fat and Scarpa's fascia are incised superiorly and laterally. Superficial inferior epigastric and external pudendal vessels are incorporated into the flap pedicle. After mobilization of the flap any excess subcutaneous tissue is excised to give better cosmesis. The abdominal design is then completed through skin excision. Through the same incision hysterectomy and bilateral salpingo-oophorectomy are easy. The abdominal fascia is closed, the umbilicus is incised and separated from the abdominal skin. Abdominal skin and subcutaneous fat are widely dissected from the abdominal wall (Fig. 3) up to the costal edge. The incision of the former umbilicus is closed and the neo-umbilicus repositioned 5 cm above the old one. The donor area...

Trauma, Gender Reassignment, and Penile Augmentation

“…Flaps more suited to total phallic construction has led to the development of the use of infraumbilical skin and groin flaps [49][50][51][52]. The phallus is often wedge-shaped, with minimal sensation and often without a urethra.…”

New Algorithm for Chest-wall Surgery and Quality of Life Assessment in Female-to-male Reassignment Patients

“… 2 , 3 Hence, the procedure of chest-wall contouring surgery—designed to create an aesthetically pleasing male-like chest contour—is aimed precisely at alleviating the high degree of discomfort associated with this aspect. 4 In small and non-ptotic breasts, this can be achieved by subcutaneous removal of the glandular and adipose tissues (semi-circular technique). In large and ptotic breasts, however, the double-incision with free nipple grafting (DIFNG) is unavoidable if the surgeon wants to remove the skin excess and to reduce and relocate the nipple–areola complex.…”

Long-term Results of Breast Reduction in Female-to-Male Transsexuals

“…In the case of FtM transsexualism, surgical intervention involves reduction and amputation procedures (reduction of breasts and removal of uterus and adnexa), and then formation of imitation penis and scrotum (8,9,10). The first stage of surgical correction of external sex organs in type FtM transsexual persons is breast reduction (11,12).…”