Female-to-male
Female-to-male surgery: phalloplasty
Phalloplasty, penoid reconstruction as part of female-to-male (ftm) gender reassignment surgery, is arguably the most challenging and complex operation in the field of transsexual surgery.
The technique developed by Dr. Paul Daverio, in which the penoid (“artificial penis”) is formed in a microsurgical operation from skin and subcutaneous tissue including nerves and blood vessels of the forearm (so-called forearm flap), is nowadays considered the standard procedure for gender reassignment worldwide. It leads to the best optical and functional results and has been practiced at Klinik Sanssouci for over 20 years.
Surgical technique: The steps of surgical gender reassignment.
Female-to-male surgical gender reassignment is performed under general anesthesia. This procedure takes about seven to nine hours and includes:
- the removal of the breasts (mastectomy)
- removal of the uterus (hysterectomy)
- removal of the ovaries and fallopian tubes (ovarectomy, adnectomy)
- removal of the vagina (colpectomy)
- the microsurgical formation of the penoid (“artificial penis”) from a part of the forearm (so-called forearm flap) including its nerves and blood vessels. This includes the following substeps:
- the shaping of the penoid including the new urethra (neo-urethra)
- the plastic reconstruction of a glans (glansplasty)
- the lengthening of the female urethra with the labia minora
- the relocation of the penoid from the left forearm to the pubic area. The arteries (arteries) and veins (veins) of the penoid are connected to the corresponding blood vessels of the thigh. At the same time, the inguinal nerves are connected to the penoid nerves, as well as the lengthened urethra to the newly formed urethra.
- covering the tissue defect on the forearm with skin obtained either from the groin or from the excess skin of the breast.
- the preparation of the labia majora, where the artificial testicles will be implanted later.
Important: The clitoris (clit) remains at the base of the penoid and is not removed, only its covering epidermis. Thus, the ability to orgasm is preserved.
After the surgery
- After the surgery, intensive supervision with monitoring takes place. There will be several daily visits as well as regular dressing changes and wound inspections by our doctors.
- You may get up for the first time on the 6th day after the surgery.
- The bladder catheter is removed on the 12th day. From this moment on you can urinate standing up.
- Usually, you can leave the clinic on the 14th to 16th day.
- Further treatment after female-to-male gender reassignment can be performed by your doctors at your place of residence.
- Depending on your professional situation, you can expect to be unable to work for about 6 weeks.
Complications
Female-to-male gender reassignment surgery, especially penoid reconstruction (phalloplasty), is a complex procedure and therefore prone to complications. At Klinik Sanssouci, complications occur with about 5% of our patients.
Possible complications of phalloplasty include:
Stenosis
This is a constriction at the connection between the urethra and the newly formed urethra (neo-urethra). This complication can usually be corrected by simple bougienage (widening) by the urologist. Only in 1 to 2% of cases is a minor second surgery required, often under local anesthesia, to widen this constriction.
Fistula
This is a connection between the urethra and the skin surface through which urine can leak out. Fistulas usually close spontaneously after two to three months. If this does not occur, the fistula can be closed in a minor procedure under local anesthesia.
Serious complications such as complete penoid loss (flap loss) are very rare.
Erectile prosthesis / testicular replacement
A second procedure is necessary if an erectile prosthesis is to be installed. This surgery is possible if there is feeling in the penoid, which is usually about eight to ten months after the phalloplasty surgery.
As erectile prosthesis we use a so-called hydraulic implant from American Medical Systems (AMS) with a pump (AMS 700), which is placed in the newly formed scrotum (neoscrotum). A reservoir is surgically placed under the abdominal wall muscles. We place two inflatable silicone rods into the penoid. An erection is then possible by means of this pumping system. We also implant silicone testicles in the scrotum.
