Male-to-female
Surgical technique
The surgical male-to-female sex adjustment is performed under general anesthesia and takes about 4-5 hours. If desired, we can perform augmentation at the same time (insertion of a silicone implant for breast augmentation or augmentation with autologous fat). At the same time, a thyroid cartilage reduction is also possible.
For sex adjustment, we offer two different methods (Classic penile inversion and combined method), both of which provide excellent results, but differ in several ways.
Classic penile inversion involves the following surgical steps:
Removal of the testicles (orchidectomy)
- plastic construction of a neovagina with an island flap plasty
- plastic construction of a sensitive neoclitoris
- plastic construction of labia from scrotum
- shortening of the urethra
- cavernous body removal
- plastic construction of pubic mound
- breast reconstruction if necessary
- if necessary, reduction of the thyroid cartilage
In the combined method, additional skin grafts and the original urethra are used to build up a neovagina. Due to the special incision in this method, a more natural vulvoplasty (plastic reconstruction of the labia) is possible.
The following surgical steps are performed:
- removal of the testicles (orchidectomy)
- plastic construction of a neovagina with a combined island flap plasty, free skin graft from the skin of the scrotum as well as pedicled urethral skin
- plastic construction of a sensitive neoclitoris
- plastic construction of labia and clitoral hood from parts of penile shaft skin
- shortening of the urethra
- cavernous body removal
- plastic construction of pubic mound
- breast reconstruction if necessary
- if necessary, reduction of the thyroid cartilage
Due to the special incision, a second surgery is mandatory for the combined method. This involves some fine plastic work that cannot technically be implemented in the first surgery. Usually, the desired breast augmentation and other optional plastic procedures are also performed during this second surgery.
In direct comparison, each method has its own strengths and weaknesses, which we will be happy to discuss with you in a personal consultation in order to select the optimal treatment strategy for you.
After surgery
- after the surgery, intensive supervision with monitoring takes place. There are several daily rounds as well as regular dressing changes and wound checks by our doctors
- you can already get up on the 1st day and also go to the toilet
- the urinary catheter is removed on day 6 to 8
- Usually you can leave the clinic on the 8th to 12th day
- further treatment after male-to-female gender reassignment surgery can be performed by your doctors at your place of residence
- depending on the professional situation, an inability to work of approx. 4 weeks is to be expected
- in the combined method, bougienage (dilatation) of the neovagina must be performed – written instructions for bougienage after discharge can be found here (PDF, 39k).
Complications
Complications occur in less than 5% of our patients.
- postoperative bleeding approx. 1 %
- narrowing (stenosis) of the urethral opening 1-2 %
- narrowing (stenosis) of the neovagina approx. 1 %
- we were not able to record any serious complications
- in about 30% of our patients, we perform corrective surgery after about 3-6 months, when the vaginal entrance is constricted by a small fold formed during invagination (invagination) of the original penile skin.
