Sex Reassignment Surgery (Female To Male) at world wide international aesthetic

LATISSIMUS DORSI FLAP PHALLOPLASTY

This technique is gender assignment surgery from female to male. It aims to create a neophallus from extragenital tissue. It is a technique developed for the provision of erectile and urinating by placing a penile implant in the neophallus and the creation of the urination feature. After drawings of the appropriate size, the skin is taken from the back muscle and the MLD wing is collected and shaped into a pipe. It is carried out in 2 stages. In the second stage, an implant is inserted into the phallus, which is created to ensure erections. Latissimus dorsi (MLD) flap is part of the back muscle and vessels, a structure that contains nerves. A thin muscle strip is collected and a cylindrical structure is created. The resulting scar is a scar that extends down the lower ridge from under the arm. The donor area where the part is taken can be closed with incision or skin graft. Latissimus Dorsi technique gives a penis of 13-16cm in length and 10-12cm in thickness.

Urethroplasty

Primary urethral can be performed in two stages with extension or secondary urethral extension.

Penile Implant

After the creation of neophallus, a penile implant is needed to achieve erections. Second These implants, which are put into the phallus at the stage, can be inflated and divided into three-part inflatable implants and three-part inflatable implants. It is recommended that patients who undergo surgery should learn about the models and brands of implants.

Advantages

• Located in less visible place
• It’s an area with fewer feathers or no feathers.
• It’s enough for penetration.
• The erogenous area is preserved, ejaculation is possible.
• The feeling is less than the RFF forearm technique.

FIBULA FREE FLAP PHALLOPLASTY

Fibula free flap phalloplasty is one of the genital reassignment surgery to make a penis for trans males. It is a good alternative for patients who do not want an arm scar. The skin of the leg is taken with the bone, the penis is cylindrical shaped and then transferred to the groin area by microsurgery.

One of the advantages of this surgery is a prosthesis is not required for the operation of the penis in this technique. The bone inside the penis keeps the penis intact. Vascularized bone flap was found appropriate after 1 year of follow-up. Disadvantages of this surgery is bone has risks such as curl and fracture. It can be difficult to hide as it is a constantly erect penis. The patient may embarrassed by this situation. Hair will grow on the skin for the reason of taken from the leg and it will disturb the patient. So, It will be effective to have a laser applied to the area where the skin will be removed before the surgery. A second session should be applied and the wound should be thinned and shaped. The head of the penis is scratched and testicular formation is also recommended. Clitoris can be buried depending on the patient’s request.

Advantages:

Less pronounced scar than RFF method;

Penetration can be achieved with the natural stiffness of the FFFP.

Natural stiffness with the length of the vascular pedicle of the wing.

Functional Loss Risk in Bone Area

Functional imbalance may occur while standing on one leg. Problems may occur in the part of the distal tibia while running. Old function cannot be expected from the leg from which the bone is taken, but there is no obstacle.

Urethral Lengthening

Urethral lengthening is performed with ILLF or VMF technique. VMF technique involves a lower risk of complications. When ILLF is performed, the risk of complications increases more.

Scrotoplasty

Implant is placed inside the labia majora tissue expanded with the help of a pump. Tissue expanding pumps are used before scrotoplasty. The aim is to give testicular appearance.

Feeling

The amount of sensation in the penis varies depending on the technique used. 10% of the patients who have surgery, do not feel anything, it was observed that 90% of them felt from the middle of the penis to the root of the penis. While performing phalloplasty, the clitoris area is preserved, orgasm occurs as the flap connects to the clitoris through nerves.

Many different gender-affirmative operations can be performed to meet the demands of individuals who wish to ensure complete integrity of sexual transition surgeries using genital surgery methods. Surgical interventions to give the penis to the individual in transitions from female to male,

• -Metoidioplasty
• -Phalloplasty, it is possible in three different ways.

How to Perform Metoidioplasty Surgery?

Metoidioplasty surgery is the surgery technique of genital reassignment for trans males which is applying on the clitoris which became bigger by using testosterone hormone to make a penis. Individuals who request sexual transition before such surgeries require testosterone treatment for at least one year. Because when the testosterone hormone is taken, clitoris can grow naturally. During metodoidioplasty surgery, clitoral ligaments are separated, allowing clitoris to grow and restore a structure similar to an organ after childbirth.

The length of the penis created after surgery varies between 5-7 cm. Is it good size for sexual intercourse or not related to expectations of the person. But most of the time, this is not a matter of concern. In addition, additional surgeries may be needed, depending on the results that trans men want to achieve, and additional surgeries can be improved in the appearance of the penis and functional characteristics.

Another technique of penis creation surgeries performed in transitions from female to male is phalloplasty surgeries. Each surgery has its advantages and disadvantages.

Advantages of Metoidioplasty Surgery

Metoidioplasty and phalloplasty surgeries are performed in accordance with individuals’ own preferences and the recommendations of the physician in sexual transition surgeries. It is very important that the person who will switch to man in preoperative consultation processes exchanged views on male interests, expectations and priorities. Although not always considered the best option, Metoidioplasty surgery can provide satisfactory results for the trans man.

Advantages:

•-More affordable prices for the surgery

•-Single stage surgery

•-Shorter healing process

•-Low likelihood of complications

•-The fact that the big scar won’t remain after the surgery

•-The natural erection 

•-The fact that the natural erotic sensation of clitoris can also be preserved in the penis is among the advantages of metoidioplasty surgeries.

By undergoing metoidioplasty surgery, it is possible to apply phalloplasty to the trans individual, which has a penis with a natural appearance. For the reasons that the individual prefers metoidioplasty surgery in transitions from female to male one is to have the ability to urinate standing up. Metoidiplasty surgery can meet the individual’s expectations by providing a production extension. Although it meets expectations, there is also a risk of creating complications of urethra extension.

In some cases, annoying results occur, but often small complications occur. These are; problems such as urinary blockages or fistula formations. Metoidioplasty surgery is generally considered a single-stage operation, but sexual transition In accordance with the expectations of the requested individual and the recommendations of the physician, improvements can be obtained in terms of function and appearance with additional surgeries. There is always more than one operation in transitions from male to female, and in transitions from female to male.