The Combined Vaginoplasty Technique for Male-to-Female Sex Reassignment Surgery: Operative Approach and Outcomes

• Published in: Journal of plastic, reconstructive & aesthetic surgery Vol. 70; no. 10; pp. 1483 - 1492
• Main Authors: Papadopulos, Nikolaos A., M.D., Ph.D., FACS, Zavlin, Dmitry, M.D, Lellé, Jean-Daniel, M.D, Herschbach, Peter, Psy.D., Ph.D, Henrich, Gerhard, Psy.D., Ph.D, Kovacs, Laszlo, M.D., Ph.D, Ehrenberger, Benjamin, M.D, Machens, Hans-Guenther, M.D., Ph.D, Schaff, Jürgen, M.D
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.10.2017
• Subjects: Adult; Cohort Studies; Combined technique; Demography; Esthetics; Female; Gender dysphoria; Humans; Male; Male-to-female; Outcomes; Patient Outcome Assessment; Plastic Surgery; Postoperative Complications - classification; Postoperative Complications - diagnosis; Postoperative Complications - epidemiology; Prospective Studies; Reconstructive Surgical Procedures - adverse effects; Reconstructive Surgical Procedures - methods; Sex reassignment surgery; Sex Reassignment Surgery - adverse effects; Sex Reassignment Surgery - methods; Vagina - surgery; Vaginoplasty; Gender Dysphoria; Sex Reassignment Surgery; Vaginoplasty; Male-to-Female; Combined Technique; Transgenderism; Outcomes; Male-to-female; Sex reassignment surgery; Combined technique; Gender dysphoria
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2017.05.040

Abstract Background Several therapy options exist for male-to-female (MTF) transgenders desiring sex reassignment. Surgery includes numerous different procedures. Of those, vaginoplasty is predominant and aims at providing attractive aesthetics and fully functional genitals.The goal of this study was to present the surgical results of our modified combined vaginoplasty technique in a consecutive patient cohort. Methods The authors included 40 MTF transgender patients undergoing two-stage sex reassignment surgery (SRS) in an observational prospective study between September 2012 and January 2014. Demographic characteristics, medical and surgical history, operative details, and outcomes after surgery were documented. Postoperatively, 23 patients received a pelvic exam following standardized protocol. Results Measured vaginal depth was 11.77 - 14.99 cm depending on dilator size used (25-40mm). Vaginal, clitoral, and labial sensitivity was intact and favorable in all examined patients. 19 women (47.5%) opted for breast augmentations to achieve feminine cosmesis making it the most common non-genital operation. Complications were mostly minor and temporary. Severe adverse events, such as wound infections (n = 3), colon injuries (3), short (1) or narrow (1) vaginas, or partial clitoral necroses (1), were rare and immediately addressed by the surgical team. No vaginal construction was lost and no secondary reconstructive approaches were required. Conclusion Satisfactory physical results and favorable low rates of complications endorse our combined technique for MTF SRS. These findings, however, need to be confirmed by other research groups as well. Therefore, in our opinion, MTF SRS remains an evolving area of development whose research is aiming to establish a state of the art surgical technique.