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Beforetheoperation

Sex-change operation is a large and complex surgical procedure that commences after receiving a psychological examination certificate proving true transsexualism.

Transsexualism is divided in two variations according to desired changes in sexual sphere and is called by the English abbreviation FTM (female-to-male), i.e. changing the gender from male into female, or the opposite variant abbreviated MTF (male-to-female).

The number and complexity of feminizing and masculinizing operations is very different. Let’s discuss the latter variant.

FTM-transgender treatment (or sex-change surgery) is a complex set of operations, which consists of several stages: mastectomy, hysterectomy and phalloplasty. Some of these operations can be combined, and some can be performed only separately. Usually, the course of action is the following: the first stage is breast removal (mastectomy); it is followed by the removal of the uterus and its appendages (hysterectomy). After these surgeries it is possible to change the documents and to have phalloplasty. The duration of treatment may differ from 6-8 months up to several years, depending on the wishes and possibilities of the patient.

Breast removal

  • Usually the first step is the removal of breast, also known as mastectomy. It is executed in such a way that in case in initial small amount of breast only one scar around the areola is left initial chest is only one scar around the areola. This method has limited potential to reduce the skin area, so a further intervention performed in order to achieve better results may be required after 6 or more months.

 Sex-change operation

In case the size of the breast is large or the skin tone is poor and there are stretch marks, it is possible to use another method of operation with a cut in the breast crease. In this situation the gland is removed along with a considerable amount of skin. The nipple is saved on its pedicle or transplanted as a free skin graft to the right, for the male breast, place. This method was called “Smile” because of the remaining semi-circular scar resembles it. The patient stays in a hospital for one day, and in the absence of complications the rehabilitation lasts for 2 weeks. The sutures are absorbable.

Uterus and ovaries removal

The next step is the removal of the uterus and ovaries, also known as hysterectomy. This operation requires a short (2 days) hospitalization. Nowadays the operation is performed laparoscopically. It leaves only three punctures on the abdomen skin. If the patient’s anatomy allows, the operation can be performed via vagina, in this case the rehabilitation period lasts for about 2 weeks. For my patients, this operation is performed in a modern multi-disciplinary hospital by one of the best surgeons and gynecologists of the city!

Phalloplasty

The longest operation is phalloplasty. In our clinic the tissue necessary for this surgery is taken from the lateral abdomen surfaces, in the place where the appendectomy incision is made.

Preparation for the surgery

Preparation for the surgery starts from making an informed decision: which way of urination would be preferable? In case the patient prefers making it standing, then an additional phase of preparation is necessary, during which the new urethra is formed. So far it is a skin tube, hidden under the skin in the groin area. In case the question of urination position isn’t that important, i.e. the patient is ready to do that as before, then after the healing of neophallus tissues (which usually takes 6-8 months) an endoprosthesis replacement can be performed. It takes 6 more months for final healing. For a more reliable supply of neophallus tissues 2 more preparatory operations should be performed. The time recommended between these operations is not less than 3 weeks, but not more than 2 months. Phalloplasty is performed as the next stage in several weeks after the healing. Phalloplasty itself is a serious interference, during which two special groin flaps are transferred to the pubis and form a neophallus with the urethra inside.

Rehabilitation

The rehabilitation period after surgery is usually 3-4 weeks, the first days the patient should stay in bed.

The order of the remaining phases depends on the mood of the patient. Originally the “connection” of the old urethra to the new one is made. This is the most delicate and difficult operation among all described. The formation of healing tissue and neophallus itself is followed by the long period of new urethra connection, and this period can be rather difficult and unpredictable.

The formation of the missing pieces between the urethra and its opening is made of a new, yet “dry” urethra created of thin flaps, the seams between which heal, unfortunately, very bad. The operation requires hospitalization for at least a week. The difficulties are associated with a high probability of poor wound sutures in the urethra itself, because of the “eroding” properties of urine. So the first week a permanent urinary catheter is necessary. In case of prosperous healing the following surgery can be performed in several months. If the first attempt of this “connection” fails, it takes a break up to six months for re-operation. In the most severe case, it requires the epitsistostomy imposition, i.e. an artificial hole in the bladder, which is exteriorized on the skin. After healing the urethra is sutured again. The strengthening of neophallus is made by stents implanting. They are divided into manageable ones and those with constant stiffness. The latter type is used most frequently, primarily because of the relative ease of operation and their affordability. Typically, this operation is easy enough, but it requires a short hospital stay and weekly rest period. The neophallus can be used afte 5-6 months. The execution of some subsequent small corrective operations to correct minor defects is possible.

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