Kızlarpınarı Mh. Uğurlu Sk. No:3 Alara Medical Plaza, Alanya, Antalya

Female To Male(Sex Reassignment Surgeries)

Trans people are the person who is born in the wrong body that makes to have different identity behaviors which are shown them as an opposite gender. During this article, we try to explain different stages of transsexual procedures for a female to male patients from the first step to the last one.

Transgender people are those kinds of people who their activities, behaviors and characters are not assigned to their birth gender. FTMs are people with the female assignment and male identification and MTF are those people with the male birth assignment and female identification.

On the second half of twenty-century medical technology was developed for sexual reassignment surgery (Susan Stryker, 1994). Penile and scrotal reconstruction in Genital surgery in FTM patients are the core procedures. The other nongenital surgeries consist of mastectomy, voice surgery, and masculinization surgeries.

In according to increasing of FTM patients amount we decided to write this article to explain how we can start to do gender reassignment surgery and how it will finish.

The first step of sex reassignment is a diagnostic phase (mostly supported by a mental health professional), then followed by hormonal therapy (through an endocrinologist), a real-life experience, and at the end the gender reassignment surgery itself.

For making sure about patient’s surgical readiness universally is recommended to get permission from Standards of Care (SOC) of the WPATH(World Professional association of Transgender Health). For being ready for surgeries is advised to stop all hormonal therapy for 2-3 weeks. Totally in transgender surgery participate, psychiatrists, psychologists, plastic surgeons, urologists, plastic surgeons, and gynecologists.

However the researches are continuing and every time discover new surgery way, the latest surgeries ways are mentioned in this article. All FTM surgeries include eight surgical procedures: hysterectomy, mastectomy, metoidioplasty, phalloplasty, salpingo-oophorectomy, scrotoplasty/placement of testicular prostheses, urethroplasty and vaginectomy. These procedures usually performed as bellow: first, the subcutaneous mastectomy which is often combined with a hysterectomy-ovariectomy (endoscopically assisted). The second surgical procedure is genital transformation and includes a vaginectomy, a reconstruction of the horizontal part of the urethra, a scrotoplasty and a penile reconstruction. In according to the previous clinical studies for FTM patients outcomes are shown the ability to perform sexual intercourse, achieve orgasm and void whilst standing.

For making penile there are 3 techniques which are same as below: 1. With a radial forearm flap (or an alternative). 

After about one year, penile (erection) prosthesis and testicular prostheses can be implanted when sensation has returned to the tip of the penis. 2. With a latissimus dorsi flap instead of forearm flap because of permanent and visible scar tried to find a place nonvisible. 3. Free fibula phalloplasty radial thigh flap instead of 2 before mentioned flaps. In this technique we use fibula bone instead of prostheses.

For the next step, we should provide sensation with neo-urethra preoperative infiltration of the cutaneous nerves. As the length of the penis should be enough it is important to use the longitudinal design for the flap. In this surgery also needs the second stage because of checking of urethra tube and then penis head and testicles will add.

Because of so many complications in the radial forearm flap technique like long time recovery 3 stages operation and no guarantee for patients satisfaction and not satisfaction after doing latissumus Dorsi flap. The third and newest technique free fibula phalloplasty technique is preferred for FTM patients.