MTF Surgery Research

Journal Articles About Male-to-Female Surgery

• Vaginoplasty
• Peritoneal Vaginoplasty
• Rectosigmoid Vaginoplasty
• Breast Augmentation
• Gender Reassignment Surgery in Thailand

Vaginoplasty

Rectoneovaginal Fistula in a Transgender Woman Successfully Repaired Using a Buccal Mucosa Graft.
Elmer-DeWitt MA, Wood HM, Hull T, Unger CA. Female Pelvic Med Reconstr Surg. 2017 Sep 27
Rectoneovaginal fistulae (RnVFs) are abnormal connections between the rectum and a surgically created neovagina. Although very uncommon, they confer significant morbidity in patients and may require a multidisciplinary team approach to the repair. Risk factors for RnVF include rectal injury at the time of neovaginoplasty, malignancy in the neovagina, trauma (iatrogenic or otherwise), radiation, and neovaginal revision surgery.
The patient is a 64-year-old transgender woman with recurrent RnVF following penile skin inversion neovaginoplasty, which was complicated by an intraoperative rectal injury. After failing an initial attempt at repair, the fistula was successfully repaired with a buccal mucosa graft.

An Update on the Surgical Treatment for Transgender Patients.
Colebunders B, Brondeel S, D'Arpa S, Hoebeke P, Monstrey S. Sex Med Rev. 2016 Sep 10.
A review of the literature was performed focusing on the most recent techniques of gender reassignment surgery. Penile-scrotal skin flaps remain the technique of choice for the vaginal lining, although indications for a vaginoplasty with intestinal transfer are becoming more common.

Neovaginal Cavity Dissection in SRS. Paper authored and presented by Dr. Kamol Pansritum.
First Global Aesthetics Conference, Miami Beach, FL, USA, November 2015.

Non-grafted Vaginal Depth Augmentation for Transgender Atresia, Our Experience and Survey of Related Procedures.
Reed HM, Yanes RE, Delto JC, Omarzai Y, Imperatore K. Aesthetic Plast Surg. 2015 Oct;39(5):733-44.
Given adequate development of the rectal-vesical space and preservation of that space with self-dilation, epithelialization will ensue providing sexual gratification for patient and partner (as per patient).

Male-to-Female Genital Reassignment Surgery: A Retrospective Review of Surgical Technique and Complications in 60 Patients.
Raigosa, M., Avvedimento, S., Yoon, T. S., Cruz-Gimeno, J., Rodriguez, G. and Fontdevila, J. Journal of Sexual Medicine, 12: 1837–1845. doi: 10.1111/jsm.12936. Article first published online: 2 JUL 2015.
GRS can provide good functional and aesthetic outcomes in patients with male-to-female GD. However, despite a careful planning and meticulous surgical technique, secondary procedures are frequently required to improve the function and appearance of the neovagina.

Effect of sex reassignment on mental well-being and quality of life. [Article in Finnish]
Mattila A, Heinonen L, Mäntymäki A, Uusi-Mäkelä N, Algars M. Duodecim. 2015;131(4):379-81.
Gender dysphoria is effectively alleviated by sex reassignment treatments. Quality of life is improved among the majority of patients, and regrets are rare. Psychiatric symptoms at the initiation of the transition process, discrimination, negative attitudes, losses in relationships, and complications in somatic treatments may deteriorate the social integration and quality of life of the transgender people. Health-care professionals can ease the transition process by organizing support for transgender individuals according to the same principles as they do for other people.

Aesthetic and Functional Outcomes of Neovaginoplasty Using Penile Skin in Male-to-Female Transsexuals.
Buncamper ME, Honselaar JS, Bouman MB, Özer M, Kreukels BP, Mullender MG. J Sex Med. 2015 Jul;12(7):1626-34.
This study demonstrates that, despite relatively low FSFI scores, this group of transgender women is very satisfied with both the functional and aesthetic results of neovaginoplasty using penile skin inversion.

Outcome of Vaginoplasty in Male-to-Female Transgenders: A Systematic Review of Surgical Techniques.
Horbach SE, Bouman MB, Smit JM, Özer M, Buncamper ME, Mullender MG. J Sex Med. 2015 Jun;12(6):1499-512.
Many surgical methods for vaginoplasty have been opted. The penile skin inversion technique is the method of choice for most gender surgeons. However, the optimal surgical technique for vaginoplasty in transgender women has not yet been identified, as outcomes of the different techniques have never been compared. With this systematic review, we aim to give a detailed overview of the published outcomes of all currently available techniques for vaginoplasty in male-to-female transgenders.

An Overview of Neovaginal Reconstruction Options in Male to Female Transsexuals
Marta Bizic, Vladimir Kojovic, Dragana Duisin, et al. The Scientific World Journal, vol. 2014, Article ID 638919, 8 pages, 2014.
A variety of surgical options exists for vaginal reconstruction. In this article, we review several different reconstructive approaches. Regardless of reconstruction method, the goals remain the same: creating a functional and aesthetically acceptable vagina and vulva, with a normal voiding function and satisfactory sexual function. Nowadays, the two most widespread techniques for neovaginal reconstruction are "penile inversion technique", with or without combining scrotal flaps and the use of intestinal pedicled transplants. Due to their importance, these two techniques will be discussed in more detail, compared to other reviewed techniques.

Fold-back perineoscrotal flap plus penile inversion vaginoplasty for male-to-female gender reassignment surgery in circumcised subjects
Kamyar Tavakkoli Tabassi, Bob Djavan, Jalil Hosseini, Alireza Ghoreifi, Mohadese Ershadi, Elahe Hosseini European Journal of Plastic Surgery 12/2014; 38(1):1-6.
Fold-back perineoscrotal flap plus penile inversion vaginoplasty is a suitable surgical approach for achieving adequate vaginal depth in cases of male-to-female (MTF) transsexual vaginoplasty when subjects have short penile skin flap because of circumcision.

Surgical reconstruction for male-to-female sex reassignment.
Amend B, Seibold J, Toomey P, Stenzl A, Sievert KD. Eur Urol. 2013 Jul;64(1):141-9.
We modified various vaginoplasty techniques to better position the urethral neomeatus in the proper anatomic location to minimize the chance for complications and enhance aesthetic satisfaction.

Factors associated with satisfaction or regret following male-to-female sex reassignment surgery.
Lawrence A. Arch Sex Behav. 2003 Aug;32(4):299-315.
This study examined factors associated with satisfaction or regret following sex reassignment surgery (SRS) in 232 male-to-female transsexuals operated on between 1994 and 2000 by one surgeon using a consistent technique. Participants, all of whom were at least 1-year postoperative, completed a written questionnaire concerning their experiences and attitudes. Participants reported overwhelmingly that they were happy with their SRS results and that SRS had greatly improved the quality of their lives. None reported outright regret and only a few expressed even occasional regret.

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Peritoneal Vaginoplasty

Pedicled Peritoneal Flap Vaginoplasty in Male-to-Female Gender Affirmation Surgery: A Case Report [FULL TEXT]
Suwajo, Poonpissamai MD; Ratanalert, Worapon M; Sooksatian, Krerkrit MD; Uerpairojkit, Ketchada; Dusitanond, Navipa MD; Chaovanalikit, Thiti MD; Jindarak, Sirachai MD; Udomsawaengsup, Suthep MD. Female Pelvic Medicine & Reconstructive Surgery, August 2020 - Volume 26 - Issue 8 - p e23-e26.

Outcomes of Gender Affirming Peritoneal Flap Vaginoplasty Using the Da Vinci Single Port Versus Xi Robotic Systems
Dy GW, Jun MS, Blasdel G, Bluebond-Langner R, Zhao LC. [published online ahead of print, 2020 Jul 2]. Eur Urol. 2020;S0302-2838(20)30469-3.
A comparison of robotic peritoneal flap vaginoplasty with two robot systems. With both systems, patients had good vaginal depth and width at an average follow-up of 1 yr. Surgery time was shorter with the Single Port (SP) robot.

Single Port and Multiport Approaches for Robotic Vaginoplasty With the Davydov Technique.
Robotic-assisted Davydov technique is a potentially applicable, efficacious, and safe method of vaginal reconstruction in cisgender and transgender individuals.
Acar O, Sofer L, Dobbs RW, et al. Urology. 2020;138:166-173.

Robotic Davydov Peritoneal Flap Vaginoplasty for Augmentation of Vaginal Depth in Feminizing Vaginoplasty.
Penile inversion vaginoplasty remains the gold standard for primary genital reconstruction in transwomen. Peritoneal flaps provide an alternative technique for increased neovaginal depth, creating a well vascularized apex with acceptable anticipated complications.
Jacoby A, Maliha S, Granieri MA, et al. J Urol. 2019;201(6):1171-1176.

Davydov Procedure for Augmenting Vaginal Length in a Postsurgical Male-to-Female Transgender Patient.
Jalalizadeh, Mehrsa, MD; Shobeiri, S. Abbas, MD, MBA. Female Pelvic Medicine & Reconstructive Surgery: July/August 2018 - Volume 24 - Issue 4 - p e9–e11.

Neovaginal Construction with Pelvic Peritoneum: Reviewing an Old Approach for a New Application.
Male-to-female gender reassignment surgery may lead to unsatisfactory vaginal length. No standard approaches are established to treat these patients. We present a case of vaginoplasty using the laparoscopic Davydov technique performed on a male-to-female transgender patient. Our case provides a novel approach to treating this rare condition and introduces Davydov procedure as a potentially effective and safe treatment.
Slater MW, Vinaja X, Aly I, Loukas M, Terrell M, Schober J. Clin Anat. 2018 Mar;31(2):175-180. (Note: Review article.)

New laparoscopic peritoneal pull-through vaginoplasty technique.
Many reconstructive surgical procedures have been described for vaginal agenesis. Almost all of them are surgically challenging, multi-staged, time consuming or leave permanent scars on abdomen or skin retrieval sites. A new simple technique using laparoscopic peritoneal pull-through in creation of neo vagina is described.
Mhatre P, Mhatre J, Sahu R.J Hum Reprod Sci. 2014;7(3):181-6. (Note: Patients were not transgender.)

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Rectosigmoid Vaginoplasty

Sigma-lead Male-to-Female Gender Affirmation Surgery: Blending Cosmesis with Functionality [FULL TEXT]
Kaushik, Narendra MBBS, MS, MCh, DNB; Jindal, Omi MBBS, MS, MCh; Bhardwaj, Devendra K. MBBS, MS. Plastic and Reconstructive Surgery, April 2019, Volume 7, Issue 4.
The Sigma-Lead MtF gender affirmation surgery is a safe and reliable technique. It allows faster healing and very minimal postoperative aftercare while delivering very natural cosmetic results in all major aspects of cis-genitals, namely, the sensate clitoris, clitoral hooding, full-length stand-out labia minora, and appealing apposed youthful labia majora with minimum scarring. It also provides a self-lubricating, fully sensate deep neovagina, allowing for clitoral and vaginal sexual arousal and climaxes with minimal dilation requirement. Complications, though present, can be treated successfully with revision surgery. Moreover, this is perhaps the largest reported series of rectosigmoid transfer in MtF transsexuals performed for primary vaginoplasty.
For more information, see: Rectosigmoid Vaginoplasty Revisited

Primary Sigmoid Vaginoplasty in Transwomen: Technique and Outcomes [FULL TEXT]
Christopher J Salgado, Ajani Nugent, Joseph Kuhn, Meghan Janette, Heidi Bahna. Biomed Res Int. 2018 May 10; 2018:4907208.
Most often, inverted phallus skin is used to create the neovagina in transwomen. However, not all patients have sufficient tissue to achieve satisfactory depth and those that do must endure cumbersome postoperative dilation routines to prevent contracture. In selected patients, the sigmoid colon can be used to harvest ample tissue while avoiding the limitations of penile inversion techniques It is now our standard of care to offer this surgery to our transfemale patients with phallus length of less than 4.5 inches or 11.4 centimeters.

Is Rectosigmoid Vaginoplasty Still Useful? [FULL TEXT]
Seok-Kwun Kim, Ji-Woen Park, Kwang-Ryeol Lim, and Keun-Cheol Lee
Arch Plast Surg. 2017 Jan; 44(1): 48–52.
Rectosigmoid vaginoplasty is useful, safe, and well-accepted operative method with good functional and cosmetic results, such as natural lubrication and adequate vaginal length and width obtained without requiring the use of a dilator.

Long-Term Follow-Up of Transgender Women After Secondary Intestinal Vaginoplasty
van der Sluis, Wouter B. et al. The Journal of Sexual Medicine , Volume 13 , Issue 4 , 702 - 710, April 2016.
In our institution, intestinal vaginoplasty before 2000 was always performed as a revision procedure after a previous vaginoplasty had failed. Although surgical corrections were frequently necessary, women reported satisfaction with the surgical outcome and with life in general.

Long-Term Outcomes of Rectosigmoid Neocolporrhaphy in Male-to-Female Gender Reassignment Surgery.
Morrison SD, Satterwhite T, Grant DW, Kirby J, Laub DR Sr, VanMaasdam. J. Plast Reconstr Surg. 2015 Aug;136(2):386-94.
This study is one of the largest and longest reported series of rectosigmoid transfers for vaginoplasty in transsexual patients. Rectosigmoid neocolporrhaphies have many times been recommended for secondary or revision surgery when other techniques, such as penile inversion, have failed. However, the authors believe the rectosigmoid transfer is safe and efficacious, and it should be offered to male-to-female patients for primary vaginoplasty.

Rectosigmoid vaginoplasty: clinical experience and outcomes in 86 cases.
Djordjevic ML, Stanojevic DS, Bizic MR. J Sex Med. 2011 Dec;8(12):3487-94.
Rectosigmoid colon presents a good choice for vaginoplasty. According to our results, sexual function and psychosocial status of patients who underwent rectosigmoid vaginoplasty were not affected in general, and patients attained complete recovery.

Long-term results in patients after rectosigmoid vaginoplasty.
Seok Kwun Kim, Ji Hoon Park, Keun Cheol Lee, Jung Min Park, Jeong Tae Kim, Min Chan Kim. Plast Reconstr Surg 2003 Jul;112(1):143-51.
The authors concluded that rectosigmoid vaginoplasty is the best choice for transsexual patients who have previously undergone penectomy and orchiectomy and patients with unfavorable previous vaginoplasty.

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Breast Augmentation

Breast augmentation in male-to-female transgender patients: Technical considerations and outcomes
Travis J. Miller, Stelios C.Wilson, Jonathan P.Massie, Shane D.Morrison, Thomas Satterwhite. JPRAS Open, Volume 21, September 2019, Pages 63-74.
For male-to-female transgender women (transwomen), feminization of the chest is a component in the management of gender dysphoria. A retrospective review of a single surgeon experience was performed for transwomen who underwent primary breast augmentation between October 1, 2014, and February 1, 2017. Most of patients (92.7%) reported being happier and feeling more satisfied with their chest than before their operation. All respondents (100%) reported improvement in their gender dysphoria and would undergo the operation again.

Differences in Chest Measurements between the Cis-female and Trans-female Chest Exposed to Estrogen and Its Implications for Breast Augmentation. [FULL TEXT]
Nauta, Allison C., Baltrusch, Kyle M., Heston, Aaron L., Narayan, Sasha K., Gunther, Sven, Esmonde, Nick O., Blume, Kylie S., Mueller, Reid V., Hansen, Juliana E., Berli, Jens Urs. Plastic and Reconstructive Surgery – Global Open: March 2019 - Volume 7 - Issue 3 - p e2167.

Long-Term Outcomes in Breast Augmentation in Trans-Women: A 20-Year Experience.
Fakin, R. M., Zimmermann, S., Kaye, K., Lunger, L., Weinforth, G., & Giovanoli, P. Aesthetic Surgery Journal. 12 June 2018.
This study aimed to present the long-term outcome and experience gained over 21 years of performing Breast Augmentation for transgender women. Trans-women who have undergone breast augmentation since 1995 were reviewed for primary surgery, type of incision, implant site, implant size and shape, and revisions. Request for larger breast implants was the most common reason for revision. Depending on the various degrees of breast tissue growth due to hormonal therapy, whenever applicable, we recommend round, low projection implants with a mean size of 360 cc in the prepectoral pocket.

Commentary on: Long-Term Outcomes in Breast Augmentation in Trans-Women: A 20-Year Experience.
Eric Bensimon. Aesthetic Surg J. 2018, 1–2.

Patient satisfaction with breasts and psychosocial, sexual, and physical well-being after breast augmentation in male-to-female transsexuals.
Weigert R, Frison E, Sessiecq Q, Al Mutairi K, Casoli V. Plast Reconstr Surg. 2013 Dec;132(6):1421-9.
In this prospective, noncomparative, cohort study, the current results suggest that the gains in breast satisfaction, psychosocial well-being, and sexual well-being after male-to-female transsexual patients undergo breast augmentation are statistically significant and clinically meaningful to the patient at 4 months after surgery and in the long term.

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Gender Reassignment Surgery in Thailand

The development of sex reassignment surgery in Thailand: a social perspective.
Chokrungvaranont P, Selvaggi G, Jindarak S, Angspatt A, Pungrasmi P, Suwajo P, Tiewtranon P. ScientificWorldJournal. 2014 Mar 19;2014:182981.
Currently, in Thailand, there are 6 major private groups performing sex reassignment surgery, and mostly performing surgery to patients coming from abroad. Particularly, the largest of these has performed nearly 3000 vaginoplasties for male-to-female transsexuals in the last 30 years.

Feminine transformations: gender reassignment surgical tourism in Thailand.
Aizura AZ. Med Anthropol. 2010 Oct;29(4):424-43.
Every year, hundreds of transgender people from the United States, Europe, Asia, Canada, and Australia have gender reassignment surgery in Thailand. Many GRS clinics market themselves almost exclusively to non-Thai trans women. This article draws on ethnographic research with patients visiting Thailand for GRS to explore how trans women patients related their experience of medical care in Thailand to Thai cultural traditions, in particular "traditional" Thai femininity and Theravada Buddhist rituals and beliefs. Foreign patients in Thai hospital settings engage not only with medical practices but also with their perceptions of Thai cultural traditions--which inflect their feminine identifications. I draw on two patients' accounts of creating personal rituals to mark their gender reassignment surgery, placing these accounts within the context of biomedical globalization and debates about the touristic appropriation of non-"Western" cultural practices.

 

Last updated: 09/25/23