One Perovic Total Phalloplasty Stage 3 patient I know suffered implant protrusion and returned to Belgrade for Dr Perovic to correct the problem. Why did that happen? What percentage of Total Phalloplasty Stage 3 patients experience implant protrusion?
Dr Perovic explains: “Prosthesis infection is a complication well known to all transgender people. The rate is higher in a Total Phalloplasty neophallus than in normal penises. In radial forearm phalloplasty, it is about 15-30%. In a Perovic Total Phalloplasty neophallus it is less than 10% because the neophallus is bigger and has more space for placement of prosthesis without tension. The main causes of infection in a neophallus are: 1) small space for placement of implants; 2) less than ideal vascularity and less than ideal quality of tissue. It is very hard to predict despite all measures that we take before, during and after implantation.
“When the complication occurs, the usual scenario is infection starts first and after a few days protrusion also. They are most often coupled. All of these procedures regarding total phalloplasty are extremely complex and difficult and infections and protrusion are the most common complications. There is no surgery without complication. (see Complications of Surgery)
“The most important thing is that all of our patients will eventually have good phalluses with a urethra and prosthesis inside.”
When I go to Belgrade can I bring Dr Sava Perovic's surgical fee as traveler's checks? Or is only cash accepted?
Dr Perovic says: “The limit for exchanging traveler's checks in Serbia is Euros 1500/day, so it is a little inconvenient. No problem at all to bring the (cash) US dollars equivalent of the Euros. It can be exchanged on every corner.”
The professor does not accept plastic card payments of any type whether for penis enlargement surgery, MtF transgender SRS, FtM transsexual surgery, penile curvature correction or hypospadias surgery. There are no down payments and no advanced payments. Normal terms are cash payment in Euros directly to the doctors in Belgrade after the pre-op consultation and physical exam when the patient has given informed consent to proceed.
Electronic money transfers in advance are not preferred and must be approved by Dr Perovic first. However, in all cases patients must bring at least Euros 4000 cash with them to cover the professor's immediate costs for services, materials and facilities, even if he approves an advanced payment by money transfer.
Americans can buy Euros at any branch of Bank of America. There is no Bank of America branch in Serbia where you could withdraw cash. It is recommended patients watch currency exchange rates and buy the Euros they need in advance when their own currency is strong and the Euro is weak to get the best deal.
What is the deepest neovagina Dr Perovic could give an MtF transsexual who has a husband with an 11-inch penis? Would the neovagina be destroyed from penetrative intercourse? Is there any hope?
Dr Perovic explains: “We can make for her a very deep vagina from penile skin if she has a big penis without circumcision. If not, we can do it from rectosigmoid colon.”
What is the advised treatment and cost for repairing penile fracture that was left untreated and resulted in corporal fibrosis and scarring? Can he get penis enhancement at the same time he gets the penile fracture corrected?
Professor Perovic says: “These can be done simultaneously. The price depends on the severity of the defect. We need precise information in order to quote cost.”
What is a vascular graft? Can you explain it's relationship to the penile implant I'm going to get?
Professor Sava Perovic has significantly reduced the 3% standard rate of penile implant prosthesis protrusion by using a hi-tech vascular graft to enclose the device before insertion. Here is a photo of a penile implant prosthesis enveloped in a vascular graft (below the image of an AMS penile implant). Click to enlarge to full-screen size.
Dr Perovic explains: “A vascular graft is an artificial pipe material made and used for replacement of injured blood vessels. Vascular surgeons use it for reconstruction of blood vessels. It has very good characteristics and we envelope penile prostheses (penile implants)in it to form a good and strong capsule around the prosthesis as well as to prevent possible prosthesis protrusion. Prosthesis protrusion is a possible complication, but mostly with implantation of a semi-rigid prosthesis or when an inflatable prosthesis is implanted inappropriately. In order to prevent this, we envelope the prosthetic cylinders in the vascular grafts and then implant it in the neophallus.”
My psychiatrist is unwilling to forward a copy of my psychiatric approval letters as explained in the Harry Benjamin International Gender Dysphoria Association's Standards of Care for Gender Identity Disorders (World Professional Association for Transgender Health) but I'm ready for my SRS. I have done very well without outside help. I have been doing fine without the help of doctors for psychiatric approval. This is not a rash decision. I have heard good things about your facility and I was hoping you would do my SRS because I am having it done and I do not want to go somewhere less qualified. Will you perform my sex change surgery?
ALL hospitals and ALL surgeons to whom we refer patients adhere to the Harry Benjamin Standards of Care. In other words, they ALL require an ORIGINAL letter from a psychiatrist documenting your suitability for sexual reassignment surgery and approving it. The surgeons merely execute what the mental health professionals have determined is RIGHT for YOU.
Why? Because there are more than 1,500 documented cases of persons who got gender reassignment surgery and later decided he or she had made a MISTAKE and it was NOT right for them. You can send us digital copies of the letters to schedule the surgery and mail the originals to the surgeon or give them to him by hand when you meet.
The Standards of Care (SOC) are guidelines to help you achieve a successful transition and prepare you for it as well as getting all your loved ones and signficant others on board and supporting your decision. The SOC are not obstacles to make your life difficult.
Professor Sava Perovic explains: “We only do regular transsexuals with psychiatric approval. You NEED to have official psychiatric approval before surgery. That is mandatory. We need some report from a phychiatrist. Under NO CIRCUMSTANCES can you be operated on without psychiatric approval. Unfortunately, a request for surgery without psychiatric approval overcomes our professional ethics. For all patients who require any kind of genital modification surgery toward the opposite sex it is mandatory to have psychiatric approval. We just do the technical part of the job.”
Surgeons at all leading hospitals and clinics in Thailand also require documenation of your hormonal therapy and your 'Real Life Experience' as well as having minimum time requirements for both of those.
Do you have orchiectomy for transsexuals available? If you do, what's the price?
A number of Thai surgeons use scrotal skin to create the female looking external genitalia during their male to female surgery. For that reason, they decline to do an orchiectomy (transgender orchidectomy) alone. They recommend it be done at the same time as SRS surgery MtF because if the testicles are removed before SRS, it causes the scrotal skin to shrink which is not ideal for their variation of the MtF transsexual surgery.
If I get a mastectomy one month before getting Perovic Total Phalloplasty using the musculocutaneous latissimus dorsi flap (MLD flap), when should I start having the MLD donor site massaged?
Dr Perovic answers: “Some time must past between these two surgeries – at least TWO months. The massaging can start approximately two weeks after the mastectomy.”
If buccal mucosa is used for urethroplasty, will it cause problems when I eat?
Dr Perovic says: “No.”
How soon after Total Phalloplasty Stage One will I be able to walk, work, drive and play sports?
After Total Phalloplasty Stage One (preceded by organ removal or not), Dr Perovic says: “It takes 2-3 days until the patient can walk unaided, 14 days until he will be able to drive and work and at least 28 days before he can resume playing sports.”
How long after Perovic Metoidioplasty 2008 will I be able to drive a car, do sports, have sex and return to work?
Dr Sava Perovic responds: “You'll should be able to drive a car after one week, work after 10-14 days, play sports after two weeks, and have sex after one month.”
The penis resulting from metoidioplasty is too short and too small for sexual intercourse but does enable a patient to urinate standing.
If the orgasmic sensation is located at the base of the neophallus resulting from Total Phalloplasty, what kind of sensation does the head and shaft have?
Dr Sava Perovic responds: “The head and the shaft, with time (1-2 or more years), slowly develop normal sensitivity as we have elsewhere on the body such as the arms, legs, abdominal skin, etc.”
If the entire vagina is removed during a vaginectomy, how is the bladder kept in place to avoid risk of prolapse and incontinence?
Dr Sava Perovic responds: “The bladder is kept in place by its natural connective tissue that holds it in that position. The risk of incontinence is minimal in our experienced hands.”
Have any patients experienced any urinary problems as a result of a vaginectomy?
Dr Sava Perovic responds: “No.”
What complications can possibly occur as a result of a vaginectomy?
Dr Sava Perovic responds: “Potential complications, I mentioned before, are: injury of bladder, urethra, rectum, and exaggerated bleeding. Up to date we haven't experienced any of those.”
What are the advantages and disadvantages of using general anesthesia vs. local anesthesia or an epidural during metoidioplasty?
Dr Sava Perovic answers: “Compared to local anesthesia (epidural), general anesthesia carries mores serious potential complications, although extremely rare. Also, recovery is much easier after epidural anesthesia. Epidural anesthesia is mostly combined with sedation – with sleep.”
What are the advantages of getting surgery from Dr Perovic in Belgrade?
The big advantage of getting the surgery in beautiful Belgrade, one of the oldest cities in Europe, is that you get longer and better post-operative attention directly from Dr Perovic and his team and incur no additional expenses like you do when he performs the surgery in other countries. For example, if you get your surgery in Thailand, Dr Perovic needs at least 3-4 patients to go there at the same time and they must share the cost of the doctor's airfare and accommodations as well as the hospital's charge for using their facility and the cost of you staying there.
The more patients you have, the less it costs for each person because the cost of the doctor's expenses remain the same regardless of how many patients are scheduled and can be shared by all the patients. He will not come to Bangkok for less than three patients.
If you go to Belgrade, you have great flexibility in choosing the date that is best for you personally. No need to wait for a date that is also convenient for other patients.
Is Serbia a third-world country? Is Belgrade a dangerous place to visit?
Dr Perovic says: “Belgrade is very safe city like anywhere else in normal parts of the world, maybe even more so. The situation in Serbia is normal and the economy is similar to that of Czech Republic or Hungary or other similar European countries. It is not as developed as the USA or Western Europe, but it is quite a normal country. We grew up with American movies and music so our people are always sympathetic towards Americans. Americans are MUCH safer in Belgrade then in the USA. We have many patients come here from the USA, England, Germany, Canada, etc. We are not a third-world country and our hotels are normal.”
What is the most famous scar surgery hospital and doctor in Thailand?
This is not easy to answer simply due to three factors:
- many of Thailand's top doctors, best surgeons and most famous doctors are government officials working at government hospitals such as Siriraj and therefore not easily accessible to expatriates;
- at many famous private hospitals and famous clinics in Thailand they work in teams and you cannot be sure who actually do the work in the operating theater;
- You would think a famous doctor in Thailand should be the one who has the most success making people better with the least complications and at good price. However, many famous Thai hospitals and many famous Thai doctors are still wrestling with issues such as openness and transparency regarding treatment success rates and rates of complications. Send us your details and we'll get evaluations and quotations for your consideration from a number of leading health care providers specifically about your case.
Plastic Surgery Thailand Genital?
Would you be surprised to know that on some search engines the best Thai plastic surgeons (world leaders in this field) for genital modification that have done THOUSANDS of procedures and have the most advanced techniques, highest success rate and lowest percentage of complications don't show up in the top 40 of results returned for this query? We can only recommend a couple of sources in Thailand for genital modification of any sort so that means the first few dozen highest ranking ones are not the best, they are just doing well on some search engines.
Penile prosthesis Thailand?
Sure, you can get them implanted in Thailand but they all come from the USA and there are many types. We recommend you get it done by a plastic surgeon who has a lot of experience with the make and model you want. Since we consider genitals rather important, we have to strongly recommend Dr. Sava Perovic. If you cannot afford him, then get the procedure from one of the Thai plastic surgeons he has trained who charge about 34% less. If you cannot afford either of those two suggestions, we have a third option that cannot be considered "Premiere League" but will likely to get you a good result and is affordably priced.
Medical tourist agencies + Thailand?
Medical-Tourism-in-Thailand.com can be categorized as a “medical tourist agency” in Thailand although many of the people who contact us are coming for procedures which won't make them feel like taking a tour. We have a recommended resort of choice for medical tourists we can book for you and we can also provide concierge services in addition to helping you find the most appropriate health care provider. We provide the most important destination management services.
What is the average penis size? Is average penis length the same around the world?
Average penis size & average penis length is based more on ethnic background rather than geographic origin or nationality. “Average” erect penis size actually varies quite a bit from 9.6 to 16 cm (3.8-6.3 inches). According to Spain's Andromedical S.L., 17 average penile length ranges as follows:
- France – 16 cm (6.3")
- Italy & Russia 15 cm (5.9")
- Mexico – 14.9 cm (5.87")
- Germany – 14.4 cm (5.7")
- Spain – 13.6 cm (5.4")
- Japan – 13 cm (5.11")
- USA – 12.9 cm (5.07") [but African Americans average penis size is about 1 cm longer and Native Americans average penis size slightly less]
- Saudi Arabia – 12.4 cm (4.9")
- India – 10.1 cm (4")
- Korea – 9.6 cm (3.8")
Can I get Perovic Total Phalloplasty & still keep my vaginal canal with the ability to be penetrated?
No, you are not a suitable candidate for this procedure. Dr Perovic says: “We don’t do these strange patients — only regular transsexuals with psychiatric approval. You can find more info about transsexuals on http://www.wpath.org/.” (or see The Harry Benjamin International Gender Dysphoria Association's Standards Of Care For Gender Identity Disorders)
Dear Professor Perovic, what is the average length and width of the penis after your metoidioplasty (metaoidioplasty)?
“From 3-19 cm length (average 5) with small width – nobody ever measured it – I don’t know why.”
Is Dr. Perovic board certified to practice in the United States?
No, he is not. But in fact, doctors in the USA are licensed by individual states, not the Federal Government. A doctor licensed in Ohio cannot practice medicine in any other state. Board certification is not the same as a medical license. Professor Perovic is a a member of the American Academy of Phalloplasty Surgeons. Most of his professional credentials are published on our page about him.
Is it possible for Dr. Perovic to bill the cost of my surgery directly to my insurance provider?
No.
What types and brands of penile prosthesis devices can Dr Perovic implant?
Dr Perovic says: “We implant all kinds of prosthesis devices: inflatable (two or three components) and semirigid, both AMS and Mentor (now Coloplast). We have great experience in that field.”
Does Dr Perovic use InteXen LP (lyophilized porcine), the dermal matrix graft material of American Medical Systems Holdings Inc of Minnesota?
Dr Perovic says: “We primarily use InteXen for reconstruction of tunica albuginea in Mb Peyronie (IPP) and it is excellent for this. It is used as a patch for correction of penile defect after curvature correction. We have had very good results with this material. We don’t use it for the procedures mentioned by the manufacturer such as augmented repairs during reconstructive surgery of the vagina, bladder and urethra and solve erectile dysfunction.” Because of it's softness, easy handling, conformance to the natural anatomies of patients and improved healing response, it has been used in more than 132,000 patients in over 54 countries.
I have a hormone condition. Can I get male breast reduction (gynecomastia) and nipple reduction at the same time I get penis enlargement surgery by Sava Perovic?
Dr Perovic says: “No problem, we can do it simuntaneously. Nipple reduction can be done too. The breast surgery would be Euros 1500 more.”
Would I be better off contacting Dr Perovic directly? And what is the schedule and number of examinations with the doctor before and after the penis enlargement surgery?
Dr Perovic says: “Before surgery, there is no need for direct contact (go through the case manager). We are so busy that we don’t have time to eat normally and we really don’t have time to answer these endless questions. Photos in flaccid and erect state would be very valuable as well as current penile measurements – length and girth.”
Although it is not the traditional format of face-to-face consultation directly with a physician, working through the professor's case manager primarily through email does give patients anywhere in the world unprecedented access to the world's top urologist and does get them the surgery they require. The professor can understand your needs by means of your medical history, photos, measurements and comments.
Patients who actually make the decision to have surgery perfomed by Dr Perovic will meet the professor and discuss their situation face-to-face in the pre-operation consultation and physical exam the day before surgery. You will settle the finances at that time directly with the doctor. He expects all other details and matters to be worked out by his team.
Why? Because he is usually in surgery almost all day every day or flying to another country to do so. He's among the best surgeons in the world so has decided to limit his role to that of surgeon, not administrator, to give the maximum number of patients the benefit of his skills.
After surgery, the doctor sees a patient on specified days to ensure healing is proceeding as anticipated. For many surgeries, hospital stay is required for close observation and post-operative health care.
If any nursing care is needed while an out-patient and before returning to the person's home country, such as changes of bandages, the host hospital provides it. In summary, Professor Perovic does only what he alone can do and delegates all other matters to his personal team and the host hospital.
You can get the most and best and longest follow-up care from Dr Sava Perovic in Belgrade.
Does Professor Perovic put in writing his assurances that he'll sort out any complications arising later from the surgery?
Dr Perovic says: “Yes, definitely.”
Are there any Thai doctors who perform Dr Sava Perovic's FtM sex change surgery in Bangkok?
Dr Perovic says: “They are not experienced in FtM surgeries like us. Neither (are their techniques) close.”
How does Dr. Perovic incorporate the clitoral nerves to the neophallus during his Total Phalloplasty?
Dr Perovic says: “We don't incorporate the clitoral nerves into the neophallus but rather the ilioinguinal nerve (rises from the first lumbar nerve, passes through the inguinal canal and superficial inguinal ring to supply the skin of the upper medial thigh, mons pubis, and scrotum or labia majora) in order to provide tactile sensation. We preserve the clitoris and cover it under the skin so the patient can have sexual arousal and orgasm.”
Is a scrotoplasty also included in the third stage of Perovic Total Phalloplasty surgery?
Dr Perovic says: “Yes, of course!” (in the case of transgender FtM sex change if it wasn't already done during earlier organ removal procedures or earlier stages of Perovic Total Phalloplasty).
Is it necessary to have a vaginectomy before getting Perovic Total Phalloplasty?
Dr Perovic says: “It's not necessary, but it is highly recommended. We can also do a vaginectomy and one week later perform the Total Phalloplasty.”
How long must a Perovic Total Phalloplasty patient stay in hospital?
Dr Perovic says: “For the first stage of Total Phalloplasty, the patient must stay approximately seven days in hospital and a few days more in his hotel — about 10-14 days in Belgrade before travelling back home.”
Is it OK to bring friends, relatives and/or other people interested in becoming patients of Dr Perovic to Belgrade when I get my surgery from the professor?
Dr Perovic says: “Yes, of course!” You are welcome to bring anyone you want to accompany you and meet the doctor.
Where does Sava Perovic usually perform Total Phalloplasty in Belgrade?
Dr Perovic performs surgery at a number of private medical facilities and hospitals in Belgrade. The type and length of surgery influences the choice of the most appropriate medical facility but there is no charge to the patient whichever facility is used since all surgical fees quoted are package prices that include everything related to the surgery, including all relevant transport, nursing, medicine, hospital stay, and anesthesia (Global Fee).
What's a fistula?
A fistula, pronounced FISS-CHA-LA, is among the most common complications of FtM sex change procedures. Sometimes called a "fistulotomy", it can result from injury, surgery, infection or inflammation.
It is an unintentional passageway from a vessel, body structure or hollow organ (such as a penis or neophallus) which enables passage of bodily fluids to the outer surface of the person's body or to another organ or area of the body.
In many cases, the injury can be repaired with simple surgery that has a success rate of 90% and costs about US$300 in the USA. It is reasonable to expect the surgeon who performed a surgery that results in a fistula to perform the repair without a fee for his service. Some doctors expect the patient to bear other expenses such as the cost of the facility and perhaps anesthesia.
There are many types of fistula including: blind, complete and incomplete. A blind fistula connects two places but is open on only one end. An incomplete fistula opens on the skin but is closed on the internal end of the duct. A complete fistula is open on both ends and these kind result in fluid transfer.
Can Professor Perovic write a letter for me stating that I've already had my sex reassignment surgery since I'm going to have it soon?
Dr Perovic says: “We will not do any false documents for any patient.”
Can Dr SV Perovic do "glans sculpting" so the glans looks more natural and conspicuous? Can anything be done in that regard in addition to the de-epithelialized skin strip at the tip of the neophallus created during Total Phalloplasty?
Dr Perovic responds: “The best way to achieve this is a tattoo. It can look very nice.” (Note: He does not do the tattoo. No photos have been provided.)
What is the actual complication rate for Perovic Metoidioplasty 2008 with the urethral lengthening procedure?
Dr Perovic says: “Fistulas in about 3-5% of patients. Of those, the majority of the complications resolve by themselves. Stenosis occurs in an even smaller percentage of patients. As far as I can remember, a testicular implant has protruded in only one patient (0.0025% of 400+ cases).”
In what way is Perovic Metoidioplasty 2008 more advanced than in the past and better than what is offered by other doctors?
Dr Perovic says: “The technique is similar but there are some small 'tricks and tips' in order to avoid complications.” (Note: The 'small tips and tricks' have been developed by doing the procedure more than 400 times over more than a decade.)
If my friend, family member, companion, wife or signficant other wants to come along with me to Belgrade to provide support and will stay with me at my hotel or apartment arranged by your team, will they need to pay extra for their accommodation?
Dr Perovic says: “Family members can stay with patients but only one medical center allows it and they must pay for bed and breakfast (€50 per day).” Most hotels allow double occupancy and good ones can be found for €60/day. The apartment available for daily rent by patients of Dr Perovic visiting Belgrade costs the same and is also large enough for more than one person.
How much does it cost to stay at a medical facility in Belgrade longer than the stipulated number of days in the surgery package price?
Staying at a Belgrade medical facility longer than the standard recovery time costs €100/day and some hospitals charge more.
Can Sava Perovic's Tissue Engineering with Biodegradable Scaffolds be used for the clitoris during metoidioplasty to gain more girth and possibly length?
Dr Perovic says: “NO, these are completely different things.”
If I went to Belgrade to have FtM metoidioplasty surgery performed by Dr Perovic himself, where and at which hospital will the Perovic metoidioplasty be performed?
Dr Perovic says: “The hospital is not important at all. We do surgeries at many places and all have good conditions for this kind of surgery.”
Who exactly IS on Professor Perovic's Team?
Dr Perovic says: “Dr Rados Djinovic is a permanent member. We have also several younger assistants.”
Does Dr Perovic's Metoidioplasty 2008 surgical fee include full hysterectomy and vaginectomy?
Scrotoplasty and testicular implants are included. Multiple FtM organ removal can be done during the same surgery session as metoidioplasty but is not included in the price for only metoidioplasty. Specify exactly what organs need to be removed to get the exact cost.
If I choose to have my Perovic Metoidioplasty 2008 done personally by the professor in Belgrade, will someone organize accommodations and transport during my stay there?
Dr Perovic says: “Of course! Our driver waits for all patients and drives them directly to hospital. We also take care of all accommodations until departure. Hospital cost is included in the price, but not the cost of a hotel when it is needed. We arrange accommodations, the hospital, transfers, any help that the patient needs, but we do not pay the hotel bill.”
Will Dr Perovic supply me with Andractim gel to put on my clitoris to make it bigger?
Dr Perovic says: “It is a registered product that can be bought in France, Germany, Italy and many other European countries. The active substance in Andractim gel is 2.5% dihydrotestosteron. So any other product with the same substance could be used.” The required active ingredient is Dihydrotestosterone (DHT) also know as 5α-Dihydrotestosterone or abbreviated 5α-DHT.
Does Dr Perovic use good medical facilities? Can your patients who go there expect to have peace, quiet and privacy, unlike what some persons have experienced with other doctors?
Dr Perovic says: “Our patients all have normal rooms ... and our patients up-to-date are satisfied.”
