FtM Transsexual Surgery Phalloplasty Using Perovic Metoidioplasty 2008
FtM gender transformation now often culminates in a transgender sex change female to male operation to complete the transition. This article does not discuss the pros and cons of sexual reassignment surgery nor advise who should get SRS surgery. However, when a female to male transsexual has made the decision to get female genital modification, surgery abroad medical tourism means everyone can now get the very best female to male operation from the best metoidioplasty surgeons.
Perovic Metoidioplasty has been considered the premier surgical method for a female to male transsexual for most of the past decade. Dr Sava Perovic has been continually developing and improving the technique during each of the more than 400 FtM metoidioplasty surgeries he has done since he started using it in 1995. The British Journal of Urology (BJU) International's article about Perovic Metoidioplasty published in 2003 is widely re-published on numerous web sites but was a study of only 22 patients and does not completely reflect the current extremely advanced state of F2M gender transformation transsexual surgery by Dr Perovic.
In the appoximately 380 metoidioplasty surgeries he has done since that report was written, Dr Perovic has constantly strived to improve the appearance of the new genitalia and significantly reduce complications. “There are a number of improvements and we have developed, some small ‘tricks’ regarding urethroplasty, so we have significantly fewer complications such as fistula and stenoses,” said Professor Perovic. “We have also improved the aesthetics greatly.”
Now FtM transsexual surgery patients can expect there will be no need for a blood transfusion and that they will get the longest penis possible unless they get Perovic Total Phalloplasty. “We cut the urethral plate in order to lengthen the neophallus and use buccal mucosa graft for the urethral lengthening,” said Dr Perovic. “Our vaginectory is almost without any bleeding and our patients almost never need a transfusion. Also, fistula and stenoses are extremely rare in our hands, compared to others. And we always implant testicular implants concomitantly.” Note: The urethral plate is a solid cord of endodermal cells coming from the bottom of the urogenital sinus a.k.a. the persistent cloaca).
So the best female to male gender reassignment surgery is better than ever and an excellent foundation for Total Phalloplasty at a later date if a patient wants a penis as large as or larger than the average male's — up to seven inches long and nearly six inches in circumference — that has feeling and can have sexual intercourse and an orgasm.
As the popular BJU article explains, FtM metoidioplasty can be considered a phalloplasty procedure because it creates a neophallus from an enlarged clitoris in female transsexuals. It costs less, takes less time and has fewer stages than Total Phalloplasty and also enables the patient to urinate standing up. Perovic Metoidioplasty 2008 is not a reprequisite for Perovic Total Phalloplasty.
One of the reasons Perovic Metoidioplasty is so effective, efficient and successful is because of Dr Perovic's extensive experience and knowledge regarding all other types of complex and challenging genital modification such as severe forms of hypospadias, epispadias and intersex in both children and adults. His remarkable understanding of anatomy and current level of expertise in reconstructive surgical procedures were showcased in the February 2008 issue of the very prestigious Journal of Urology of the American Urological Association.
FtM SRS transsexual surgery includes removal of the female genitals followed by a female to male operation to reconstruct male genitals. Both are best done by a board certified urologist surgeon with experience doing hundreds of cases of FtM gender reassignment surgery such as Dr Perovic.
The professor removes the female genitals, including the uterus, ovaries and vagina using a trans-vaginal approach so there are no visible scars, then immediately does metoidioplasty to create a micro penis. If the patient wants the large male genitals provided by the Total Phalloplasty female to male operation using the MLD flap so one of the various AMS penile implants will be able to fit, the professor first removes the female genitals in one surgical session, then 5-7 days later can safely perform Total Phalloplasty Stage One.
The trans-vaginal hysterectomy, oophorectomy and vaginectomy take about three hours of surgery under general anesthesia combined with epidural anesthesia. If only the vagina needs to removed the surgery takes two hours.
Some pre-operative preparation for SRS (sexual reassignment surgery) is the same whether it will end with FtM metoidioplasty or a week later with the Total Phalloplasty female to male operation. Every sex change patient needs to stop taking hormones at least two weeks before surgery to reduce risk of deep vein blood clots and should be admitted to the medical facility one day before SRS surgery for bowel cleaning — certainly not less than 18 hours before. Only clear liquids, no solid food, can be eaten the day before transsexual surgery.
FtM metoidioplasty patients are advised to apply 2.5% dihydro-testosteron gel on their clitoris twice daily for at least one month in order to increase its size. Small vacuum devices can be used for 2-3 months for the same purpose.
Because metoidioplasty or urethral advancement in preparation for the Total Phalloplasty female to male operation are done simultaneously with the removal of the female genitals, post-operative care is the same for both procedures. The FtM patient will have perineal drainage for 2-3 days and needs to recover in hospital 5-7 days.
Although the primary complications surgeons experience during FtM SRS surgery is injury of the rectum, posterior urethra or bladder, Dr Perovic has experienced none of these problems using his very advanced techniques. In addition, almost none of his patients require a blood transfusion. Approximately 4% of patients who get urethral lengthening develop fistulas and even fewer experience stenosis (constriction or narrowing of the opening and passageway). Most heal without intervention and the others require minor corrective surgery. The professor has had only one case (0.0025%) of testicular implant protrusion.
Perovic Metoidioplasty 2008 uses the clitoris to create a small micro penis that is usually 3-5 cm long when erect. Even the longest recorded, 8 cm when erect, is still insufficient for sexual intercourse with vaginal penetration but can be used to urinate while standing. The length of the penis resulting from this female to male operation depends primarily on the clitoral size, not the surgeon.
Scrotoplasty is done at the same time and is a standard part of Perovic Metoidioplasty 2008. The size of the testicular implants made by “Eurosilicone” of France ranges from 12 to 18 ml. Like the size of the penis, the size of the testicular implants chosen depends on the amount of labia majora skin the patient has available for implantation without tension and risk of protrusion. It depends very little on the discretion of the doctor and the preferences of the patient.
