Massage Tips to Prepare for Total Phalloplasty
The first step towards having a long, large, visually pleasing neophallus is proper massaging of the musculocutaneous latissimus dorsi flap (MLD flap).
Daily massage is a vital component of Perovic Total Phalloplasty whether to solve micropenis syndrome or as the ideal final female to male operation in transsexual surgery.
Patients with a Body Mass Index in the range termed "obese" must first lose weight or get liposuction of the donor site before transsexual surgery if the female to male operation gender transformation is to be followed by Total Phalloplasty seven days later during the same trip to Belgrade.
However, many FtM gender reassignment surgery patients as well as many micro penis patients are lean.
Proper massaging gives you greater penis size options but has many other benefits, particularly for thin persons. Some female to male sex change patients are not very concerned whether their neophallus is average penis size or average penis length.
A number of persons want the smallest possible size of the penis which is 12-13 cm and depends on skin thickness. The smallest AMS penile implants are 12 cm long.
But men born with a penis only a few centimeters long often want the full 18 cm length and 15 cm girth (7" x 5.9") Professor Perovic can achieve.
If you are a lean person with a very low Body Mass Index (BMI) or your skin is not very elastic, then proper massaging is the solution.
The intensive daily PROFESSIONAL massages must create the neophallus at the MLD donor site prior to surgery so that it is only slightly missed when moved.
The MLD donor flap must become completely redundant prior to surgery or there will be great difficulty closing the donor site properly and there will be tremendous stress on the wound.
YOU CANNOT EFFECTIVELY DO THE MASSAGE YOURSELF.
Dr Perovic said: “The possibility of surgery for lean persons depends on the patient's skin elasticity -- sometimes patients have very elastic skin. Photos of the MLD flap donor area could be helpful in evaluating skin elasticity.”
If during the pre-op consultation and physical exam in Belgrade before surgery, the doctors discover you have NOT prepared the MLD donor site and neophallus sufficiently with the massaging, your surgery will be postponed until it is properly prepared.
In November 2008, a patient going to Belgrade for this surgery was sent home and surgery postponed until December because of unacceptably high BMI and totally inadequate donor site preparation coupled with thick skin.
You will not get the result you desire without proper preparation.
FtM SRS surgery patients who recently had a mastectomy particularly need very good professional massage in order to prepare the back well.
Dr Perovic said: “Some time must past between these two surgeries (mastectomy and Total Phalloplasty) — at least two months. Massage can start approximately two weeks after mastectomy.”
The massage should be superficial and involve only the skin and subcutaneous tissue. It is best to massage both sides and Dr Djinovic will choose the best donor site.
Note that the goal is to make the tissue that will be used for the neophallus redundant and healthy. It is not a typical massage to soothe muscles and joints and align and reposition bones.
Dr Perovic said: “The patients should not be obese in order to be able to create normal size penis — not too thick — and they should prepare the donor area skin by intensive massage in order to increase skin elasticity and enable us to close the donor site defect directly. The massage is best done by a professional. All skin should be treated in the directions shown by the arrows in this photo.” Click on photo to enlarge to full-screen size.
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One Perovic Total Phalloplasty patient and his professional massage therapist recommend the following tips for patients preparing for surgery. However, AFTER the surgery, the patient reported:
“I would recommend at least TWO months of massaging the donor site for lean guys. I started at six weeks prior but seriously did the massages only approximately FOUR WEEKS prior and it was NOT elastic enough for Dr Perovic when he checked upon my arrival … Before flying off to Belgrade I could pull out approximately TWO INCHES but it WAS NOT ENOUGH!
“I recommend two months (intensive massage) at least! …
“ … It also necessary to get someone to 'pull out' or 'pull up' the donor site using both hands, not pinching but grab lots of tissue and pull it upwards then hold it and release — then do same again, pulling more each time! The person would have to lie on his side and let the masseur work on the top side.
“ … After having the 1st Stage (Perovic Total Phalloplasty), the skin across my chest was so tight, I could barely breath!”
Their other recommendations are:
- It's important to have the massage daily!
- Every morning or every night doesn't matter but massaging twice a day is better!
- If twice daily, then do a hard massage once and a soft massage once (i.e.; soft in morning, hard at night to minimize tissue bruising).
- Go for deep tissue massage using your fingers or the palm of the hand and do fast strokes!
- Then alternate using a forearm to do a slow deep stroke across. This varies the tissue stretching and helps builds the elasticity.
- It's best to use a Vitamin E moisturizer cream!
- Vitamin E improves the skin elasticity as well as keeping the donor site skin healthy and enabling it to heal quickly after the surgery.
- Hint: Apply the cream on hands and rub in prior to massaging skin, not directly to skin, or will be slippery and impossible to massage!
- Tip: For lean guys, really try and get the site massaged twice daily!
Here is the iPod version of Dr Perovic's new MLD Donor Site Massage Technique Video: Click here to download (8565 KB).