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Reversal Phalloplasty in Regretful Male to Female Transsexuals after Sex Reassignment Surgery
SIU Academy®. Djordjevic M. 10/13/14; 59851; UP.511 Topic: Complications/comorbidities
Prof. Dr. Miroslav Djordjevic
Prof. Dr. Miroslav Djordjevic
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Introduction: Sex reassignment surgery (SRS) has proven to be an effective intervention for the patient with gender dysphoria. In general, it’s reported that transsexuals who have undergone gender reassignment surgery are happy to have done so. However, there are some who regret their decision and need reversal surgery. This review is based on our experience with five patients who came to regret their decision after male to female surgery.
Materials and Methods: Between November 2010 and September 2013, five male patients aged 31, 35, 37, 49 and 53 years with a previous male to female sex reassignment surgery, underwent reversal phalloplasty. Preoperatively, they were additionally examined by three independent psychiatrists. Surgery included three steps: removal of female genitalia, total phalloplasty with microvascular transfer of the musculocutaneous latissimus dorsi flap and urethral lengthening with penile prostheses implantation.
Results: Follow-up period was from 6 to 39 months (mean 17 months). Good postoperative results were achieved in all patients. In two patients, all surgical steps have been completed; one is currently waiting for penile implants, while two patients decided against penile prosthesis. Complications were related to urethral lengthening, two fistulas and one stricture, respectively. All complications were repaired by minor revision. According to patients’ self-reports, all patients were pleased with the esthetic appearance of their genitalia and with their significantly improved psychological status.
Conclusions: Most transsexuals are contented with their decision following gender reassignment surgery, with only a few regretting it. Reversal surgery is indicated only after a new cycle of preoperative psychological and endocrinological treatment. Further insight into the characteristics of persons with postoperative regret would facilitate future selection of applicants eligible for SRS. Another recommendation is to actively search for individuals who have come to regret their decision and to try to systematically describe their life and treatment histories.
Introduction: Sex reassignment surgery (SRS) has proven to be an effective intervention for the patient with gender dysphoria. In general, it’s reported that transsexuals who have undergone gender reassignment surgery are happy to have done so. However, there are some who regret their decision and need reversal surgery. This review is based on our experience with five patients who came to regret their decision after male to female surgery.
Materials and Methods: Between November 2010 and September 2013, five male patients aged 31, 35, 37, 49 and 53 years with a previous male to female sex reassignment surgery, underwent reversal phalloplasty. Preoperatively, they were additionally examined by three independent psychiatrists. Surgery included three steps: removal of female genitalia, total phalloplasty with microvascular transfer of the musculocutaneous latissimus dorsi flap and urethral lengthening with penile prostheses implantation.
Results: Follow-up period was from 6 to 39 months (mean 17 months). Good postoperative results were achieved in all patients. In two patients, all surgical steps have been completed; one is currently waiting for penile implants, while two patients decided against penile prosthesis. Complications were related to urethral lengthening, two fistulas and one stricture, respectively. All complications were repaired by minor revision. According to patients’ self-reports, all patients were pleased with the esthetic appearance of their genitalia and with their significantly improved psychological status.
Conclusions: Most transsexuals are contented with their decision following gender reassignment surgery, with only a few regretting it. Reversal surgery is indicated only after a new cycle of preoperative psychological and endocrinological treatment. Further insight into the characteristics of persons with postoperative regret would facilitate future selection of applicants eligible for SRS. Another recommendation is to actively search for individuals who have come to regret their decision and to try to systematically describe their life and treatment histories.
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