Michael L. Brownstein, M.D., FACS

VAGINOPLASTY (PENILE INVERSION TECHNIQUE)

There are several methods of FTM genital reconstruction. The procedure I prefer is the penile inversion technique I have observed this technique with Dr. J.J. Hage in Amsterdam and is the most often used technique to reconstruct the vagina. One of the goals is to achieve adequate neo-vaginal depth. The greatest challenge to attaining good functional depth is lack of sufficient penile skin for lining of the new vagina.

Contrary to popular belief, the penis is not amputated in the literal sense. Internal penile tissue is mostly removed, but the outside skin is left attached, inverted and inserted into the body inside out as the new vagina. A flap of tissue from the perineum is used with the penile skin to aid in giving depth and to avoid contracture. The nerves and vessels on the upper surface of the penis are preserved and retained with a portion of the glans, which will form the new clitoris thus retaining erotic sensation. The testicles are removed, but scrotal tissue is left attached and used to fashion the labia.

Once you are anesthetized in the operating room surgery begins by slitting the skin of the penis lengthwise from the glans down to the base on the underside. The skin is then peeled away from the penis but remains attached at the base. The urethra is freed and shortened and the spongy tissues associated with erections is removed as well as the testicles. The penile skin is then turned inside out and the slit is sutured together with the perineal flap creating an inverted penis (penile inversion) which will create the new vagina.

Skin is lifted on the lower abdomen. After a vaginal opening is created it is lined with the outer layer of penile skin. A small opening is made in the skin near the base and tissue is passed through the slit forming the equivalent of a clitoris.

Another slit is made for a female urethra. Scrotal sac tissue is formed into inner and outer labia. The shortened urethra is moved to a proper location and sutured into place. A clitoris is made form nerve bearing tissue taken from the penis in the first part of the procedure. The new vagina is filled with gauze and anchored into place.

Breast implants may be placed at the same time as the vaginoplasty or at a later date.

The entire procedure may take up to four hours and you should expect to remain hospitalized for five to six days. During hospitalization you will have a urinary catheter for several days. Most patients are back to work in two to three weeks after surgery.

Labiaplasty may be performed at a later date. I believe a finer cosmetic results is achieved if the tissues are allowed to heal.

Upon discharge from the hospital you will continue with certain exercises and instructions for maintenance of the neo-vagina with dilators until regular sexual activity is achieved. Proper postoperative self-care is essential to maintain vaginal integrity.

LABIAPLASTY

If desired labiaplasty which can better define the labia can be formed three months or more following vaginoplasty. The procedure usually takes about one hour and can usually be performed under local anesthesia.

TRACHEAL SHAVE

A tracheal shave involves shaving the tracheal cartilage to achieve a more feminine appearing neck and, in most instances, be performed utilizing local anesthesia.

LIPOSUCTION

Dr. Brownstein was one of the first two doctors to perform liposuction in San Francisco. Liposuction is popular among MTFs particularly for eliminating bulging fat around the waist. If you have localized excess fat or desire contouring in any many areas including cheeks, jowls, neck, upper arms, abdomen, waist, hips, buttocks, or inner and outter thighs. Liposuction can be performed on several areas of the body at the same time.

RESOURCES

Gender.org

For more information, e-mail Dr. Brownstein or call tollfree (877) 255-2081.



	VAGINOPLASTY (PENILE INVERSION TECHNIQUE) There are several methods of FTM genital reconstruction. The procedure I prefer is the penile inversion technique I have observed this technique with Dr. J.J. Hage in Amsterdam and is the most often used technique to reconstruct the vagina. One of the goals is to achieve adequate neo-vaginal depth. The greatest challenge to attaining good functional depth is lack of sufficient penile skin for lining of the new vagina. Contrary to popular belief, the penis is not amputated in the literal sense. Internal penile tissue is mostly removed, but the outside skin is left attached, inverted and inserted into the body inside out as the new vagina. A flap of tissue from the perineum is used with the penile skin to aid in giving depth and to avoid contracture. The nerves and vessels on the upper surface of the penis are preserved and retained with a portion of the glans, which will form the new clitoris thus retaining erotic sensation. The testicles are removed, but scrotal tissue is left attached and used to fashion the labia. Once you are anesthetized in the operating room surgery begins by slitting the skin of the penis lengthwise from the glans down to the base on the underside. The skin is then peeled away from the penis but remains attached at the base. The urethra is freed and shortened and the spongy tissues associated with erections is removed as well as the testicles. The penile skin is then turned inside out and the slit is sutured together with the perineal flap creating an inverted penis (penile inversion) which will create the new vagina. Skin is lifted on the lower abdomen. After a vaginal opening is created it is lined with the outer layer of penile skin. A small opening is made in the skin near the base and tissue is passed through the slit forming the equivalent of a clitoris. Another slit is made for a female urethra. Scrotal sac tissue is formed into inner and outer labia. The shortened urethra is moved to a proper location and sutured into place. A clitoris is made form nerve bearing tissue taken from the penis in the first part of the procedure. The new vagina is filled with gauze and anchored into place. Breast implants may be placed at the same time as the vaginoplasty or at a later date. The entire procedure may take up to four hours and you should expect to remain hospitalized for five to six days. During hospitalization you will have a urinary catheter for several days. Most patients are back to work in two to three weeks after surgery. Labiaplasty may be performed at a later date. I believe a finer cosmetic results is achieved if the tissues are allowed to heal. Upon discharge from the hospital you will continue with certain exercises and instructions for maintenance of the neo-vagina with dilators until regular sexual activity is achieved. Proper postoperative self-care is essential to maintain vaginal integrity. LABIAPLASTY If desired labiaplasty which can better define the labia can be formed three months or more following vaginoplasty. The procedure usually takes about one hour and can usually be performed under local anesthesia. TRACHEAL SHAVE A tracheal shave involves shaving the tracheal cartilage to achieve a more feminine appearing neck and, in most instances, be performed utilizing local anesthesia. LIPOSUCTION Dr. Brownstein was one of the first two doctors to perform liposuction in San Francisco. Liposuction is popular among MTFs particularly for eliminating bulging fat around the waist. If you have localized excess fat or desire contouring in any many areas including cheeks, jowls, neck, upper arms, abdomen, waist, hips, buttocks, or inner and outter thighs. Liposuction can be performed on several areas of the body at the same time.
	RESOURCES
	Gender.org