TRANSGENDER SURGERY

Kişinin ait olduğu genetik yapıdan farklı olarak karşı cins gibi sosyal yaşantısını belirlemesi ve içinde bulunduğu vücuda ait olmadığı hastalarım tarafından en sık söylenen şikayetlerdir. Ben bir Plastik Cerrah olarak bu içsel yapının neden böyle oluştuğu ve niçin bu kişilerin böyle hissettiklerini uzman olmadığım bir konu olan psikolojik ve psikiyatrik alt yapısını burada açıklama yetisine sahip değilim. En iyi yaptığım iş olan cinsiyet değiştirme ameliyatlarının cerrahisi ve yasal prosedürü ile ilgili ise gerekli bilgileri sizlere verebilirim.

Cinsiyet Değişimi Kanuni Yönleri

Female to Male Transgender Surgery

Operation Process

Within the framework of our procedure, the breasts and internal genital organs are first removed during the first surgery. The technique we apply while taking the breasts is in 3 ways. If the patient’s breast is in a small volume, since we only remove the whole breast from the nipple, there are no surgical scars left in the chest area, but are not visible in dark color in the nipple impression. If the person has a medium breast tissue, one incision under the armpit from the side of the nipple or the second incision in it.

Starting from the nipple and adding an incision in the midline of the body, the breast tissue is removed.
In patients with large breasts, the nipple is removed and the whole breast is removed through a horizontal incision in the whole breast chest. Nipples are placed in a suitable localization. Obstetricians take the patient’s uterus, ovaries and ovarian canals in the same session, and the vagina is removed. The important thing here is to remove almost the entire vagina, which requires an experienced gynecology surgery.

 

Approximately 6-8 months later, the person will be ready for the second surgery. In this surgery, scrotum and penis reconstruction is performed on the person. The scrotum is used for the outer genital organ of the person, the large, small lips and the pubic area on the clitoris. In this way, the skin color of the scrotum is close to its normal color. In addition, scrotum reconstruction is performed without the need for testicular prostheses by using this fatty and thick area tissue. Although there are many techniques for penile reconstruction, we use the “radial forearm flap” using the anterior and lateral skin faces of the arm, and the “fibular bone-skin flap” containing the skin covering the shinbone and outer surface of the leg. Microsurgery techniques must be used in these operations. These are the procedures performed under a microsurgical microscope or special advanced magnification glasses. In these surgeries, they are taken together with the penile vessels prepared from the areas I have described and placed on the upper part of the newly made scrotum and the circulation of the tissue is provided by combining the vessels of the new penile tissue under the microscope with the vessels prepared in that area. If penile reconstruction is achieved by using fibular bone and skin, there is no need for a second operation since the rigidity will be provided with this bone. However, if a radial forearm flap is used, then inflatable or breakable penile prostheses should be used to provide rigidity to the penis. In my opinion, both techniques have advantages and disadvantages compared to each other. The right thing is for the patient and the surgeon to negotiate and decide which surgery to prefer. However, as a personal opinion and in the feedback I receive from my patients, fibular bone can dissolve in the penis over time. In addition, some patients may have osteomyelitis, which we call permanent bone infection in this bone, even in the late period. Therefore, I have to say that I had to remove this bone in some of my patients. In radial forearm flap, some of my patients are uncomfortable with scars in the arm area. Making the Urinary Canal
Appearance in Surgery
Post-operative Appearance Penis Reconstruction with Underarm Skin TissueI started thinking about what I can do when my patients who applied for gender change or some of my patients whom I had previously operated on, informed me that they did not want a scar on their arms or that they were uncomfortable with these scars if they had surgery. I started thinking about the method that was applied years ago and is currently only applied by a few surgeons around the world.In this method, I started to take the necessary tissue for penile reconstruction from the armpit and back area. With this method, there is only a thin stitch mark left in the place I bought and this is not noticeable from the outside when the arms are next to the patient. Sometimes if I am going to use wide texture then I use a skin patch to cover the gap where I get the texture. Since this creates a slightly more visible scar, I remove this skin patch during the insertion of the penile prosthesis and close this area in the form of a thin line.
The Image of the Penis Shaped Armpit and Back Skin Under the ArmpitsDuring the surgery, the circulation of the penile tissue is provided between the leg veins and the veins of this tissue as a result of the microsurgery procedure. Surgical scars on the legs usually create quite acceptable results aesthetically as they remain in underwear.Postoperative second year images of my patient who had another penis reconstruction. After the operation, the edema in the tissue is completely resolved and the tissue is softened and in its final form. The next step is to place 3 or one-piece penile prostheses, which are now only specially manufactured by a single company in the world, for reconstructed penises, in order to achieve the physiological function of the reconstructed penis.

 

Male to Female Transgender Surgeries

There are many techniques in these surgeries as well, and surgery can be considered easier if microsurgery operations are not preferred, compared to women-to-men conversion operations. It is the removal of testicles called castration during surgery and the creation of vaginal tissue from the scrotum and penis skin after tissue is removed from the penis. There are some disadvantages in these surgeries according to my opinion and what I hear from my patients. This is especially the formation of strictures in the newly made vagina and problems related to dryness during sexual intercourse. In these surgeries, I recommend patients to make a new vagina with intestinal tissue that is most similar to the female vaginal structure in the body. Because the intestinal tissue has its own secretion. This secretion offers a high level of comfort to the person while continuing his normal life and during sexual intercourse. It can be done by opening the abdomen and bringing intestinal tissue to the area where the vagina will be without separating the vessels. Although this surgical technique is simpler than the use of microsurgical technique, the disadvantage is the scar formed in the middle of the abdomen. I am entering these surgeries with a general surgeon who is experienced in this field. The general surgeon prepares the intestinal segment in the abdomen and takes it out laparoscopically, with 3 traces of 2-3 mm in the abdomen. Subsequently, the circulation of this tissue is provided by me by connecting the vessels of the intestinal tissue with microsurgery to the neighboring vessels in the region that will be the vagina. In this closed technique we use, the intestine is prepared without opening the abdomen, so that the vaginal reconstruction can be done with an almost scarless result on the front of the abdomen.

 

Post-operative viewHere, you can watch the video of this surgery we performed with my colleague who is general surgeon the large intestine segment (sigmoid) to be used for vaginal construction in the abdomen is prepared approximately 30 cm long. Subsequently, this intestinal segment is extended from inside the abdomen to the outside of the abdomen to form a vagina. As a result of all the procedures, only 2-3 scars of 2 mm remain in the abdomen, and an almost completely scarless surgery is performed. Below, you can follow the interview with a female patient who does not have a congenital vagina, where I performed vaginal reconstruction from the large intestine with the technique I applied in same sex change surgery.

 

Gender Change SurgeriesThe most frequently mentioned complaints by my patients are that the person determines his social life like the opposite sex and does not belong to the body he belongs to. As a Plastic Surgeon, I am not capable of explaining why this internal structure is formed this way and why these people feel this way, the psychological and psychiatric background, which is a subject I am not an expert. I can give you the necessary information about the surgery and legal procedure of sex reassignment surgery, which is my best job.
Legal Aspects of Gender Change

First of all, surgeons cannot legally perform operations that will change the gender of everybody. Because in these surgeries, reproductive function suitable for the genetic structure of the person is permanently eliminated. Therefore, this operation imposes very serious legal obligations on the surgeon, and they can be prosecuted with the provisions of the TCK due to unauthorized transactions. Then let me explain what kind of process is the legal way. Of course, I am not a lawyer after all, but as a member of the gender identity council, I have some information because I am constantly dealing with these procedures and the responses we write to the courts. First of all, the person has to apply to the court with this request to change his gender and change his identity from pink to blue or blue to pink. Subsequently, the court judge requests that the person be submitted to the official institutions with a sexual identity council such as Hacettepe University in order to fully reveal the person’s sexual identity and to understand whether he is transsexual. Turkey council sexual identity is also included in several university hospitals. This council includes Psychiatry, Obstetrics, Urology, Endocrinology, Plastic Surgery and lawyers.

 

However, as can be guessed, Psychiatrists are the predominant decision-makers in this council. Psychiatrists sometimes follow the applicant for up to approximately two years. Here, he investigates whether the patient’s sexual identity and genetics are really appropriate. In the meantime, the patient is given hormones suitable for the gender he wants to change by the endocrine, and changes are made in his body. In this way, when the person really wants to be the opposite sex, again important findings are obtained as a result of this endocrine treatment. Ultimately, this treatment is reversible and if the patient gives up the gender change process, the drugs are discontinued and it returns to its former state. If the psychiatrist decides that the sexual identity of the person is the opposite sex, he / she takes these people to the sexual identity council and the final decision is made by re-evaluating the sections I mentioned earlier. Decision Appropriate for Gender Change for the PatientIf the council decides that gender change is appropriate for the patient, the judge evaluates this result and allows the person to have a series of surgeries that will result in the loss of permanent reproductive function and to make new sexual organs. With this permission, the person can go to the institution or doctor of his choice and have these surgeries. Later, he applies to the court again and declares that he has sex change surgeries. The court judge may request the patient to be examined in a fully-fledged hospital to see if these surgeries have been performed at this time. When the doctor report that the person has sex change surgeries reaches the judge, the court allows the person’s identity card to be issued in accordance with the opposite gender.Below You Can Find My Interview With Legal And Medical Information Of Gender Change

 

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