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.İdrar Kanalının Yapılması
Making the Urinary Canal
Appearance in Surgery
Penis Reconstruction with Underarm Skin Tissue
I 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 Armpits
During 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.