MTF SURGERY

With the advancement of technology came the faster and wider spread of information. With that came the better understanding of transgender people and a change in the public’s perception about transgender people. Information for transgender people themselves about “who they are” and the availability of options about what to do have also been readily available due to the advancement of information.Transgender is a sexual concept that should be distinguished from homosexuality, a person who thinks of sexuality as opposed to the natural body. “Transgender” is an umbrella term that describes people whose gender identity or expression does not match the sex they were assigned at birth. For example, a transgender person may identify as a woman despite having been born with male genitalia. Because of cultural or religious factors, a lot of transgender people are forced to live their lives depending on their gender they were assigned with at birth and that creates a lot of confusion, stress, and even trauma for a lot of transgender people. Because of this, transsexualism is a concept that is should not be determined in one day norshould it never be.
Thailand is famous all over the world as a destination for transgender people because they are generally accepted here and not ridiculed.Patients from all over the world visit Yanhee International Hospital in Thailand for sexual reassignment surgery through adequate preparation and consultation, and live satisfying and fulfilling lives after surgery. Because of that, hospitals and doctors in Thailand lead the worldin terms of experience and value for money for services and procedures that cater to the needs of the transgender community such as sex reassignment surgery.

Sex reassignment surgery is a technique that requires high skill and is one of the toughest surgeries to perform even for experienced surgeons.This is the most advanced surgery in the plastic surgery category and must be done perfectly because any minor mistake can result to fatal side effects to the patient.Also, sex reassignment surgery is an irreversible surgery meaning once the surgery is done there is no going back if ever you change your mind.Many factors must be considered and confirmed before the surgery is performed, such as sufficient consultation with a psychiatrist, administration of hormones through a specialist, and sufficient time in living life of the opposite sex.

Why Yanhee for SRS?

Highly experienced surgeons
: Our surgeons are Thailand surgeons board certified specialize in sex reassignment surgery, highly experienced on new technique
High satisfaction rate
: The neovagina will look exactly and naturally like a biological vagina.
Variety of techniques
Penile Inversion Vaginoplasty – More vaginal depth
Colovaginoplasty – Smoother vaginal cavity
Penile Peritoneal Vaginoplasty – More vaginal depth with self-lubricant
Complete care by medical support team
: High safety at every step of procedure as you are taken care by our highly experienced and skillful medical team.
State-of-the-art operating theatre with HEPA Filter system
: Our operating rooms are designed to have positive pressure and the HEPA filter is installed in every operating room with more than 15 air changes per hour according to JCI standards.

MTF (Male To Female transgender) – There are preparations that must be done before surgery. These are the minimum requirements and must be strictly followed

You must be over 20 years old. You must also have experienced at least one year living life of the opposite sex.

A psychiatrist’s letter of referral from your country that confirms you are eligible and stable enough to undergo the surgery is needed and must be in English. Indeed, it’s the psychiatrists, not the plastic surgeon that determines if you are eligible to undergo the sex reassignment surgery. In addition to the letter issued from your country, you have toalso undergo a consultation with the psychiatrist of Yanhee InternationalHospital to ensure the prudence of the surgical decision.

Drinking and smokinghave very adverse effects to the results of your surgery.General recommendation is to quitdrinking and smoking at least two weeks before the surgery but we strongly advise you to quit at least several months in advance for better surgical results.

You must be in good health to undergo the surgery not only for the surgery itself but for the long-term hospital stay and post-operative care.

Processes before the surgery

Consultation with the doctor who will perform the surgery. At this point, your doctor will check your psychiatric findings and your health status and if there are no reasons for disqualification, will determine the site of surgery and explain the process.

After signing the various consent forms, payment is completed and various tests prior to surgery are performed.

After anesthesia and psychiatric consultations, return to your room and relax.

will be staying in the patient’s room to prepare for the surgery and have an enema before surgery.

MTF SRS Surgical Techniques

By skin graft – Reconstructing the female genitals using existing male genital skin to create anatomically complete female genitalia, including the labia, clitoris and vagina. After extraction of the testicles and cutting of the penis, the vagina will be made among the urethra, the prostate, the bladder, and the large intestine. The separated glans parts will be made into a clitoris by using the intact vessels and nerves for sensual function as well as cosmetic outcome. Finally, unnecessary erectile tissues near the urethra are removed to prevent the erection of red blood cells from sexual arousal. The risk of stenosis is higher than that of the Sigmoid colon or PPV techniques, so constant care is required as directed.

PROs
1. Simple procedure with low risk of complications
2. Does not involve abdominal cavity
3. No hypertrophic or keloid scar on the abdominal area

CONs
1. No self-natural lubrication
2. High chance of inadequate vaginal depth and neovaginal stenosis. Dilation is recommended.

Sigmoid colon – If the patient has had surgery before but needscorrectionor if male genital skin is not enough to form the vagina, surgery can be done by using the Sigmoid colon method. One or two physicians will be added to the surgical team to remove the Sigmoid colon. This method has a lower likelihood of narrowing the vagina thanthe skin graft method and has mucus from the colon wall which has a similar textureto female vaginal fluid. Due to the nature of the colon, unpleasant odor can be noticed if vaginal cleaning is not done properly.

PROs
1. More natural vaginal cavity
2. Less chance of neovaginal stenosis

CONs
1. Chance of keloid and hypertrophic scars on the abdominal area
2. Longer recovery period
3. Higher cost
Penile Peritoneal Vaginoplasty (PPV) – This technique is generally recommended for any patients who wish to undergo sex reassignment surgery for the first time and/or do not have enough penile skin and a portion of scrotum as well as for those who have penile inversion technique done but are not happy with the vaginal depth and do not want to correct using colon technique. This method can create a good functioning neovagina with a depth of 6-6.5 inches.
The procedure involves inserting a laparoscope to pull peritoneum flaps through to the area that will become the future vagina. The vaginal opening is made using penile inversion technique then is connected with peritoneal tissue which is the new vaginal canal. The outcome of this technique creates a smoother vaginal cavity and in some cases, also creates self-lubricating vagina.

PROs
1. More vaginal depth than penile inversion technique (but less than colon technique)
2. Self-natural lubricating, in some cases

CONs
1. Formation of intra-abdominal adhesion
2. The vaginal scarring and shortening due to lack of proper dilation

* The difference between these 3 techniques is performed intra neovagina only which means the only difference is the inner vaginal canal, the appearance will look exactly the same.

Result

The vagina will look like a biological vagina.
The vaginal depth depends on the anatomy of an individual, generally for Asians, the depth can reach 5-6 inches.
The neovagina is functioning as same as biological vagina, including sexual intercourse.

Importantly, the surgeon will preserve the sensory nerves and use them to make clitoris, labia minora and around the urethra.

However, we cannot avoid the scar on the labia majora but the surgeon usually hides the stitches at either the middle or the edge of the labia majora. After 6-12 months, the scar will gradually fade away.

Recovery

Block the vaginal opening after surgery to minimize side effects from pressure and infection. Avoid excessive movement and pay special attention to the surgical site.

For the skin graft and PPV techniques, there are no food restrictions and a normal diet is advised but for patients undergoing the sigmoid colon method only water is allowed for about 5 days to prevent bowel movement. After the support gauze that blocks the vagina is removed to check for abnormalities in the surgical area, the catheter is removed and the patient is allowed to walk lightly.

Drink plenty of water to allow waste to flow out of your body through urine. There may be some difficulties with early urination but you will gradually become accustomed to urinating on your own.

In about 7 days, the dilator will be used three to four times a day, depending on the length and width of the patient’s vagina, along with vaginal cleaning. During this period, you should be familiar with the tips and methods of dilation conducted by medical staff so that you can do this on your own when return home. Care of the surgical site is as important as the surgery itself so be sure to do it as instructed.

After the hospitalization period is over, stay in a hotel for about a week and do the dressing and dilation as instructed. The hospital will provide dilation equipment and cleaning supplies and a medical certificate.

Post-operative care

After returning home, the patient must do the dilation 3-4 times a day. It usually takes about 30 minutes to 1 hour or more, usually for 6 months. After that, you only need to do it once or twice a day for another 6 months.

You can take a shower as usual, and after shower you should apply the medication that the doctor prescribed around the urethra and clitoris to prevent infection.

You might find sutures that have come off on its own during the healing process. The suture that will be used for the procedure will dissolve on its own and is harmless to the body so no need to worry.

Sexual intercourse may be possible after at least two months. Avoid intense sex at the beginning.

After daily and prudent care as instructed the swelling will subside in about 6 months.

Important notes

Please take note of all the things that were asked of you to prepare before the surgery.

You must stop drinking and smoking. During surgery, blood vessels constrict, causing relatively high blood pressure, which causes a lot of bleeding. This will affect the outcome of the surgery.

The staff in the hospital are experts and experienced professionals. Please kindly follow the instructions.

Disinfection and dilation are definitely the most important patient responsibility. If neglected, you might need to have corrective surgery done due to infection or narrowing of the vagina. This will all result in extra costs and unwanted stress of having to do corrective surgery. In some instances, corrective surgery may not be able to correct the damage.

Self-care is as important as the surgery itself. Be sure to follow instructions carefully and prudently to reduce the possibility of problems in the surgical site.

If you have any questions or if ever you find any abnormalities, please contact us.

Costs

Skin graft: 9 nights – 420000 THB

Sigmoid colon (abdominal incision): 9 nights – 580000 THB
Sigmoid colon (laparoscopic): 9 nights – 820000 THB
Penile-Peritoneal-Vaginoplasty (PPV, laparoscopic): 9 nights – 720000 THB
Corrective surgery (by Sigmoid colon, abdominal incision): 5 nights – 445000 THB
Corrective surgery (by Sigmoid colon, laparoscopic): 5 nights – 810000 THB

Voice feminization surgery: 2 nights – 125900 THB

Adam’s apple shaving: 38500 THB

Breast augmentation: 1 night–up to 125000 THB

Other surgeries: Please inquire us