Penile Inversion Vaginoplasty with or without Additional Full-Thickness Skin Graft: To Graft or Not to Graft?

Marlon E. Buncamper · Wouter B. van der Sluis · Birgit Ilja Lissenberg-Witte · Mark‐Bram Bouman · Margriet G. Mullender

73 citations0/0 files storedPlastic & Reconstructive Surgery

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LGBTQ Health, Identity, and Policy Urological Disorders and Treatments Sexual Differentiation and Disorders

Abstract

BACKGROUND: Penile inversion vaginoplasty is considered to be the gold standard for gender reassignment surgery in transgender women. The use of additional full-thickness skin graft as neovaginal lining is controversial. Some believe that having extra penile skin for the vulva gives better aesthetic results. Others believe that it gives inferior functional results because of insensitivity and skin graft contraction. METHODS: Transgender women undergoing penile inversion vaginoplasty were studied prospectively. The option to add full-thickness skin graft is offered in patients where the penile skin length lies between 7 and 12 cm. Neovaginal depth was measured at surgery and during follow-up (3, 13, 26, and 52 weeks postoperatively). Satisfaction with the aesthetic result, neovaginal depth, and dilation regimen during follow-up were recorded. Satisfaction, sexual function, and genital self-image were assessed using questionnaires. RESULTS: A total of 100 patients were included (32 with and 68 without additional full-thickness skin graft). Patient-reported aesthetic outcome, overall satisfaction with the neovagina, sexual function, and genital self-image were not significantly associated with surgical technique. The mean intraoperative neovaginal depth was 13.8 ± 1.4 cm. After 1 year, this was 11.5 ± 2.5 cm. The largest decline (-15 percent) in depth is observed in the first 3 postoperative weeks (p < 0.01). CONCLUSIONS: The authors can confirm neither of the suggested arguments, for or against full-thickness skin graft use, in penile inversion vaginoplasty. The additional use of full-thickness skin graft does not influence neovaginal shrinkage, nor does it affect the patient- and physician-reported aesthetic or functional outcome. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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References

2015Outcome of Vaginoplasty in Male-to-Female Transgenders: A Systematic Review of Surgical Techniques 2011Gender reassignment surgery: an overview 2015Outcome of Vaginoplasty in Male-to-Female Transgenders: A Systematic Review of Surgical Techniques 2001Male‐to‐female transsexualism: a technique, results and long‐term follow‐up in 66 patients 2005Gender Identity Disorder: General Overview and Surgical Treatment for Vaginoplasty in Male-to-Female Transsexuals 2015Aesthetic and Functional Outcomes of Neovaginoplasty Using Penile Skin in Male to Female Transsexuals 1995Refinements of Pre-, Intra-, and Postoperative Care to Prevent Complications of Vaginoplasty in Male Transsexuals 2015Male-to-Female Genital Reassignment Surgery: A Retrospective Review of Surgical Technique and Complications in 60 Patients

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2019Management of Vaginoplasty and Phalloplasty Complications 2019Outcomes and Predictors of Revision Labiaplasty and Clitoroplasty after Gender-Affirming Genital Surgery

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