The surgeons´ team is led by Dr. Daverio who has developed a method
to perform the free forearm flap phalloplasty without loss of sensation
in the genital area.
Since 1985, Dr. Daverio has successfully performed over 140 female-to-male
surgeries, more than 25 of them in Potsdam in cooperation with Dr.
M. Krueger M.D.
Dr.P.Daverio is fully qualified in surgery, plastic surgery, urology,
and microsurgery and is doubtlessly the only surgeon worldwide, who is
able to perform all stages of these very sophisticated operation.
The Klinik Sanssouci Potsdam is a private clinic with huge comfort, 3 operating theatres, intensive care and all necessary facilities.
The admission of a patient to the clinic is generally the day before
surgery.
Patients from abroad may stay some days prior to the surgery in a near
by hotel.
To be elegible for S.R.S. one must
1. have had hormonal treatment for at least 6 month
2. have two recommendations of S.R.S made by two clinical
behavioural scientists
3. 3-4 units of of preferably own red blood cells (otherwise
we need often foreign rbc)
Surgical technique:
Female to male sex reassignment is done under general anesthesia and
takes between 9-10 hours of surgery.
We prefer to perform all surgeries in one stage.
1. Mastectomy
2. Hysterectomy, Ovarectomy
3. Kolpectomy (exstipation of thevagina)
4. taking of a forearm-flap (including vessels and neves)
with microsurgical technique
5. covering the forearm-flap-area of the arm with a full-thickness-skin-graft
from the inguinal region
6. creating a phalloplastic with a neo-urethra
7. prolongation of the female urethra with the labia minores
8. microsurgical anastomosis of artry (end-to-side to femoral
artery) veins (end-to-end to perisaphenic veins) and neves (end to
end to inguinal neves by gluing) and anastomosis of the neo-urethra
to the prolonged urethra, so the phallus is sitiuated in the midline similiar
to the normal male anatomy
9. preservation of the clitoris on the base of the phallus to
maintain the ability to have orgasm postop. The ability will be as good
as preop. The clitoral organ is deepithelisized only and will be
located at the base of the penoid, and covered with skin of the future
scrotum. So during sexual intercourse the clitoris will be stimulated.
Post operative care:
1-2 days intensive care
3rd day single or double room in the clinic (room will be shared w/
other Ftm only).
6th day getting up for the first time
12th day removal of the phallic catheter so that the patient is able
to urinate while standing
14th -16th day demission
We suggest an additional stay near the hospital for another 2-3
weeks so that professional post-op care is provided.
What do we finally achieve with our technique?
n the best aesthetic result
n the best achievable functional result
n shortest time of inconvenience (one stage procedure)
n usually return to work after a maximum of 6 weeks
Complication rates:
less than 7% in our patients such as
1. Stenosis at the anastomosis urethra-neourethra. Easily solved
by an urologist by stretching with special devices (reoperations necessary
in less 2% of all occuring cases, will be done as an outpatient procedure)
2. fistulas at the same anastomosis. They will close spontaneously
within 2-3 months. They should be covered with fingers during urinating.
(in less than 2% a closure is necessary as an outpatient procedure)
During the last 135 female to male surgeries there was no loss of a
flap (neither totally nor partially) so that in no case a correction was
necessary.
We give a one-year-warranty concerning all complications that might
occur. That means we cover all costs in our clinic and charge no additional
fees in case you need any kind of correction.
The total costs are approx US$ 45 000.-
This contains:
1. fees of Dr.Daverio
2. fees of anesthesia
3. intensive care
4. hospitalization for 16 days
5. blood examinations
6. one-year-warranty for the result, no extra fees for complications
resulting out of the first procedure (concerning the aesthetic and functinal
result)
A second operative procedure is necessary to put testicle implants and
a penile implant (erectile prothesis)
This is done after 8-12 months when sensitivity is present in the phallus.
We use the prothesis Dynaflex from AMS and silicon testicles. During
that procedure we create a neo-scrotum. One will have to stay approx. 6
days in our clinic.
Return to work after 2-3 weeks, first sexual intercourse will bepossible
after approx 6 weeks.
120 implanted prothesis à rate of complications less than 1%
Total costs approx US% 11 500.-
Frequently asked questions:
1. Which method of phalloplasty do you perform and how is the functional result?
n we perform the phalloplasty with a free-forearm flap, so that a patient
is able to urinate while standing 14 days after surgery. We guarantee
preservation of sexual sensitivity. Kolpectomy, hysterectomy, ovarectomy,
and mastectomy are performed simultaneously with the creation of
the phalloplasty.
2. Why are all these stages of the operation performed simultaneously?
This reduces the total time of hospitalization, the number of
anasthesias, the out-of- work-time. The risk of a combined procedure is
less compared to multiple procedures
n The operation area esp in the region collum uteri and vagina is without
internal scars, so that the exstirpation of the vagina is safer.
n We can use excess of skin from the mastectomy-procedure to cover
the donation area on the forearm.
n Psychological aspects are very important because we can avoid multiple
procedures .... you arrive as a biological woman in our clinic and leave
as a phenotypic men.....
3. Do you work with microsurgery?
Yes.
4. How many operations will be necessary?
1. OP: Hysterectomy,Ovsrectomy,Kolpectomy,mastectomy,phalloplasty
2. OP: Penisprosthesis (for errection), scrotoplasty, silicon
testicle implantation
5. Which kinds of complications may occur? what is your rate?
-loss of forearm-flap (loss of phallus)
1 case in more than 140 surgeries
-stenosis of the neourethra
less than 7%
-fistulas of the neo-urethra
less than 7%
-common complications such
as bleeding, infection, thrombosis etc
less than 2%
6. How long does a patient have to stay in the clinic?
approx 14 - 16 days for the phalloplasty
7. What are the special fields of the surgeons?
Dr. P. Daverio M.D.: plastic and recostructive surgeon trained
in neurosurgery,
urology, and microsurgery
Dr. M: Krueger M.D.: plastic and reconstructive surgeon
8. Since when do you perform this kind of operations ?
Dr.P.Daverio performs this method which was developed by him since 1985.
9. How many sucsessfull operations in female to male operations did he perform?
More than 140.
10. What about the sensitivity of the neo-phallus?
Normal cutaneous sensitivity (comparable to the sensitivity the skin
of the arm has) will develop within 8-10 months after surgery.
11. What happens with the clitoris? Will it be completely „cut
off" or will this very important
organ be preserved on the base
of the phallus? What about ability to have orgasm?
We keep the clitoris intact and maintain hereby the sensitivity
for orgasms. The clitoris will only deepithelisized and positioned at the
base of the neophallus, covered by the skin of the neo-scrotum. The ability
to have orgasms will be the same as before the operation and stimulation
during sexual intercourse will also be possible. It definitly makes no
sense to remove the clitoris (as others surgeons do) and connect its nerves
to the neo-phallus in the weak hope that these reconnected nerves will
pass sensibility and overmore possibility to have orgasms. Especially since
everybody knows that sometimes even with an intact clitoris orgasm problems
may occur.
Therefore we avoid an amputation and are able to guarantee the retention
of orgasm ability as before the surgery.
12. Will there be any longterm damage of the forearm?
No!
13. How does the size of my forearms effect the final result?
How much skin of the forearm
will be needed?
The circumference will have effect on the diameter of the penis, but
it will never look too thin at all. The length of the forearm will effect
the length of the phallus.
We do not need skin from all over the forearm. Usually about one half
of the forearm will be involved in the procedure. So the scar is much smaller
than in the methods of other surgeons.
14. Where on the penis will be scars? Will they be very visible?
There will only be one scar on the back of the penis, which can not
be seen from front view.
15. Are pics of final results available?
Those will be sent to you upon request.
16. Is there anybody who has had the surgery and whom I could contact?
Write to: TDavid@goplay.com
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