Taken from another German website without permission, roughly translated

The Penoidaufbau with woman to man Transsexuellen although in the procedure for the Transsexuellengesetz for the modification of the sex affiliation only the chest operation and the distance of the internal sex organs is required, wants many Transsexuelle also a Penoidaufbau to have.  Because they attach importance to it,

 

in being to urinieren to be able sexual intercourse to have been able no more prostheses into the trousers to plug to have or it are the opinion that a Penis belongs to to a complete man picture.  Depending upon personal experiences and interests the one or the other reason more weight has.  The today usual operation procedures developed from the techniques to the Peniswiederaufbau, e.g. after accidents, with bio men.  The target of these operations was to re-create the original form and as also as possible the function.  Depending upon size of the damage in addition fabric had to be also occasionally more or less transplantiert.  Transferred to the woman to man Transsexuellen it is particularly difficult, because with them quasi an additional organ from that does not have to be created anything.  The material in addition must be gotten by other body places, where is somewhat dispensable.  With man to woman Transsexuellen it is relatively simple:  the Penishaut is folded inward and lines the new sheath.  The skin of the sheath with woman to man Transsexuellen cannot be simply outward folded against it, because it is mucous membrane, which is too sensitive, in order to cover an outside body surface.  It can be used however to extend the urethra.  In the surgery different procedures or transplant possibilities for the Penoidaufbau were tried out (skin rags of antinode bulge, thighs among other things), and those best were developed further.  Objective of all methods is to come the natural model if possible close to fulfill i.e. the following demands:

 

aesthetic and genuine appearance Kohabitationsfaehigkeit, i.e. -- functional size -- stiffness or reinforcement possibility sensitivity of the Penoids receipt of the Orgasmusfaehigkeit possibility, in being of urinieren further ones of targets are:  to keep low inconspicuous scars if possible no impairment of the function of other parts of the body the health risk for the patient and the danger of complications, i.e.:  not to long operation duration few operations and hospitalizations, thus combination of several pending operations, as far as possible advising particularly complication-rich operations against had with the selection of the skin rags and/or fabrics which can be used and the reinforcement implants thus to it is paid attention that the Hautlappenpenoid is as unbehaart as possible penisaehnlich colored, largely enough and, both the skin rag as well as the inside is well supplied with blood and with nerves supplied, a fabric-compatible, not slipable implant for the reinforcement with be inserted can, additionally a hodensack be structured can, if possible from the large schamlippen.  The classical operation, which was executed long time, was the Rollhautlappenpenoid.  A piece of antinode bulge skin is together-rolled and folded downward twice, whereby it must again again increase each time, until it is sewn on to good the latter in the place intended.  **time-out** I deal here not in greater detail with this operation in, because of it only advise against can.  The remarkable scars on the antinode bulge and the optical and functional result are in no relation to the many long hospitalizations, which are necessary for it.  (the operation can be executed only in several (at least 3) indexing steps.)  In the meantime other, better techniques were developed.  After detailed experimenting the advancement in each case of the best appearing operation techniques led to relatively good results.  One can detect, what her to represent to be supposed.  Boundaries

 

Also the best results are still far from the natural Penis naturally.  Therefore such imperfect Penis is mostly called Penoid.  Everyone should realize itself that it will not be possible in foreseeable time (perhaps even never), to bring to make the body to produce hormones of the new sex independently from a woman Mrs. a fruitful man body.  After the distance of the ovaries (or the gebaermutter) the person is to be designed irreversibly sterile a Penis, which independently free-handle is erigierbar.  Up to now there is the possibility, a Penoid, which is bendable constantly in itself rigidly and at the base to create only.  Even if an implant was already used, which is reinforced by means of a pump, which is e.g. in the testicle.  The female swelling body can be used not by means of Transplantation as male swelling bodies.  The fabric is not the same and the mechanical loads would not withstand.  Additionally the female swelling body is to be designed many smaller than the male acorn, which resembles the male in colour, size and sensitivity.  The comparable organ of the female body, the Klitoris, is smaller and can without sensitivity loss only to to the base of the Penoids be shifted.  Also the education of a relocatable foreskin is to be manufactured - particularly for lack of material - not possible perfect an extended urethra.  Their diameter can narrow itself or (in parts) be far, the connector between old and new urethra can the focal infection and thus the starting point for Fisteln (unnatural remark courses) become, and if the urethra with gap skin (that is thin, transplantierte skin, in which also smallest hair can be) is lined, blister stones can form at hair in the urethra.  In the case of the urethra extension up to the Penoidspitze - independently of complications - an additional problem often results:  The female bladder musculature is not adjusted to a so long urethra and is made excessive demands of.  It can press the urine not completely or not with enough momentum by the urethra.  The consequence is a long Nachtraeufeln with (and possibly also after) the Urinieren, or it remains urine in the urethra, again inflammations and contraction for which can cause.

 

Today usual operation techniques

 

 

I want in the following at present best, most well-known operation techniques in the German-speaking countries to present and objectively compare.  The description should be for the concerning information and an assistance with the selection.  So far they have - if at all - mostly only one-sided one, i.e. a certain technique information concerned get, depending on, with whom they spoke or on which coincidentally pushed them.  That leads the firstbest surgeon to the temptation to take without for a long time thinking.  Despite this assistance everyone should inform additionally still in other places (books to read, ask other Transsexuelle) and particularly with several surgeons, who come for it into the closer selection, a consulting discussion to agree.  Although I in this report gives all writings to the topic and empiric reports of concerning, which I, considered and also the physicians questions could find placed, it surely aspects, which I overlooked or did not experience.  Additionally there are constantly new developments and improvements in the medicine and surgery, whereby a new status can lose fast at topicality.  I want none of the operation techniques into the dirt to pull also none recommend and nobody with its decision influence, hold it however for important that each concerning knows all possibilities.  In the final result everyone must decide, what or how much it wants operate to let and which physician is to execute the operation.  This decision must be egoistic in certain degrees, because who excluding considers the desires of the Partnerin, can experience heavy disappointments, at the latest or above all, if with the operation everything does not become in such a way, like it was planned (which can always occur) or if the friend leaves one (can also occur).

 

Is the Klitoris to remain received?

 

By the longer persisting handling with male sex hormones the Klitoris becomes larger.  However not so strongly that from it a Penisersatz becomes.  Their sensitivity against it decreases mostly easily, it distributes itself as it were on a larger surface.  That is however hardly noticeable usually, because the Libido strengthens clearly.  Naturally the Klitoris is still more sensitive than the adjacent skin portions, which becomes negatively apparent above all, e.g. in the form of scrubbing trousers seams.  Woman to man Transsexuelle develop different relations with their Klitoris.  For some it is a so female - and therefore rejected, verhasstes, disgust-exciting - feature that it only disturbs, particularly under the aspects represented above.  Anyhow, as long as it is in its original place.  Others have a better relationship with the Klitoris.  It belonged to their body, is an organ, with which they can feel desire.  They regard it as a Penis too small turned out.  Probably there are also Transsexuelle, which accept their Klitoris in original form and position, as soon as they got additionally a Penoid.  Nevertheless it is a sexual Stimulationsorgan, whose Orgasmusfaehigkeit is achieved so far and up to further by no Penoid.  In principle there are 3 possibilities, how will proceed with the Klitoris can. 

 

They are independent of the Penoidaufbau:

 

The simplest method is to leave it like it in such a way is.  The full Orgasmusfaehigkeit is preserved.  Some operating surgeons shift it toward Penoidbasis - or with the Klitorispenoid as Penisersatz -, so far, as it is possible without large sensitivity loss.  The Klitoris is attached to particularly many nerve strands, and each disconnection of such nerves - if they become too short - causes a sensitivity loss.  Therefore it cannot be shifted also to to the Penoidspitze, because then would have all supplying nerves splits to become.  After the misalignment to the Penoidbasis the Klitoris is theorethisch along-stimulated on stimulation of the Penoids.  The Klitoris - or sections of it, e.g. the point - is removed.  Me only one case is well-known, where the superficial section were cut.  The sensitivity was then everywhere equivalent strong, which did not leave itself earlier position of the Klitoris by contact to no more to constitute.  The Orgasmusfaehigkeit was preserved.  Probably because the Klitoriskoerper has a certain depth and by movement or contact of the surrounding structures (Leistenhautlappenpenoid) is provoked.  From this cannot a case be judged the public.  One must thus also with a sensitivity loss rake.

 

The Klitorispenoid user:  Prof.W.Eicher, Heidelberg among other things.  That woman to man Transsexuellen is best to, which is so self-confident or convinced that they can live without Penis.  They save a quantity of pain, grind, temporal and financial expenditure and are received a clearly smaller health risk.  The Klitorispenoid - of some also small solution mentioned (do not mistake with the small solution of the Transsexuellengesetzes!)  - can be regarded as compromise settlement.  It is so small that it is not even called of each surgeon Penoid, enabled however allegedly a Urinieren in being.  The question is, as well it folds with directing.  Eicher published a photo in its book, where someone pinkelt somewhat forward with Klitorispenoid bent without trousers in being.  The principle of the operation is simple:  The urethra is extended and flows in the increased, somewhat after Klitoris (Mikropenis), shifted in front/above, outward.  The increased Klitoris can be extended by certain cutting forces and rag plastics over approx. 2cm.  Most surgeons, who manufacture normally larger Penoide, have this operation also in their repertoire.  It is often constituent of the larger operations.  Therefore it can be also temporary solution:  A Transsexueller, which meant, became it a Klitorispenoid rich and then later nevertheless still differently decides, can be able to be made generally still another larger Penoid.  Natural this 2-Phasen-Loesung is not recommended, even if one can achieve the same with an operation.  The operation is relatively little complex and takes only approx. 1 hour.  The hospitalization is set - without other operations - on 5-7 days.

 

Flow of the operation

 

Eicher proceeds as follows:  Over the Klitoris increased by the hormone handling a cut in form of a Y which is on the heading is made (fig. 2).  Afterwards it becomes bauchwaerts into the outermost end senkrechten of the Y of thigh over the shame hill pulled and there fixes.  The remaining shame gap is locked for muscles, which run circularly around the area of the sheath and urethra delta, now by opening and union completely.  Into the urethra a catheter (a hose for the derivative of the urine) is inserted.  Over this the small schamlippen are combined and sewn, so that he in a pipe from meat, which is appropriate for later urethra (fig. 3).  The highest seams refer the foreskin, which coats the Klitorispenoid, also.  The highest Hautschicht was removed from this, so that she can stick together well and grow together later.  The skin seams consist of individual small, lying one behind the other, interlocked loops, which hold the Wundraender together.  Into the skin of the large schamlippen shifted to the rear Silastic gel balls can be inserted as mini testicle prostheses.  (fig. 4) possible can be removed still unnecessary fat from the shame hill, whereby the Penoid becomes effective better.

Hautschicht removes, so that she can stick together well and grow together later.  The skin seams consist of individual small, lying one behind the other, interlocked loops, which hold the Wundraender together.  Into the skin of the large schamlippen shifted to the rear Silastic gel balls can be inserted as mini testicle prostheses.  (fig. 4) possible can be removed still unnecessary fat from the shame hill, whereby the Penoid becomes effective better.

later deformed can.  The skin seams consist of individual small, lying one behind the other, interlocked loops, which hold the Wundraender together.  Into the skin of the large schamlippen shifted to the rear Silastic gel balls can be inserted as mini testicle prostheses.  (fig. 4) possible can be removed still unnecessary fat from the shame hill, whereby the Penoid becomes effective better.

 

 

 

Complications

 

Fisteln (leakage in the urethra) Stenosen (urethra narrowing) dispersion of the urine jet repulsion of the Silastic balls the larger possibilities

 

There also different surgeons in Germany, who apply similar techniques as described the here, are the larger possibilities beside (most well-known) the operating surgeons mentioned here.

 

The Leistenhautlappenpenoid user:  Dr. K.Exner, Frankfurt Dr. Exner developed a reliable and relatively little complex method, with which apart from good optical and functional result also inconspicuous scars were achieved.

 

Principle of the operation:  Tape a particularly coated silicone staff with an even antinode bulge muscle folded downward, which hangs still on its original blood vessels.  Expresses coverage by two turned down border skin rags, which are supplied likewise still by original blood vessels.

 

 

 

Flow of the operation

 

First the outlines of the border skin rags are recorded on the skin.  With its extents the planned size of the later Penoids, which they are to cover, must be considered.  Both skin rags are equivalent large, the average mass are 24x7cm.  The upper cut is made as during an antinode bulge rationalisation.  It follows the tape in the leistenbeuge and the intestine leg comb laterally at the basin.  In the center the cuts over the shame hill meet.  The middle cut takes place, where the base of the Penoids is to be.  By the lower cut the border skin rag in the middle third gets the scope of a boomerang, in order to facilitate the sewing of the two rags downward after swivelling.  The border skin rags can be also already before-cut in an earlier operation (e.g. together with the distance of the chest and the internal sex organs) approximately 1 week before the Penoidaufbau and replaced easily.  Thus they get accustomed already somewhat to the future reduced blood circulation.  Afterwards the antinode bulge skin (without additional cuts into the skin) up to the rib elbow is raised.  One of the two perpendicularly in the center of the antinode bulge next to each other-running even antinode bulge muscles - normally the left - is separated scarcely under the rib elbow and folded carefully downward together with a 3cm broad strip of its front muscle covering from taut connective tissue, whereby the blood vessels on its surface are to be preserved.  (in this operation phase very good the internal sex organs under direct view can be removed, if this already did not take place beforehand.)  The length of the antinode bulge muscle permits a non-standard adapted organization of the Penoids in any size.  Normally the size of an average erigierten Penis is aimed at.  In order to enable late sexual intercourse, is necessary it to use a reinforcement implant.  The ideal possibility was found, as a silicone staff was coated completely by a hose from including-like Dacrongewebe, which has the same diameter as the staff.  The connective tissue of the body grows later into the Dacrongewebe (by a rungs of stable Kollagenfasern) and forms in this way a relatively fixed connection to the silicone staff, so that printing and course are distributed evenly and it during load not by the Penoidspitze push can.  There is the semirigid silicone staff in different lengths and in the diameter of 11-13mm in the trade.  Since it is relatively rigid, the later Penoid would be away.  Therefore the staff at the base of the Penoids is bendable.  Here the silicone is softer than at the shank, or it is trained a twisted wound silver wire.  The silicone staff is used under strictly germ-free conditions.  The muscle rag is wrapped lengthwise around the silicone staff, so that the Bindegewebshuelle comes to be situated inside.  The end of the muscle rag is sewn over the point of the staff.  The base of the staff is fastened to the Symphyse (the knorpeligen connection at the schambein).  At this time the length of the new Penoids can be co-ordinated.  The implant is completely included, as the muscular tube with fine seam material, which becomes later absorbed by the body (thus diminished), is together-sewn.

 

The replaced border skin rags are transferred now into the center.  They are turned at an angle of approximately 150 degrees.  Here special caution is required, because at the only connecting piece to the remainder body there are anatomical differences in the process of the blood vessels.  It is safest to receive approximately in order the blood vessels additional fabric so that the blood supply of these sensitive skin rags is ensured.  Now the skin rags become, on the basis of which point sews, over the Muskelpenoid wrapped and - first at the lower surface of the Penoids - with a seam, which runs schlangenlinienfoermig between the Wundraendern under the skin, whereby only a strichfoermige scar develops later.  The best form is achieved, if the seam runs as even line.  If the " feet " are too narrow the border rag, a t-shaped catch is safer.  At the top side of the Penoids the skin is sewn in the same way.  The broader paragraph of the border rags forms the upper base of the Penoids.  The process of the blood vessels at the top of the muscle must be considered, which excessively may not be pressed strained or.  Possibly something skin must be shifted or transplanted within the area of the base of the border skin rags.  In the end the abdominal wall is re-created.  The upper blood vessel ends of the gastric region are tied, and those front covering of the even antinode bulge muscle is locked surely.  With bent waist of the patient the antinode bulge skin is pulled downward, in order to cover the lying exposed donor area within the border area (similarly as during an antinode bulge rationalisation).  The paragraph at the shame hill is sewn to the base of the new Penoids.  All these seams should run preferably under the skin, evenly in two layers, in order to reduce the Hautspannung.  Suction drainage is put in order to suck the Wundabsonderungen off and to avoid cavities under the skin rags.  They are pulled a few days after the operation.

 

After the operation the patient with bent hip in (with the feet downward) bent a bed is stored.  (fig.8)

The Penoid, which can swell in the first days on lower arm thickness, must be held in a erigierten position, in order to avoid each break or print position at the edges of skin.  That can be achieved with according to into shape-cut thick foam material.  It swells in approximately 5 weeks on its later size off.  Naturally it will seem to the patient at the start after its hospital dismissal very largely, bulkily and immovably, but gives oneself fast by Abschwellung and mutual habituation to the new circumstances.  With over-weighty persons the aesthetic figuration of the Penoids is difficult.  Must late subcutaneous fatty tissues be removed by additional operations, in order to obtain a natural form.

 

Urethra extension, sheath catch and structure of testicle these measures are executed at the earliest 8-12 weeks after the Penoidaufbau in a further operation, if the patient attaches importance to it;  they are however not mandatory necessary.  An alternative possibility for the urethra extension is to leave the original urethra in their female length to pull it forward a little and to forward shift thus the output a piece.  For an urethra extension the hairless skin of the small schamlippen offers itself.  They are folded to the center and together-sewn tubularly.  Additionally still another skin rag from Vaginalschleimhaut can be used.  The Klitoris can be shifted for instance to 4cm, without it comes by nerve separation to a sensitivity loss.  It is shifted to the base of the later hodensackes and mobilized similarly as easily with the Klitorispenoid, so that the new output of the urethra at its point can flow.  Thus a Urinieren is possible in being in many cases.  In the case of a further extension of the urethra up to the Penoidspitze the probability of complication is very large (50-80%).  Therefore it is not recommended and by Exner very critically is judged (which it is not to be called that he does not execute it, if the patient insists on it).  It has hope that in the future a safer method is developed.  The urethra extension up to the Penoidbasis or a Klitorispenoid does not exclude a later, more far-reaching urethra extension.  During the complete extension in the Penoidteil the urethra is then lined exclusively with Vaginal mucous membrane.  This skin fulfills still earliest the demands of an urethra skin, which must be hairless, flexible and urine compatible.  It is prepared from the sheath.  Afterwards there are different possibilities for using:  It can be bolted e.g. around a thick catheter by çm diameter and be pulled with this practically by the Penoid, where it increases within 8 days.  Or the Penoid is lengthwise cut open at its lower surface, and the Vaginalschleimhaut is inserted in form of a strip into the wound.  After the mucous membrane increased and to some extent healed - after approximately 3-6 weeks - it tubularly around a catheter is folded up and sewn.  As muzzle place outward the Penoidspitze is aimed at.  If however with a small sheath too few Vaginalschleinhaut is available, the urethra must flow already beforehand, thus somewhere at the Penisschaft outward.  Reduced however not the ability to urinieren in being.  The use of blister mucous membrane offers further possibilities.  In addition the abdominal cavity must again be opened.  Also from the border skin of the Penoids a part of the urethra can be formed, if no Behaarung exists.

 

Caution:  by the hormone handling the general Koerperbehaarung increases, possibly also here.  It can take years as well known, until a satisfactory beard grows.  Exactly the same still individual hair, e.g. in the border area or on the Penoid, can come also after years.  After healing the seam completely - thus again 2-3 weeks later - the catheter can be pulled and the new urethra be used.  Naturally the patient does not have to remain the whole time in the hospital or quietly be situated in bed - it will dismiss 1-2 weeks before the catheter pulling from the hospital.

 

If the patient does not require an urethra extension or an urethra extension up to the Penoidspitze, it can decide freely, what is to occur with the Klitoris.  It can be left in its old place, shifted direction Penoidbasis, their point can be cut, or it can be more or less completely removed.  After withdrawal of the Vaginalschleimhaut, sewing of the Wundhoehle and catch of the former sheath output the strikeless, wounds walls of the sheath cave sticks together and grows together in the next 4 weeks, whereby (according to Eicher) a small depression at the former sheath output remains, which can be gradened later.  From this wound it still some days can bleed after the operation.  From the large schamlippen by misalignment a hodensack is formed and the shame column to a male dam is then transformed and course-sewn.  The structure of testicle is uncomplicated, because by swivelling the border skin rags already skin bags formed downward, which are upward still increased by the turning of the large schamlippen and adapted form-moderately.  The implants are used during the urethra extension or by a lateral small cut.  They consist of silicone and are egg or ellipsenfoermig.  In the trade they are offered in 3 sizes of approx. 3-4,5cm, one can select itself a non-standard size thus.  (in the photo in the documentation of Anita large implants were used.)  It is advisable to discuss the size before the operation with the surgeon otherwise this looks itself up a size out...  A more natural appearance can be achieved, if the two implants are not brought exactly on the same height or if two different sizes are used.  The silicone prostheses are included by the body by a bindegewebige cap.  Thus the relocatability is reduced in some cases.  A repulsion is well-known only with additional bacterial inflammation.

 

In the last years occasionally instead of the silicone staff inflatable reinforcement implants were used into the Penoid.  By it independent being of the Penoids is possible.  They were developed originally for impotente bio men, can be used however partially also with Transsexuellen.  There are two considerable manufacturers, Mentor and AMS, that offer also folders (s. appendix).  The pump is directly in the shank of the prosthesis or in an extra section, which is used with schlauchfoermiger connection to the remainder prosthesis in the testicle.  The disadvantages speak against it however clearly:

 

The operation is difficult and the technical errors very frequent, since leakages and scar formation can limit the function of these implants substantially.  The complication danger with the Penoidaufbau is increased (delayed Wundheilung, blood circulation disturbance of the skin rags, infections of implant stocks with repulsion of the prosthesis).  The implants are very expensively (approx. 10000 DM) and normally not by the health insurance companies are paid.  Even if a part of the costs in another place of the operation calculation is hidden, the patient must pay nevertheless still approx. 7000 DM from own bag.  It is thus appropriate to discuss the use of such an implant between patient and surgeon thoroughly.  Operation duration:  only Penoidaufbau:  approx. 3-4 hours of Penoidaufbau with distance of the internal sex organs:  approx. 5-6 hours structure of testicle, urethra extension and sheath catch:  3-4 hours of Penoidaufbau with inflatable implant:  approx. 5-6 hours of duration of the hospitalization:  Distance of chest and internal sex organs and Penoidaufbau:  20-30 days structure of testicle, urethra extension and sheath catch:  approx. 14 days urethra extension up to the Penoidspitze, sheath catch (and structure of testicle):  25-30 days

Results after the operation remain (mainly strichfoermige) to scars on both sides in the leistenbeugen, at the Penoid, at the dam and in the testicle area, which is covered completely by the trunk.  The Penoid resembles its natural model in the colour and the hair poverty.  It is very satisfying in appearance and size.  Its stiffness the bend is not noticeable optically (e.g. in the trunk).  When carrying trousers the silicone staff becomes bent somewhat, so that the Penoid sets itself like a natural Penis on the body.  Therefore it is advisable to bend it or the Penoid occasionally straight.  The stiffness of the silicone staff is somewhat smaller than with a natural erigierten Penis.  So far none of the patients over pressing or boring the silicone staff deplored itself with the sexual intercourse.  The sensitivity development goes slowly before itself, after 6-12 months is achieved however most.  Their speed and its extent are non-standard different.  The border rags have a surface sensitivity (palpation sensitivity) in their bodynear proportion.  Here is to be expected at earliest the something.  In small measure new nerve fibers grow into the Penoid in.  The feeling creeps slowly direction Penoidspitze.  There are however misalignments - one does not feel a contact necessarily, where she took place, but e.g. somewhere beside the Penoid.  After approximately 2 years one feels it i.d.R.  in each place of the Penoids, if one in-pinches oneself.  One feels more careful attacks only at the base third of the Penoids, because body henceforth of it there is in the long run only a small protection sensitivity (minimum touch-sensitiveness, depth sensitivity).  Despite everything is possible also to the Penoidspitze a certain sensitivity, since an attraction appears rarely as pure contact attraction, but usually in combination with other attractions (e.g. movement of the Penoids), so that a clear contact is assumed altogether nevertheless.  With receipt of the Klitoris naturally also the Orgasmusfaehigkeit is preserved.  In the case of misalignment it can be limited easily, with distance of Klitoristeilen also more strongly.  Always there erogene sensitivity spreads sometimes also on the testicle area or even on the Penisbasis or was (secondary erogene zones).  The course of skin and scars can affect additionally stimulating the Klitoris which are situated in the proximity of the Penoidbasis.  As a result of of on the left of coming muscles and later scar formation around the silicone staff arises an easy inclined slopes of the Penoids.  If it should be very strong, it can be corrected operationally.  Theoretically the Urinieren is possible in being and in sitting after the urethra extension up to the Penoidbasis, which was achieved also in many cases.  Because the Klitorisspitze, in which the urethra flows outward, was sufficiently extended and mobilized, so that it can be raised and steered for directing.  There are naturally also cases, with those the Urinieren in being (e.g. because of target problems, dispersion, direction deviation o.a.)  was not possible.  The conditions can be however mostly improved in a correcting intervention.  Because of the missing striking T-fitting at the antinode bulge after the misalignment of the border skin rags the antinode bulge skin stretches itself strongly, and which first going attempts in the hospital leave themselves only in strongly bent attitude (ape course) to execute.  Within 2-4 weeks after the operation the skin stretches however, so that an upright course is again possible.  Naturally one feels a certain voltage within the antinode bulge area and at the thighs also in the following months occasionally.  The absence of the antinode bulge muscle becomes as follows apparent:  There is i.d.R. no antinode bulge pain after the operation, only a few days long easy pain in a strichfoermigen area parallel and briefly under the lower edge of the thorax.  In the first days one can hardly lift its heading, in the first weeks gives it to difficulties when putting up from the upside-down position, and in the first months that cannot be done, without thereby with the levers resting (which most humans make however anyway).  Also in other situations, in which antinode bulge muscle power is in demand, this will be still weak.  At longer term are however again more strongly loadable antinode bulge muscles, and hard manual labor is possible without restrictions.  Sportily ambitionierte humans come at the latest into 1 year with consistent regular gymnastischen antinode bulge muscle exercises again on their old level.  Only with extreme loads of the abdominal muscles in the performance sport (e.g. force training, rudders etc..)  there are permanent restrictions of the carrying out us ability.  Bodybuilder must count on an asymmetrical relief and a light pit beside the antinode bulge navel.  In individual cases it can come to a break gap of the abdominal wall (narbenbruch).

 

In the course of the time the fabric of the former antinode bulge muscle builds itself over (particularly in fatty tissue), and becomes more softly and possibly shapeless, so that with some concerning a subsequent correction in form of a Penoidverschlankung becomes necessary.  With this medically indicated (!) correction OI a fat exhaust and a dermis defatting (skin cutting with attaching fat proportions) take place.  No additional scars develop.  The hospitalization duration amounts to at least 6 days.

 

Most patients are so content with the total result that the address gets around itself and can the transsexuellen patients in the plastic surgery at the St. Markus hospital in the meantime to the hard core be counted (i.e. one has good prospects to get as bed neighbours only FzM TS).

 

Complications Penoidaufbau:

 

Wundheilungsstoerungen secondary seam occasionally necessarily (in voltage places) dying fabric at the rag point (can be recovered by the good blood supply of the antinode bulge muscle early by skin transplant) infection or breaking through of the silicone staff (not occurred since use of the Dacronueberzugs) narbenbruch in the border area (rare) urethra extension:  Dispersion and/or direction deviation of the urine jet Fisteln and/or narrowings in the mobile urethra section (rare) additionally when extension up to the Penoidspitze:  Fisteln and/or narrowings, particularly at the connector between schamlippen and freely transplantierter urethra extension/expansion before the narrowing with unhealthy urine rope contraction of the urethra skin, the one decrease of the Harnroehrendurchmes sers cause contraction of the external scar with curvature of the Penoids structure of testicle:  Encapsulation scar formation inflammation

Nicotine and Fettleibigkeit can cause additional complications!  (also with other surgeons!)

 

The Penoid from lower arm fabric principle of the operation:  free Transplantation of a together-rolled, penisaehnlich formed thick lower arm skin rag with blood vessels and nerves and micro-surgical container link in the new beginning place.  Reinforcement implant:  a piece of bone from the spoke or an artificial implant (Abb.9-11)

 

Flow of the operation (after a description/publication of Biemer, 1988) at the beginning a general description of the operation technique.  All surgeons, who apply this technique, proceed approximately after the basic principle described here, whereby naturally non-standard small deviations are not impossible.  Before the operation it is advisable to clarify the exact position of the Arterien (arteries) in the donor area by a special radiograph since only Arterien can be taken, which are not necessarily necessary for the supply of the lever and the hand.  At the beginning of the operation a plan on the lower arm is attached, which determines the size and form of the skin rag which can be removed (e.g. as in Abb.12+13).  The exact outlining form of the skin rag depends on whether out of the skin rag also equal the urethra is along-formed, or whether it is formed from transplantierter skin by other body places.  The urethra can be (as in fig. 12+13) in the center of the transplant or also because of the edge.

 

The inside of the lower arm is suitable well as donor area, since the there skin is relatively unbehaart and since the function of the directly lying under it blood vessels and nerves can be transferred by other lines in the lower arm to a large extent.  The length of the skin rag covers the lower and middle third of the lower arm bend page.

Die Innenseite

Lines in the lower arm to be to a large extent transferred knows.  The length of the skin rag covers the lower and middle third of the lower arm bend page.  If a part of the skin rag is to form the urethra, the skin rag must be as broad as possible.  Handnear end is m-foermig, so that out of both m-elbow a round Peniskopf can be formed.  Body near end of the transplant is w-foermig, so that it can be inserted optimally into the diagonal cut on the shame hill.  The piece, which is to form the urethra, must be extended by 4-5cm.  The extension is necessary, so that the urethra extension can be attached directly to the end of the old urethra.  The next step is the replacement of the skin rag.  First at both pages of the skin rag the Arterie with their Begleitvene is separated.  These blood vessels running in the skin rag have a diameter of approx. 1-2mm. by it the later Penoid with blood are then supplied.  Then the skin rag is replaced, beginning at the thumb page toward small finger page up to the Speichenarterie.  This skin rag contains also the superficial taut Bindegewebshuelle, which is very thin and close runs muscles, and which network from smallest blood vessels between the large blood vessels and the skin purifies.  If for the reinforcement a piece of bone is used, a 10-13cm becomes long on the spoke bone and approximately 1/3 of the bone scope broad, schiffchenfoermiges piece mark and with a reciprocating saw out-sawed.  The connection between container handle and bone must remain received.  The gap in the bone closes up later partly, similarly as with a fracture.  The gefaessbuendel is separated now on the handnear page, and the skin nerve, which lengthwise-runs in the skin rag, is cut out up to the elbow.  It must be so long, because it later continues to remove been situated nerve branch to is attached.  Before also body near gefaessbuendel one separates, i.d.R. the urethra is formed.  In addition at the boundaries along the appropriate skin paragraph two or ever a 5mm of broad strips are enthaeutet.  The section between them is lengthwise together-rolled around a catheter, so that the two enthaeuteten paragraph come to be situated over the catheter hose one on the other.  These are together-sewn with a double seam series.  The catheter is now in a hose from skin.  The internal surface of the new urethra consists of the former oberhaut of the lower arm.  / uebrige(n) section (E) of the skin rag, on the basis of the urethra seam, tubularly around the urethra hose are put, so that the skin surface comes to be situated outside.  Now the Penoid is finished for the Transplantation.  It hangs however still on the lower arm on its supplying blood vessels.  In this status it remains so for a long time, until the recipient area is prepared.

In the area of the shame hill, in the place, where normally the Penis sits, a rhombus-shaped cut is made, so that into the developing gap the two wings of the w-foermigen base of the transplant can be inserted.  The cut is led at a page up to the perceptible Oberschenkelarterie.  At this a suitable side branch is looked up.  Additionally a Vene in the proximity and one are looked up more near with the small schamlippe (than additional blood discharge possibility for the extended urethra).  At these containers the containers of the implant are attached micro by surgery, i.e. the gefaesswaende are together-sewn under the microscope, after the implant was inserted into the cut on the shame hill.  It is mostly fastened in such a way that the urethra runs along the top side and the seam line on the lower surface of the Penoids.  The outstanding nerve end of the implant is connected to that one, which runs deeply in the large schamlippe with a suitable nerve, which runs in the proximity, e.g..  Here then a new nerve can along the course old nerves into the Penoid in-grow and for its sensitivity (often only a minimum contact feeling) provide.  If a nerve splits became, it does not function provisionally any longer, even if the ends are together-sewn.  On the body-further page of the disconnection place the body diminishes the nerve, and along the course diminished nerves can, outgoing from the not-diminished part nerves, a new nerve in-grow.  If the nerve ends in the disconnection place had no more connection, the nerve would always end here and a stump would form.  In this case - or if it does not fold with that a waxes new nerves - it comes to feeling disturbances, e.g. deafness or pain.  The skin of the small schamlippen is cut in the center, and the sections on both pages are separated.  Two wings are formed by this technique, which cover then the rough surface of of the extended urethra, which stands out still from the Penoidbasis.  After the catheter, which is in the new urethra, was inserted into the blister, a skin ring is removed around the original urethra output of approximately 2 cm broad and the new urethra here is sewn on.  In the end still the point of usage at the lever is supplied.  The missing part of the Speichenarterie is filled out with a transplant - a piece of Vene -.  Then the strikeless surface at the lower arm is covered with a transplantierten skin rag, which festwaechst there in the course of the time.  This transplantierte skin rag is mostly narrower than the defect.  It is cut with a special technique (Meshgraft) and can be pulled apart then netlike.  Into that, " later automatically new skin grows holes in the network.  Naturally a wide scar at the lever, which is to be hardly still seen however alleged after 1 year, develops.

 

User of the lever rag technique:

 

Professor Dr. E. Biemer, OA Dr. create, Munich:

 

The lever rag technique is executed by Biemer since 1981.  It became possible by the discovery or appropriation of the free Gewebstransplantation in the surgery.  However it modified its operation technique in the meantime partially, so that it any more does not correspond in all details with its English original publication of 1988.  (also beautiful-calibrate and Oeking from Munich the same technique described, but in the meantime again off it got.)

 

How does Biemer proceed or which he makes in the meantime differently?

 

Biemer and create use for the urethra no skin rag of the lower arm more, but so-called gap skin of the thigh (for cosmetic reasons mostly of the thigh inside).  Gap skin is oberhaut, which is made so thin that no hair bellows and thus also no hair in the urethra are mittransplantiert to occur.  If there nevertheless still hair regenerates, to it unpleasant urine stones can form.  Because of to frequent complications the Penoidaufbau is executed now no more like in former times in an operation, but in several steps.  Independently of it the reduction of chest and the distance of the internal sex organs are executed as own interventions.  A combination even of these interventions with the reconstruction of the Penoids does not appear Biemer because of the length of the operation and because of the high blutverlusts meaningfully.  An allocation into individual operation steps is particularly important with the urethra reconstruction, since the gap skin has a clear contraction tendency, which is only stopped after 6 months after the operation always.  Is thus advisable, one if possible to large gap skin to transplantieren, whereupon 6 months wait and then only the actual urethra to form.  With this procedure the Fistelrate could be lowered around 50%, which knew Fisteln occurring nevertheless after further 6 months being waiting however everything is completely locked.  In the future quite non-standard depending upon patient different rags use will find if necessary, which do not mean no more an expanded distortion at the lower arm.  The skin, which covers the Klitoris increased by the hormone handling, is separated from this.  Then the Klitoris is opened from above in such a way that a butterfly-similar form develops.  It is pulled upward and integrated as far as possible spitzenwaerts into the Penoidbasis.  For this purpose the seam is isolated to the Penoidbasis again around the necessary length.

 

In the last year with very good successes with the Klitorisverlagerung the nerves of the lower arm rag were attached to Klitorisnerven, so that in the Penoid allegedly the same feeling as comes in the Klitoris and so that also a klitoraler Orgasmus is possible.  With the Klitorisverlagerung nerves are free-prepared  consciously, split and here a nerve seam with along-elevated skin nerves of the lower arm rag created.  Thus a decrease of the sensitivity of the Klitoris results.  From the principle this remains however received (so Biemer).  This must with the patient before the operation be discussed in detail and can then non-standard with the operation be considered.

 

The sequence of the operations:

 

Distance of the internal sex organs chest operation urethra extension with a sheath mucous membrane rag, which leads to a change of direction of the urine jet.  This intervention can be combined with the presentation of a gap skin to above the Klitoris.  Transplantation of the lower arm skin rag.  The Penoid is covered at the lower surface still left open - thus not to a Roulade rolled - and with gap skin.  Roll up the rag to the actual Penoid (only, if the gap skin at least 6 months well enter-hurried and developed completely, i.e. also to a large extent finished shrank) and simultaneous education of the entire urethra.  Structure of testicle.  Bring from silicone implants into the large schamlippen.  Operation duration:  4 1/2 8 hours (only Unterarmlappentransplantation!  / Nr.4, s.o.)  over the duration of the other operations no specification duration of the hospitalization:  22-97 days, on the average 51 days (this are values of 1988.  Because of the many section operations the total hospitalization lasts in the meantime longer, Biemer + creates gave however no exact specification, like for a long time.)

 

Results

 

 

At the lower arm a wide scar develops as well as at at least a Unterschenkel or in other donor areas.  The bone fragment used for reinforcement is partly absorbed.  It rounds off.  In order to avoid the breaking through danger, the bone fragment is completely inserted into the somewhat more largely along-lifted bone skin and covered then again when rolling the rag up with Faszie.  A breaking through did not occur so far.  Because of the taken bone fragment a clearly increased danger of fracture exists at the spoke bone in the first 3 months.  The regeneration of the bone is usually during increasing load re-created after 6-12 months.  Sensitivity in the Penoid develops through a waxes, the micro by surgery connected nerve courses given by nerves along.  With the connection of the skin nerves of the lever rag with feeling nerves from the border region a feeling feeling is achieved, which is however often only a minimum contact feeling.  In addition, by the additional misalignment of the Klitoris and the link of Klitorisnerven at nerves of the skin rag a klitorale sensitivity is possible in the Penoid.  Naturally the nerves must in-grow only.  Therefore a sufficient sensitivity in the Penoid is to be expected at the earliest after 1 year.  At the point of usage at the lower arm sensitivity, only a depth sensitivity does not return is here possible.  To a restriction of muscle power it does not come however, because muscle proportions are not used in the transplant.  The scars can pull together in small extent, which can influence the mobility.  However a complete mobility in the wrist and the long finger are in most cases again available after 6 months.  The majority of the patients it was content with the functional results such as appearance, sensitivity, Orgasmusfaehigkeit and stiffness, criticized however that it cannot be independently.  The connection to the basin is not to be reinforced.  With sexual intercourse the Penoid with the hand must be put up and held.  Because of the limited surface at the lower arm, where suitable skin can be taken, the later size of the Penoids developing from it holds itself also within limits.  This was also criticized.  Additionally the subcutaneous fatty tissue at the lower arm is unfortunately pronounced only meagerly with many Transsexuellen, so that it comes here also to an accordingly small, slim Penoid.  For this reason in some cases another rag was taken by the shoulder area.

 

Complications

blood circulation disturbance, Thrombose (blood grafting formation) within the operationally attached small blood vessels of the rag.  That forces to an immediate further operation, as still as possible at the same night.  Thus the danger can be usually gotten into the grasp.  Partial or complete dying of the Penoidgewebes as sequence of it (very rarely).  Wundheilungsstoerungen.  Fisteln, particularly at the connector between old and new urethra (contrary to in former times only rarely).  Handling:  Operational catch after termination of the scar maturing, i.e. after 6 months.  If one tries too early to lock the Urethrafistel it comes with the scar fabric not developed yet very frequently to renewed Fisteln.  The gap skin does not turn on.  Urethra narrowing.  Handling:  Bougieren, i.e. stretching with special rod-shaped urologischen instruments, or operational extension.  Dispersion and/or direction deviation of the jet with the Urinieren.  Here clear improvements can be obtained with small interventions.  Hair growth in the urethra, if the gap skin is too thick;  Formation of urine stones at the hair of further users of the lever technique:  Dr. P.j.d. Daverio, Lausanne Daverio executes the chest operation, the distance of the internal sex organs and the entire Penoidaufbau in a session.  For the structure of testicle and/or using a reinforcement implant however at least a further operation is necessary!  By the summary the operation lasts for a very long time - up to 11 hours.  Lately however the operation duration could be substantially shortened according to Daverio, by no more being successively made, but a team of operating surgeons in several places of the body operates at the same time.  Nevertheless a very long operation saves a certain risk, also which concerns the Narkose.

 

Flow of the operation this operation technique corresponds on the whole above to the describing.  The Penoid is formed also here out of lower arm fabric and transplantiert then.  The form of the skin rag is somewhat different (see Abb.14+15).  Here is the paragraph for the later urethra at the edge.  After separation of the skin rag of the lever and free preparation of the large blood vessels and of 4 nerves the urethra screen end section is enthaart and removed at the edge strip the highest Hautschicht.  This section is wrapped around a catheter, so that the abgehaeuteten strips be come and together-sewn can be situated one on the other.  (fig. 16) the remainder of the skin rag is around it-wound, whereby the whole is  as penisaehnlich as possible formed.  It is sewn with a longitudinal weld.

After the distance of the internal sex organs, the sheath catch and the sewing of the large schamlippen the beginning place of the Penoids is prepared and the blood vessels is prevented.  The Klitoris is folded to the page and toward Penoidbasis, so that it the future extended urethra in the way is not situated, and with Penishaut covers.  On the Symphyse, which knorpeligen connecting piece in the schambein, a lattice attached, to which the later prosthesis can be fastened.  Prosthesis can also freely in fabric to be situated, with which hope that around their rear end, which provokes the bone by contact fixed connective tissue forms that the prosthesis grows together as it were with the bone or the Symphyse.  The past blister catheter, which was assigned with the operations evenly specified, is exchanged against a new, which is partially in the Penoid.  The Penoid is aligned in such a way with the fact that the urethra and the seam are situated to the Penoidunterseite.  The original urethra is extended with the small schamlippen sewn folded to the center and, and to these the outstanding end of the newly formed urethra on impact is sewn on.  The carried forward blood vessels and nerves, which stand out also from the Penoidbasis, are attached to suitable, free-prepared containers and nerves of the thigh and shame area (e.g. to the Oberschenkelarterie):  the blood vessel ends will become together-sewn and the nerves stuck together.  The lever is covered with a skin transplant.  This can be taken by different places at the body, whereby however to the fact it is paid attention that as inconspicuous a scars as possible develop.  If the patient had e.g. a large chest, so that when their reduction skin was removed, such can be taken a skin rag.  Otherwise a Hautstreifen from the border area or the lower antinode bulge area is mostly used.  (fig. 17) leads to additional scars!  These transplantierten skin rags cannot be as well supplied with blood as the original skin of the lower arm, because in latter more blood vessels are.  After taking the lever off holes are stung into the skin, in order to prevent Bluterguessen and water enrichments in the fabric.  The blister catheter is removed at the earliest after 12 days.

 

If the patient wants to get a reinforcement implant and/or testicle implants assigned, this is made in a second operation.  It takes place, after the structured Penoid to some extent healed and the Penoidschaft is sensitive, thus at the earliest after 8-9 months.  At reinforcement implants there are several different types:  inflatable implants or simple silicone staffs with silver wire.  The implants are developed for impotente bio men;  for TS Penoide the point is somewhat too hard.  It can break through easily.  Therefore Daverio submits for approx. 9 months Dacrongewebe at the point.  Daverio mostly uses an industrially manufactured, up pumpable plastic implant named Dynoflex (fig. 18).  It consists of silicone and is rod-shaped.  In the rear section a reservoir is, in the middle section is a body, that is mobile and a pump.  With this pump by the reservoir the liquid is pumped to the middle body, whereby the reinforcement is achieved.  In order to remove the reinforcement again, one bends the Penoid with the hand few second downward.  With a large Penoid two of these implants are inserted, with a small Penoid only one.  With infections the implant must be removed and be waited at least 3 months, until a new can be used.  For using the testicle implants the schamlippen are somewhat stretched, and the implants are inserted as far in front as possible.  When desired optically an acorn can be copied later.  In addition at the point of the Penoids the skin is circularly cut, so that a scar forms, which is darker than the skin.  Additionally the skin surface is taetowiert within the ring.  (fig. 19) earlier ones of attempts to transplantieren Vaginalhaut into the acorn area furnished good coloured, but unaesthetic results.  At present Daverio experiments with " acorn cushions ", i.e. with soft (however not liquid) silicone implants, which are acorn-similarly formed and are used to the Penoidspitze.  Such an implant must be manufactured non-standard according to measurement.  It has the size of a natural acorn and coated with its 2 caps the points of the double reinforcement implant.  In the center is a hole for the urethra.  (fig. 20-22) it has a protective function apart from the optical function also, because it catches the impacts of the prosthesis point and avoids thereby a breaking through of the prosthesis point by the skin.

 

                                               

 

 

 

 

 

 

 

 

 

 

 

 

 

Operation duration:  9 hours (1.op) duration of the hospitalization:  14 days (1.op) that is relatively short.  In Germany the patients will rather keep for a long time than too briefly to in the hospital to clean-receive in order the cash for the hospital daily rates.  In addition, but an optimal monitoring of the state of health of the patient is ensured, and a possible complication can be directly treated.  Whether this short hospitalization duration in Switzerland for the patient could represent a risk, I cannot judge.

 

The costs of the 1.  Intervention approx. 85000 amounts to sfr.  How far this handling is refunded abroad by the health insurance companies, should be clarified beforehand, above all, since frequently still further operations are necessary!

 

Results

 

 

The appearance of the Penoids is estimated as very satisfying.  Its size is limited, because at the lower arm no larger skin rag can be removed.  At the lever there are sensitivity disturbances in the first 1.5 years because of the distance of nerves.  It does not come however therefore to motor failures in the fingers.  The skin transplant is not sensitive.  The sensitivity development, i.e. until one can feel something almost everywhere in the Penoid, at least 1 year lasts.  A stronger develops, in others a weaker sensitivity in some zones.  The sensitivity of the Klitoris is preserved.  At the lower arm a wide scar develops, in whose skin itself no more sensitivity developed (s. Biemer).Zusaetzlich develop for scars in the donor area for the skin coverage of the lower arm.  The use of reinforcement implants is problematic, because it often comes to technical problems and because relatively point sharpens those easily by the skin push can.

 

Daverio constantly looks for new, better methods and tries it out.  Therefore its procedures change frequently and often still are in the experimentation stage.  The specification given here could not be current thus within a short time any longer.

 

Complications

 

Infections hair growth in the urethra, if gap skin too thickly;  Formation of urine stones Fisteln, particularly at the connector between old and new urethra narrowing of the urethra, particularly at the connector (very frequently, approx. 80-90%), before it can come it with the urine pressure to an expansion.  Thrombosen dying fabric technical difficulties with inflatable implants direction deviation and/or dispersion of the jet with the Urinieren generally higher complication risk (too short or no aftercare)

Handling of complications the probability to get urethra complications is with Daverio with 30-40%.  The critical place for Stenosen (narrowings) is at the transition between old and new urethra (fig. 23).  There ever smaller or larger narrowings develop.  One can do these with 80% of the patients between 3. and 12.  After week the OP mechanically up-stretch.  The rate of the Stenosen, which must be again operated, is with 20%.  A possibility of concerning a Stenose is burning through with the laser:  Here with a so-called Fibroskop into the urethra is received, and the laser is fired in the desired place.  Usually a Laserung is enough, sometimes is 2 necessarily.  More one should not make than 2 however.  In this case the urethra must be again cut open and sewn, possibly again supported by a Hauttransplantation.  Another type of complications, which occur frequently with urethra extensions, are Fisteln (leakages).  These preferably develop at the Penoidansatz or at the dam (the area between after and testicles).  Here with water flush, until the urinary passages are clean, then they are locked in an operation.  Such complications occur also with other surgeons and by them are probably also similarly treated.  Daverio is however the only one, which dealt more exactly in its lectures (with the Transidentitas trade conferences) with the complication handling.

 

Sources / literature

 

Biemer, E.:  Penile Construction by the radial lever Flap.  Clinics in plastic Surgery 15, 1988, S.425-430 Eicher, W.:  Transsexualismus.  Possibilities and boundaries of the sex transformation.  Fischer Verl., Stuttgart 1992 Exner, K.:  Penile Construction in Female to paints Transsexualism:  A new Method OF Phalloplasty.  in Proceedings OF the Xth internationally Congress OF plastic Surgery, Madrid 1992, volume I, Elsevier Science Publishers B.v., Amsterdam, P. 347-351 Exner, K.:  Possibilities and boundaries of the plastic surgery with sex-adapting operations in that feminine to maskulinen Transsexualitaet out:  Magin, A.:  The phenomenon of the woman to man Transsexualitaet beautiful-calibrate, H./Oeking, G.:  Of woman to man - the attacked sex out:  Kamprad, B./Schiffels, W.:  In the false body, cross Verl., Zurich 1992 even if I in this report exclusively with the techniques for the Penoidaufbau dealt with itself, liked I again to point out that the structure Operation(en) with the other sex-adapting operations is combinable.  Each patient should let all operations execute after possibility at a center and not in different hospitals.  I thank all physicians and concerning, those by the patient answer of my questions to the emergence of this work contributed and thank Dr. Exner for its corrections and supplements.  For possible errors or lack of topicality I do not take over adhesion.

 

 

The accommodation into this list should not be quality judgement, concerning the respective operating surgeons.  I specified here everything, which admits to me in Germany and environment is.  The opinions to the different operation methods may be different.  Thus everyone should inform beforehand in detail.  If somewhat goes wrong, it is to be corrected afterwards badly.  And finally the operation is a decision, which concerns the whole further life.  On this list are many operating surgeons seen, who made themselves rather as operating surgeons MzF a name.  I do not know, which operations (Mastektomie, Hysterektomie, Penisaufbau) execute the respective operating surgeons.  Actually e.g. the Hysterektomie, to the operations, belongs which each Gynaekologe should have learned, exactly the same the Mastektomie (in different beauty degrees) with cancer of the breast, which in addition, surgeons should control, because they are also also dealt with to large chests with men (Gynaekomastie), or (it gives also) with cancer of the breast with men.  Kritsch it becomes correct actually only with the Penisaufbau.  If I forgot or other address, please one sends to me mail exactly the same is interested, particularly I in experiences, if I can publish it on the homepage.

Addresses:

 

Dr. Klaus Exner St. Mark US hospital Frankfurt/Main re-creation surgery William - Eppstein - STR 2 60431 Frankfurt/Main Tel.:  069 - 9533 - 2459 or 2341 fax:  069 - 9533 - 2446

 

Professor Dr. med.  Son St. Mark US hospital Frankfurt/Main Urologi hospital William - Eppstein - STR 2 60431 Frankfurt Tel.:  069-9533-2640 fax:  069-9533-2683 E-Mail:  uro.mk@diakonie kliniken.de

 

Dr. J.c. Bruck plastic surgery hospital " at the Urban " Berlin Dieffenbachstrasse 1 10967 Berlin telephone:  030 - 697 - 360

 

Dr. Ares Alsoufis bath Homburg telephone:  06172 - 690878 od. 61348

 

Professor Dr. Ruebben & Dr. S. Moellhoff Urologi hospital of the University of meal Hufelandstr.  55 45122 meals telephone:  0201 - 723 - 3216

 

**time-out** Professor Jonas hospital for urology the Med. university Hanover Konstanty Gutschow road 8 30625 Hanover telephone:  0511 - 532 3649

 

Professor Biemer & Dr. create Abtl.  Plastic.  Surgery of the surgical hospital of the TUM Ismaninger road 22 81675 Munich telephone:  089 - 4140 - 2171

 

Dr. Daverio hospital Sanssouci potsdam Helene long road 13 14469 potsdam Tel.:  0331-280-870 fax:  0331-280-4086

 

Dr. Daverio surgery plastique et reconstructive Avenue de Savoie 10 CH - 1003 Lusanne telephone:  004121 - 3112711

 

Dr. intelligent hospital yard home plastic. -  Hand and re-creation surgery p.o. box 1240 65702 yard home / Taunus telephone:  06192 - 200 - 289 or 292

 

Professor Rindt Dudweiler road 1 66111 Saarbruecken telephone:  0681 - 34483