Transgender Surgery in Miami – From Female to Male

The full spectrum of microsurgical and local phalloplasty options are available at The Maercks Institute.  However, Dr. Maercks’ preference is to use an advanced technique described below that maximizes safety, efficacy, form and function called the MAERCKS Phalloplasty.  Each technique is described below and a highlight of advantages and disadvantages is included.  Dr. Maercks prefers to avoid conventional techniques because of extensive scar burden, long term complications, poor sensation, the need for implants, staged procedures and revisionary procedures.

Conventional Transgender Phalloplasty

  • Conventional Flaps  – Whereas standard procedures use Conventional Flaps which are the standard techniques used by most phalloplasty surgeons, Dr. Maercks prefers to avoid them because of unnecessary donor site morbidity and complication profiles. We do offer these techniques to patients that specifically request them, however recommend the procedures listed under modern histiocentric phalloplasty.
  • Radial Forearm Flap –  This is the most commonly used phalloplasty technique.  The advantages are: it is a very straight forward reliable procedure with enough pliable tissue to create a urethra and penis of sufficient length with a nerve supply. The disadvantage are: the large and obvious donor site, scarring both on the wrist and forearm and additionally on the leg or back where a skin graft must be taken to cover the wrist defect.Furthermore as a significant portion of the blood supply is removed from the hand, patients may experience pain and cold intolerance later in life. The flap is also generally thin which can often limit girth of the penis resulting in a less than ideal length to width ratio.The radial forearm flap also requires an expensive secondary procedure of placing an implant or pump in order to be sexually functional.  Also creating a glans, or a head of the penis is an additional procedure and results typically look surgically created or unnatural.
  • Anterolateral Thigh Flap (ALT Flap Phalloplasty) – The anterolateral thigh flap has the advantage of being less conspicuous than a radial forearm flap and yielding much more tissue to work with. It is also harvested with a nerve and has enough tissue to provide a ureter but can be difficult to sculpt when used this way and typically appears unnatural. The donor site is large and like the radial forearm flap a secondary defect for skin graft harvest is necessary leaving behind a thigh covered in scarring.
  • Latissimus dorsi, Lattisimus Perforator & Parascapular Flaps – These are great reliable flaps that can be configured to create a wonderful phallus with chimeric opportunities but leave behind extensive donor site and require skin grafts like the two flaps above. Thus these techniques are avoided unless specifically requested by the patient.

Modern Histiocentric Phalloplasty

  • SCIP flap Superficial Circumflex Iliac Perforator flap – The SCIP flap has the advantage of leaving only an abdominoplasty scar-like donor site, unlike the extensive morbidity of the flaps listed previously.  It is a wonderfully reliable flap that if harvested from both sides can be used as a double flap that has many advantages functionally and aesthetically over the two former flaps. This flap however has been drastically improved upon through Dr. Maercks’ studies and experience leading to the two flaps listed below.
  • CIS phalloplasty flap Clitorally innervated SCIP flap  – The CIS flap is a breakthrough developed by Dr. Maercks and brought to reality by his collaboration with international colleagues.  The advantages of the CIS phalloplasty include: no need for skin grafting and only a single closed scar that resembles that of an abdominoplasty. Innervation from the clitoral nerve is concentrated near the head of the phallus, more closely approximating natural anatomy and the base can be innervated by local nerves in the groin.  The glans is thicker than the shaft in a single stage and a secondary urethral design is not necessary, reducing chances of complications of the two techniques mentioned under Conventional Transgender Phalloplasty.

The MAERCKS Phalloplasty

The Multifocal Anatomic Emulating Reconstructive Clitoral Kinaesthetic SCIP – The Maercks phalloplasty is the result of Dr. Maercks’ dissatisfaction with the amount of morbidity associated with female to male phalloplasty techniques and the relatively poor function, need for foreign bodies and the vast complication profile.

Dr. Maercks goal was to design a transgender phalloplasty that would be aesthetically pleasing with crucial anatomical features, leave behind no stigmata of transgender surgery, provide more analogous innervation to a natural penis with independent clitoral sensation to the glans, obviate the need for secondary procedures including implants or pumps, provide robust independent flap tissue for the urethra to avoid the common problems of urinary fistulas and strictures and limit recovery time for the patient.

Maercks visited multiple international centers and brainstormed with colleagues and did extensive anatomical research and cadaver study to bring this ultimate phalloplasty to fruition.  The first step was to prove that the novel vascularized nerve supply was attainable.  The CIS Phalloplasty was developed and successfully demonstrated this concept.

By taking a flap in the groin crease of both sides the patient is left with a  straight line scar that resembles an abdominoplasty scar and does not clearly declare reconstructive efforts.  An independent flap is used for the urethra and the second flap is used for the penile shaft.  This methodology allows independent innervation of a true glans that actually appears like a shapely natural glans without additional stages.

The Maercks phalloplasty is the only transgender phalloplasty technique with three modes of innervation, the glans, the shaft and the internal base of the flap are fed by three independent nerves making it the most innervated phalloplasty to date.  By virtue of this separated innervation, the perception of kinaesthesia and more natural sexual feedback is possible.  By nature of its double flap construction and tissue quality, implants and pumps are not necessary for penetrative intercourse.  Size and girth are not restricted and truly customized phallus can be designed. Some patients require a condom for penetrative sex however there is an option to include natural cartilaginous structure again in one stage to avoid the need for a condom, The MAERCKS-s Phalloplasty which stands for structurally supported.

FTM Bottom Surgery Requirements

Before a patient can undergo any type of sex reassignment surgery concerning the genitals they must have two referral letters from a gender psychiatrist, therapist, psychologist or primary care physician and one from a doctorate-level professional stating that the transgender surgery is the next step during the transition process from female to male. If you don’t currently have a therapist, we encourage you to find one before you start thinking about surgery to drastically change your body.

Female to male patients interested in genital surgery are required to be under hormone therapy for 12 consecutive months. The journey to a new body can be a long one, but we vow to help you every step of the way as you transition your body to match your identity. Call to learn more about the requirements for surgery.

Schedule a Consultation Today

If you have determined with your therapist or primary doctor that you are ready for transgender surgery from female to male, it’s time to schedule a consultation at the Maercks Institute. When you choose us, you get a plastic surgeon with years of experience, medical personnel that truly care about your future, and access to state of the art technology and methods that make all the difference in the outcome of your surgery. For such a big step in your life, you can’t afford to take chances with a surgeon you don’t trust.

Every patient is unique, and your sex reassignment surgery is different than any other individual’s surgery. We customize a treatment plan to ensure that you get the results you want after your initial consultation. We can answer any questions you have, discuss the cost and the risks of surgery and guide you on the next step to a body that matches your identity after a quick meeting with our plastic surgeon.

Start the process to a new body with the plastic surgeon you can trust to genuinely be invested in your future. Call the Maercks Institute today to schedule a consultation for transgender surgery in Miami – from female to male.

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